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Healthcare in Spain

Health Insurance and the Healthcare System of Spain Explained

Spain’s public healthcare system is among the best in the world and it is mostly free. Healthcare for non-residents can either be private or public, but bear in mind that expats will not have immediate access to the public system. For this reason, you should invest in a temporary travel health insurance.

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This guide will provide you with an overview of the healthcare system and health insurance in Spain. We go over everything from who is eligible for public healthcare coverage, to finding a doctor, what costs to expect, and an overview on giving birth in the country.

Spanish healthcare is established widely throughout the country. It is public, free, and available to every Spanish resident. People who work pay monthly social security contributions to uphold the public healthcare system. These contributions guarantee that almost everyone can access healthcare for free and only has to pay a percentage on prescriptions.

There are only very few cases in which people are not eligible for public healthcare. These cases are mostly non-residents who still have their own health insurance abroad. Be advised that some health centers and hospitals offer both public and private services. You will need to make it clear which service you are opting for. When in doubt, consult Sistema Nacional de Salud (SNS), which regulates public healthcare in Spain.

How Healthcare Works in Spain

Apart from some small costs, like a deductible on prescriptions, the public healthcare system in Spain is free for every citizen. This is made possible because it is funded by social security payments from employed and self-employed workers. Everybody working and paying taxes in Spain is eligible for public healthcare, which covers almost everything you need. Spouses and children of the insured person also benefit from coverage. In this section, we will break down Spain’s healthcare system and explain how it works, as well as list the pros and cons.

Spain’s Public Healthcare System: Pros and Cons

Relocating to a new country requires a lot of research on the local healthcare system. It is advisable to relocate with travel insurance that can be cancelled when the local insurance comes into effect.

Before breaking down the pros and cons of Spain’s healthcare system, let’s look into some interesting healthcare facts.

  • According to a national survey, the general opinion is that public healthcare services work well and provide sufficient care.
  • This is not very surprising, considering that spending for healthcare amounts to 9% of the country’s annual GDP. Spain is the 13th biggest spender in Europe, with an average annual spending of 2000 EUR (2,265 USD) per person.
  • Spain is required by law to provide emergency and basic care for its citizens.
Pros of Public Healthcare in Spain
  • The Spanish public healthcare system is generally of high quality, with well-trained medical staff.
  • Spain has a good network of hospital and medical centers, some of which are ranked among the best in the world.
  • The public healthcare system also covers the direct family of a beneficiary, such as spouses, dependents under 26 years of age, and siblings.
Cons of Public Healthcare in Spain
  • The waiting times for surgeries, procedures, and treatment from specialist doctors are frequently cited as the main setback of public healthcare in Spain.
  • Public healthcare services do not allow you to choose your doctor or specialist.
  • You may have some difficulty finding English-speaking staff in public hospitals or care centers.

Lack of coverage of dental care and other treatments often leads insured people to supplement public services with private insurance.

What Does Public Healthcare Cover in Spain?

When thinking of public healthcare, most people automatically think of Medicare. Public healthcare in Spain is called SNS (Servicio Nacional de la Salud) and is more inclusive than Medicare, as it is targeted at every resident. It also provides primary care services, such as family medicine, pediatrician, nursing services, midwives, and physiotherapists, as well as all matters related to prevention, diagnosis, rehabilitation, and emergency services. You will be appointed a family doctor and pediatrician in your region, who will refer you to a specialist when needed.

The type of healthcare services provided may vary between autonomous regions, so always check the conditions that apply to you and your place of residence.

Does Spain Have Free or Public Healthcare?

Free healthcare is confused with public healthcare. In order to explain the costs of Spain’s healthcare system, it is necessary to differentiate both terms. Spain offers public healthcare. Basically, every person paying into the social security fund is making public healthcare available to everyone else, as well. Old people, children, unemployed workers can all access healthcare for free even if they themselves don’t pay social security. The costs of public healthcare may vary between autonomous regions as well. On average, you will find out-of-pocket payments to be around 24% of the total cost. This is higher than in most European countries.

You are also responsible for the costs of any pharmaceutical, orthotic, prosthetic, and other health products. You may pay between 10 and 60% of the full price, depending on your level of income. Medicines and pharmaceuticals can only be purchased at pharmacies, and some require prescriptions.

Public healthcare does not usually cover adult dental care, except for basic extractions. Dental prostheses and eyeglasses are also not covered by the Spanish healthcare system.

The national healthcare system issues documentation for sick leave or other medical discharge certificates that are deemed necessary.

Who is Eligible for Public Healthcare in Spain?

Spain offers its residents public healthcare, which is covered by social security contributions. To benefit from public healthcare, you will need:

  • legal residency;
  • to be registered with the Instituto Nacional de la Seguridad Social (INSS), the National Institute of Social Security;
  • public health card, tarjeta sanitaria individual (this card must be shown every time you visit a public hospital or health center).

Family members of insured people may also benefit from public healthcare, but only if they legally reside in Spain. This includes spouses, children under 26-years-old, and siblings of the insured person.

In Spain, if you do not meet the criteria for any type of public healthcare, the Spanish Social Security offers a special pay-in scheme, the Convenio Especial. This allows access to the public healthcare system for a monthly fee. You can request the Convenio Especial by presenting the form TA-0040 at the social security office of your place of residence.

How to Obtain the Tarjeta Sanitaria Individual?

You can get a tarjeta sanitaria individual at the local health center (Centro de Salud) that corresponds to your place of residence. You will need to contact your local Centro de Salud to know the exact procedures for applying for this card, as requirements may vary by autonomous regions. In general, make sure to bring your identifying information and any other documents that prove you are eligible for social security.

If you are living in Spain, but cannot benefit from Social Security (for example, you do not work in the country), or you are a beneficiary of an insured person, you can apply for public healthcare. To do so, you must visit your local social security office with the following documents:

  • The application form for recognition of the right to healthcare.
  • An identification document:
    • EU citizens: the certificate of registration and national ID or passport;
    • Non-EU citizens: TIE (Tarjeta de Identidad de Extranjeros) and your passport.
  • If registering beneficiaries, such as spouses, children, or siblings, you will need a family record book, or civil registry that proves your relationship with the insured person.

After the INSS confirms that you qualify as an insured person or beneficiary, you can apply for a tarjeta sanitaria individual.

Costs for People Who Do Not Qualify for Public Healthcare

People who do not have medical insurance will be treated in case of an emergency, but they will be required to pay for the treatment. The costs vary depending on the type of treatment.

As mentioned above, if you do not meet the criteria for any type of public healthcare in Spain, the Spanish Social Security offers a special pay-in scheme. This allows access to the public healthcare system for a monthly fee of 60 EUR (67 USD), or 157 EUR (176 USD) for people over 65 years of age. To request this type of healthcare plan, fill out the form TA-0040, and hand it in at the social security office of your place of residence.

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An Overview of Private Health Insurance in Spain

Generally, you do not need private health insurance in Spain but knowing how it works is always a good idea. If you would like to avoid the delays of public healthcare, or if you simply prefer to have private health insurance, there are many insurance types and plans to choose from.

However, it is important to keep in mind that you need health insurance to enter Spain. Most visa applications require proof of healthcare. It is advisable to either have travel health insurance from your home country or, better yet, apply for a private healthcare plan in Spain. The insurance companies in Spain will know how the local healthcare system works and which procedures are covered with your plan.

How to Get Private Healthcare in Spain?

Anyone can get private health insurance in Spain. There are no specific requirements. Opting for it has manybenefits such as allowing quicker access to specialists, the possibility of choosing English-speaking healthcare providers, and overall more comfortable hospitals and medical centers.

In general, private insurance is used by around 19% of Spanish residents. Many Spaniards choose to add a private plan to their public healthcare to access quicker and more extensive treatments. A lot of health insurances even offer both public and private provisions. Some job contracts may include private health insurance, so check with your employer before signing with an insurance company.

Private healthcare plans are especially popular among expats. Mainly because in 2013, a law that regulates the Spanish healthcare system was modified and a lot of healthcare services became inaccessible for expats. Moreover, expats are required to show proof of health insurance when applying to visas. If you cannot find work right away, you need to demonstrate to the government that you won’t cost them a lot of money in case of an accident.

Why do I need Private Health Insurance in Spain?

Which are the specific situations in which expats need to show proof of private health insurance?

  • When applying for a residency card as a family member of an EU citizen.
  • When reuniting a family member.
  • When you are a non-EU citizen on a student visa.
  • When applying for a non-lucrative residency.
  • When applying for Golden Visa.
  • When applying for a tourist visa.

Types Private Health Insurance Providers

When choosing private healthcare insurance, it is advisable to make your decision based on the coverage and package each provider offers, and not solely on the cheapest plan. This could turn out costly in case of emergencies, if your plan does not cover everything.

You can choose from a variety of health insurance plans in Spain: from low-cost plans with few services to more extensive health insurance coverage. Health insurance plans vary depending on the insurance companies. You can check prices and deals on their individual websites and easily sign with an insurance plan online.

The most popular Spanish Private Insurance providers are:

  • Sanitas
  • Adeslas
  • Asisa

If you are unsure which provider to choose, you can always check out the websites Rastreator and Acierto. Both compare different private plans and options and help you find the best one for your individual needs.

Average Cost of a Health Insurance in Spain

Are you wondering how much private health insurance is? The cost will depend on your age, gender, and any pre-existing conditions. The average cost of health insurance is typically from 100 to 200 EUR (112 to 224 USD) per month. You can also find plans for as low as 50 EUR (56 USD) per month with some of the bigger insurance companies. Primary care consultations and specialists in the private sector usually cost between 100 and 150 EUR (112 to 168 USD) per consultation.

For those who prefer to use private health insurance to supplement services not covered by public health insurance, there are basic, affordable plans that include services like dental care and blood tests, but exclude surgeries and hospitalization.

With most private plans, you will be asked make co-payments upfront for services. The rest of the treatment will usually be covered by your insurance. However, you may still receive additional bills via the mail even after your co-payments, so always check which specific procedures are covered by your insurance plan. You may also have some triangulation between your insurance provider and hospitals or medical centers, so expect to play some part in the communication between these services.

How to Find Doctors or Dentist

If you are at the stage in your relocation, where you are wondering how to find a doctor or dentist, then congratulations, you have come very far. As part of the public healthcare system in Spain, you are entitled to a family doctor who can offer consultations free of charge. You just need to register with your local clinic and bring along your registration documents (such as the empadronamiento from when you first registered your place of residence). A family doctor will then be assigned to you. These are general practitioners who can refer you to a specialist in the public healthcare system whenever needed.

In general, if you need to find a doctor or specialist, you should not have much difficulty. You can easily find private practices if you search for médicos near you. Dental services are not covered by public healthcare, so you will need to look for a private dentist. To find a dentist, you can look up dentistas online. You can also search for reviews and compare prices on specialized websites such as Medigo.com.

The first dentist appointment and dental check-up are often free of charge, but any procedures thereafter are charged. The prices are set by each medical practice. For reference, a filling tends to cost around 60 EUR (67 USD).

How to Find Specialists

If you need a specialist, your general practitioner (family doctor) will refer you. This referral is important for insurance purposes. If you visit a specialist without a referral, your insurance may not cover any of the costs. You also run the risk that a specialist may not treat you without a referral. If you want to look for a family doctor or a specialist, you can check the medical directory.

Keep in mind, whenever you request public healthcare services, be sure to carry your personal health card with you (tarjeta sanitaria individual).

What are the Waiting Times to See a Doctor in Spain?

You can expect long wait times and delays with public healthcare services in Spain. On average, you may have to wait around 57 days to see a specialist. The longest delays are for traumatologists (68 days) and ophthalmologists (64 days).

For surgeries, the average national wait time is 93 days. However, these delays vary from region to region. Madrid, La Rioja, and the Basque Country tend to have the shortest waiting periods for surgery: 48 days. The Canary Islands, Castilla-La Mancha, and Catalonia have the longest wait times: around 140 days.

Hospitals in Spain

The public healthcare system covers emergency care, which includes going to the hospital in case of an emergency or having to undergo surgery. Public and private hospitals in Spain are ranked among the best in the world. The only downside to public healthcare in Spain is the long waiting lists for specialists and non-emergency care.

To find the nearest hospital, check the Spanish health ministry website.

Ambulance Services in Spain

To call for emergency assistance (ambulance, police, fire department) in Spain, you will need to dial the number 112. The first responders are trained staff among of which at least one is an emergency physician, an emergency nurse, an emergency medical technician, and a patient transport assistant. The Spanish emergency medical services consist of a two-tiered response system, Advance Life Support with physicians and nurses, and Basic Support with technicians. After assessing you on site, the staff will transport you to the nearest hospital.

Emergency care is generally covered by public health care in Spain. If you have private healthcare or are not yet eligible for Spanish healthcare, you will probably need to pay for the services yourself and send an invoice to your healthcare provider.

Where to Get your Medication in Spain

Over-the-counter medication in Spain can be purchased in pharmacies. Prescription medication will need to be prescribed by your physician and can later be obtained at a pharmacy.

Costs for Prescription Medication in Spain

There are prescription fees in Spain. Children are free of charge. Pensioners who receive a state pension are only charged 10%. Employed Spanish citizens pay the highest rate, with a charging fee of 50%.

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Giving Birth in Spain

Giving birth in Spain as a non-resident is not such a hassle. The costs for uninsured foreigners are reasonable. However, it is crucial to have insurance to obtain a visa. It is not possible to be uninsured in Spain.

As a registered short-term or permanent resident with access to public or private healthcare, the cost of having a baby in Spain is covered by insurance. The benefits of giving birth in Spain as a permanent resident are many. Mother and child are accompanied medically throughout the whole pregnancy and after with prenatal exams, scans and intervention during delivery and after childbirth. 

Having a Baby in Spain as a Foreigner

As a registered working resident in Spain, you have access to public healthcare. If you are pregnant and decide to give birth in a public healthcare facility, a hospital in your district will be assigned to you. If you happen to go into labor while far away from your assigned hospital, other hospitals will take care of you.

Cost of Having a Baby in Spain

If you are entitled to using state healthcare, giving birth in Spain is free. If you have private insurance, the additional personal costs might vary depending on your insurance plan. In this case, it is best to find a plan that covers childbirth in full.

Giving Birth in Spain without Health Insurance

Being uninsured in Spain is practically unheard-of, as it is stated in the Spanish constitution that the government has to provide basic and preventative care for all. If you really are uninsured for some reason, then you won’t risk bankruptcy just for having a child. According to a study, the costs for giving birth in Spain are one of the lowest in the world at around 1,950 USD.

Giving Birth in Spain for Citizenship

In the US, children born in national territory are immediately awarded citizenship, regardless of their parents’ nationality. Spain operates with different laws. A child of foreigners is not automatically awarded Spanish citizenship just for being born on Spanish ground.

Spanish law follows the concept of Ius sanguinis (right of blood) before applying the concept of Ius soli (right of territory). Children born in Spain to non-Spanish parents, will have the parents’ nationality. If either of the parents are Spanish nationals, or were born in Spain, then the child is eligible to apply for Spanish citizenship.

This said, according to article 17 of the Civil Code, Spain does award Spanish nationality to babies born in Spain, if the parent’s nationality cannot be awarded to the child for legitimate reasons. For example, if both parents come from a country that does not automatically award nationality by blood. In these cases, Spain operates under article 15 of the Universal Declaration of Human rights, which dictates that every human being is entitled to a nationality.

Do you want to relocate? If you have never moved abroad, the process will be overwhelming, and if you have, you know the burden that lies ahead. Whatever stage you are at, InterNations GO! can help you with a complete set of relocation services, such as home finding, school search, visa solutions, and even pet relocation. Our expert expat team is ready to get your relocation going, so why not jump-start your move abroad and contact us today? Best to start early!

Updated on: September 08, 2020
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