Understanding healthcare in Spain
If you’re a UK expat planning to move or retire to Spain, understanding the Spanish healthcare system is as important as choosing the right location. Alongside climate and cost, you’ll need to think about how you’ll access healthcare in Spain and what it means specifically for UK expats
The good news is that healthcare in Spain is generally excellent, similar to that in the UK, in that it’s based on a dual public/private system.
- The public healthcare system – or Sanidad Pública – is public healthcare funded by social security contributions. Like the NHS, it’s mostly free at the point of need for those who are eligible to use it.1
- Private insurance is available for those who don’t qualify for public healthcare, or who want faster access to a wider choice of services or access to English-speaking doctors.2
Spain has well-established public and private healthcare systems, so you should be well looked after. But, like the UK, there are some costs to account for, even in the public system. For example, you will be asked to pay between 10% and 60% of the cost of prescriptions, depending on circumstances.3
And, depending on the type of healthcare you’re entitled to, you might also pay for services like non-urgent transport or dietary supplies.
We’ll explain all the nuances of healthcare in Spain in this article, including who is eligible for free public healthcare (spoiler: you probably are) and how to access the care you need.
Who can access public healthcare in Spain?
Is healthcare in Spain free in Spain for UK citizens? The answer is generally yes, so long as you complete the relevant registration procedures (more of that later). So what’s the eligibility for public healthcare?
There are several ways to access the public healthcare system in Spain, typically tied to residency status and social security contributions:
- You’re employed or self-employed and paying into the Spanish social security system. If so, you’re automatically entitled to public healthcare. In this case, it doesn’t matter if you’re a permanent or temporary resident.
- You receive a UK state pension and are resident in Spain. In which case, the S1 form shows that the UK government will fund your healthcare when you live in Spain. An S1 form usually covers your dependents, too. Request an application form from NHS Overseas Healthcare Services.5
- You join the public healthcare insurance scheme. If you’ve lived in Spain for over a year but are not a permanent resident, you can apply to join the Convenio Especial. You pay a monthly fee but then have access to the national Spanish healthcare system, which is similar to the NHS in the UK.
- You’re a permanent resident. After five years, you can apply for permanent Spanish residency and enjoy the same healthcare access as a Spanish citizen.
When you have access to public healthcare, you can expect the same standard of treatment that you’d get in the UK, from emergency treatment to GP care and more extensive tests and therapies in hospitals. As mentioned, there are some “co-payments” – partial costs – for prescriptions and some less common kinds of treatment.
Accessing healthcare if you receive a UK state pension
As we’ve mentioned, you can use an S1 form to access Spanish public healthcare.
- To be eligible, you need to be resident in Spain and receive a UK state pension (or another exportable benefit).6
- When you have the S1 form, you need to register it with the INSS (the Spanish social security office), after which you’ll be entitled to healthcare on the same basis as a Spanish citizen.
- Your dependents will also be covered.7
Again, it’s worth repeating that however you access the Spanish public health systems, there are some things that won’t be free. That includes some prescription costs and anything but basic dental treatment. Most people in Spain use private dentists.8
Your retirement visa status can also determine your eligibility for public healthcare and how soon you can register.
Private healthcare in Spain for expats
If you can’t access the public healthcare system in Spain, you’ll need to take out private health insurance. But that’s not the only reason you might want to do so. Many people who can get public health treatment take out private health insurance anyway. The benefits of private insurance are similar in Spain and the UK:
- You may get quicker access to GP appointments and hospital tests and treatments.
- You may be eligible for services not available in the public health system, like more advanced dental treatment, vision care (like glasses and contact lenses) and care for mental health issues.
- For UK expats, specialised private insurance may make it easier to access English-speaking doctors or translation services.
The public health system in Spain is excellent, but when you compare public vs private healthcare, it’s clear that private insurance can be an attractive option for some UK expats.
The cost of private healthcare in Spain
As in the UK, the cost of private health insurance in Spain depends on a number of factors, including age, your medical history and the kind of cover you need. As a general rule, you can expect to pay between €50 and €250 per month.
The details of registering for healthcare in Spain for expats can depend a little on your circumstances, but the main steps are generally the same.9
Register your address.
You can do this at the local town hall to obtain an “Empadronamiento” certificate, confirming your registration as a resident.
Get a social security number
You won’t be able to access healthcare services without a social security number. If you’re working, your employer should take care of this. If you use the Convenio Especial scheme, or your pension entitles you to an S1 form, you’ll need to present the relevant documents at a social security office.
Apply for a health card at your local health centre (centro de salud).
To do this, you’ll need your social security number, Empadronamiento, NIE (Identity Number) and your passport or other ID. You’ll then receive your health card (Tarjeta Sanitaria Individual or TSI) which can be used to access the full range of public health services.
The process can take between two and six weeks in total, and it’s important to note that you may not be fully covered for health care until it is complete, though of course you will always receive emergency treatment.10
Managing prescriptions and ongoing costs
Even with your health card, medicines are not free in Spain. Prescription costs in Spain vary between 10% and 60%, depending on a number of factors.
- Residents pay a percentage of the costs of prescriptions, known as a co-payment.
- If you’re working, your contributions will be calculated on income.
- Pensioners often pay just 10% of the full cost.11
Finding doctors, clinics, and hospitals in Spain
You’ll probably want to use the local health centre nearest to your home, but there may be reasons to seek healthcare further afield. For example, you may want to talk to an English-speaking doctor.
Join local expat groups online and ask for recommendations of English-speaking practitioners, or check clinic websites.
Talk to the receptionist at your local clinic when you first register (take a Spanish-speaking friend with you if necessary) to see if an English-speaking doctor is available at the practice.
If an English-speaking doctor is non-negotiable, private health insurers may be able to guarantee it as part of their service.
Of course, the other difference between public and private healthcare facilities is generally the speed of access – much the same as in the UK. You may get appointments more quickly with a private provider.
Emergency care in Spain
If you require emergency services:
- Calling 112 is the Spanish equivalent of calling 999. Calls are free and will connect from mobile phones “even when they are blocked, when the SIM card is inactive, or there is no coverage from the mobile phone provider.”12
- Alternatively, you can go straight to the emergency room of the nearest hospital.
Long-term health management in Spain
The public health system is generally excellent but does face challenges when managing chronic condition care in Spain and providing ongoing health support.
If you have a long-term condition, it is sensible to understand how it will be managed before you make the move to Spain.
- Check out local healthcare clinics online – Google should translate websites into English – and take into account repeat-prescription costs and access to specialist services.
- Talk to your NHS GP before you go about how your medical records can be transferred to your Spanish healthcare provider.
If you’re taking out private health insurance, ask your broker or provider how they will coordinate your care with local public healthcare practitioners.
Additional considerations for UK citizens
There’s one more thing to consider when thinking about healthcare in Spain for expats: what happens if you return to the UK and need treatment? NHS eligibility is based on residency, so you may lose your right to free NHS care if you move permanently abroad.
What that means in practice is that you may have to apply for a European Health Insurance Card (EHIC) before your visit to access free medical care in the UK. If you’re a resident in Spain, your EHIC will be issued by the Spanish authorities.
Planned treatment is not covered by the EHIC. For that, you’ll need to apply for an S2 form in Spain, which will cover you for ongoing treatment during your stay in the UK.13
Currency and money management for healthcare costs
Managing healthcare costs in Spain as a UK expat takes planning. Even if you’re using the Spanish public healthcare system, you may need to pay towards prescription costs and for certain services and treatments. It’s worth considering potential healthcare costs in your budget planning when thinking about your move to Spain.
If you need to send money to Spain, we can help you do it in a seamless and cost-effective way.
1 UK government – Healthcare in Spain
2 AXA Global – Private health insurance in Spain
3 UK government – Healthcare in Spain
4 UK government – Healthcare in Spain
5 UK government – Healthcare in Spain
6 UK government – Healthcare in Spain
7 UK government – Healthcare in Spain
8 UK government – Healthcare in Spain
9 International Insurance – Healthcare application process
10 Barcelona City Council – Individual healthcare card (TSI)
11 UK government – Healthcare in Spain
12 Ministry of the Interior – National emergency services
13UK government – Healthcare for visitors to the UK
