In Spain, healthcare is free for citizens and residents affiliated to the country's social security system. However, it is necessary to follow a specific care pathway within the public health sector. Outside the public sector, the insured bears the cost of the medical expenses, unless they have private health insurance.
Health insurance for expats in Spain
The health insurance system in Spain
Spanish health insurance is managed by the Sistema Nacional de Salud (SNS). Residents (and their dependants) can join the system if they:
work in Spain as either an employee or self-employed;
register as jobseekers with the Instituto Nacional de Empleo (National Employment Institute);
are retirees receiving pensions from a Spanish organisation.
Registration at a Social Security General Treasury office is requested after three months in the country.
Under this public coverage, healthcare is totally free and no advance payment is required, as long as the care is provided within the public system and follows a specific care pathway. The Spanish health system assigns each insured person a general practitioner and a health centre of reference. These local health centres, known as “centro de salud”, generally bring together GPs, specialists, and nurses. If needed, the GP can refer the patient to their referral hospital (depending on where the patient lives) or to a specialised hospital; in this case, hospitalisation is also fully covered.
How to choose health insurance in Spain: local or international?
Patients wishing to seek treatment in the private sector have to pay the full cost of their healthcare, unless they have private health insurance that covers all or part of the costs.
In addition, dental care is rarely covered by public health insurance, and optical aids are only partially covered. It is therefore common to opt for supplementary insurance which covers at least these types of expenses.
Local insurance companies usually cover treatment in a number of affiliated hospitals and health facilities. International health insurance can, however, provide access to a wider range of care
> Good to know: Having health insurance is required to obtain Spanish residency for foreign citizens who are not (yet) working in the country.