Health Care and Medical Insurance in Spain


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Health Care and Medical Insurance in Spain

That said, you can occasionally "beat the system" with luck and persuasion. "

Posted by Casi Cielo

Information on expat health insurance, public and private health care in Spain, as well as and international travel medical and health insurance.

Let’s not bury the lead: Spain has the #1 ranked healthcare system in the world according to the World Economic Forum for 2019!

Read the full competitiveness report for 2019 here

Yes, health care in Spain is free and universal, in fact it's mandated by the constitution to be provided by the government. According to the WHO, Spain’s healthcare is ranked 7th in the World, yet ranks 24th overall in cost per person (lower rank is better). For comparison purposes, know that the UK ranks 18th in healthcare effectiveness and 26th in costs per capita; the US healthcare system ranks 37th and 1st(!) respectively.

The cost effectiveness of Spain’s healthcare system, compared in terms of life expectancy versus spending, is 2nd behind Japan’s.

The problem is that to become an insured you have to have a social security number. To get one, you generally have to either work for a company or become self employed (in which case you’ll pay to be part of the system). That said, you can occasionally “beat the system” with luck and persuasion. An American friend of ours arrived to Spain when she was 76 years old, and managed to convince the people at the social security office to give her a number.

If your country of origin has universal health care, then you may be able to get your country to pay Spain to cover you. For the UK, this is the case for those over 60 and for some people who qualify for the invalidity benefit. You will need the appropriate form (E121 or E106).

In some cases, you may want to keep your universal health care provided by your home country if you intend to be back and forth between Spain and home. In this case it would be recommended to purchase additional health or travel insurance from a home-country insurance provider that supplements your universal health care for the duration of your stay in Spain. In Canada, for example, you will need to continue paying for your provincial health care and notify them of your extended absence from the country to ensure continued coverage. This is a requirement of getting private health or travel insurance anyway.

If you have a Certificado de Empadronamiento, you have the right to emergency care in any public hospital. Once any temporary health care from your country runs out, look into contracting Spanish health insurance.  Also see Doctors in Spain for more about your empadronamiento, getting your health care card and finding a doctor.

... you can sometimes negotiate (or avoid) the initial fee if somebody with that insurance company recommends you. "

Expat Health Insurance

In Spain the major health insurance companies that provide nation-wide coverage (with a few exceptions for areas like the Basque Country and Cantabria due to having their own local systems):
  • Mapfre
  • DKV Seguros
  • AXA
  • Asisa
  • Sanitas
Familiarize yourself with those names since you'll see them around everywhere. In fact, here is their popularity rank as of 2019: The problem for us as expats is multi-fold: 1) we are required to have expat-level insurance that meets specific visa and residency requirements, 2) representatives of these companies rarely, if ever, are able to handle calls or emails in English, 3) the policy details are confusing, 4) the application process can be slow. For example, when we last applied for our visa, it took almost three weeks to finalize, very nearly jeopardizing our visa application . We worked directly with Sanitas, thinking we would save money, but in the end the price is the same even if you're working with one of their agents. As for the visa/residency requirements, sometimes it's not clear exactly what the standards are that must be met. For example, the Spanish consulate of New York indicates that only a certificate of coverage is required, without stipulating the exact levels of coverage or co-pays. The Spanish Consulate of Los Angeles is much clearer:
  • No travel insurance, it must be local to Spain
  • Total coverage of sanitary assistance, accidents, emergencies and repatriation for medical purposes and/or death
  • No deductible ($0) and no co-payments
  • Medical coverage has to be at least 30,000 EUR (thirty thousand euros) or its equivalent in USD
  • Valid in all the Schengen States
Prices for private insurance start at about 40 €/month for a 30 year-old male. For the two of us (under 40), our expat medical insurance with Sanitas that met the visa/residency requirements came to about 120€/mon. Note that most (not all) of these companies often won't insure people over 70 years old, and some won't insure those over 65.

SpainExpat does insurance, sorta

After our last experience getting insurance through the Sanitas website we set out to identify an elite group of English-speaking insurance agents that will provide no-nonsense, expat-specific medical insurance quotes that meet the requirements set by the Spanish consulates (see above requirements). SpainExpat Expat Insurance Quotes Tool

Last updated 13 01 2021

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cliff said:

I have just visited the Conselleria de Sanitat en Valencia and they indicated that the new voluntary quota system will soon be in place (it could be by the end of September but definitely before the end of this year 2009)
It will allow individuals, that are not covered by any of the other methods of contribution, to pay into and benefit from the Spanish National Health System.

The quota will be 270 euros every three months for people under 65 and 330 euros every three months for those 65 and over.

The cover will be National (not just in Valencia) but will not extend to the rest of Europe.

BigRobUK said:

Does anyone have the figures for the monthly contribution yet and is this system likely to be implemented in other regions?

cliff said:

I was informed that in VALENCIA the quota will be 270 euros every three months for people under 65 and 330 euros every three months for those 65 and over.

I am not sure about other regions.

cliff said:

I have been told that in VALENCIA the quota will be 270 euros every three months for people under 65 and 330 euros every three months for those 65 and over.
I do not know about other regions.

ROB1305 said:

Hi Cliff - can I ask told by whom?

ROB1305 said:

another thought.........surely those over 65 qualify as pensioners for free treatment via their UK contributions (and same for other EU ?)

incantata2020 said:

We are 68 and 69. Sanitas has agreed to offer us a comprehensive health insurance policy. The quoted rate is ?125 / month / person = ?1500 annually per person.

We know that Helvetia also offers insurance to people over 65, but we do not know the rates.

dgb380 said:

We provide private medical insurance for anyone up to the age of 75 years. Of course pre-conditions and medical history will have to be taken into account. We will gladly advise you, on which company and policy is best suited to your specific needs.

suzanashaun said:


I am an American planning on moving to Spain within 2 years. I am also a Portuguese Citizen and hold a EU passport. My question is this: once I get a job, how long before I can qualify for universal healthcare? I will be moving with child and husband, will they fall under my healthcare plan? Overall, how is the healthcare in Spain compared to the US?

dgb380 said:

Private health insurance: there are medical directories to help you choose from 45,000 doctors and about 1500 health clinics and hospitals in Spain (all private). Unlimited cover for operations +aftercare. If abroad on holiday and there is a emergency the health insurance will cover you for hospital stay, operations and repatriation if necessary Dental cover: 1 check up + hygiene clean yearly The age limit for this health insurance is 75 years 2. Private health insurance - International You can choose any medical doctor and hospital internationally and in Spain. Unlimited health-cover for operations and aftercare in Spain Dental cover: hygiene clean and extractions and large discounts on dental work at selected hospitals. Age limits are between 65 and 79 unless you are on a group or family plan. Enquire with your local English speaking agent.

illstone said:


I will be moving to Spain with my family in October to become an EFL teacher. It will be temporary contract until June next year. I will then have to get a similar contact for the following year with a gap in employment during July, August, September. I understand that whilst I am paying into social security me and my dependents will be covered for healthcare. Does my contractual arrangement mean that we will not be covered during those months of 'unemployment'? This is an even greater cause for concern as we are considering having another baby whilst we are in Spain.

Any help appreciated, Thanks

MyralineB said:


We need this kind of service because this would be of great help indeed especially to the pregnant women.Two recently published studies examine the influence of the economy on the unborn. The study implies even they are affected by the economic down-turn. One draws a parallel between the recession and declining birthrates. Another, more disturbingly, shows a fall in the wellness of those that are born. Here is the proof: Studies say that the poor economy affects birthrates and newborn health

Thank you!

bobdole said:

Since healthcare is becoming a hot topic again you should think about putting out a new updated article. FXDD

Eigra said:

Hi to all!

I am from Philippines and I will be studying Spanish course in Valencia. But my Sponsor are required to obtain a Medical Insurance for me provided by an authorized insurance company. Is there someone can help us where to obtain that and how much does it cost or how long does it takes? I am looking forward hearing from your answers..

Thank you so much in advance! Argie 😊

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Thank you!


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