Health Insurance and Healthcare in Spain Explained

Jump right in:

• How healthcare works in Spain
• Does Spain have free or public healthcare?
• Pros & cons of the Spanish healthcare system
• An overview of private health insurance
• How to find a doctor or dentist
• Giving birth 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’s funded by social security payments from employed and self-employed workers.

Everybody who is registered with social security in Spain is eligible for public healthcare, which covers almost everything you need. Spouses and children of the insured person also benefit from coverage.

What does public healthcare cover in Spain?

Public healthcare in Spain is called SNS (Servicio Nacional de la Salud) and is a universal and publicly funded system that provides care to all legal residents.

It also provides primary care services, such as family doctors, pediatricians, nursing services, midwives, and physiotherapists, as well as services related to prevention, diagnosis, rehabilitation, emergency care, mental health, palliative care, subsidized medication, dietary products, dental care, and medical transport. You’ll be appointed a family doctor and pediatrician in your region, who’ll 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.

You’re also responsible for the costs of any pharmaceutical, orthotic, prosthetic, and other health products. You may need to 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.

Does Spain have free or public healthcare?

Free healthcare is often confused with public healthcare. In order to explain the costs of Spain’s healthcare system, it’s necessary to differentiate both terms. Spain offers public healthcare. Basically, public healthcare in Spain is funded primarily through general taxation. Old people, children, and 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 expenses to be around 21% of the total cost. This is slightly higher than the EU average of 14.5%, but not among the highest in Europe.

Who is eligible for public healthcare in Spain?

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
• a 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, in certain conditions, other dependent relatives such as siblings, grandparents, or grandchildren who meet legal residency, economic dependence, and cohabitation requirements.

If you don’t meet the criteria for any type of public healthcare, 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 must bring your official identification document (DNI, NIE, passport, or TIE), a current certificate of registration (empadronamiento), and a document proving your entitlement to public healthcare (such as a Social Security affiliation certificate).

Requirements and procedures may vary slightly between autonomous communities, and some allow online applications through their regional health websites. If you live in Spain but are not directly affiliated with Social Security, you may still be entitled to public healthcare as a dependent or under specific circumstances. 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
• a certificate of registration (empadronamiento), issued by your local town hall and no older than 90 days

If registering beneficiaries, such as spouses, children, or siblings, you’ll need a family record book, birth certificate, or civil registry document that proves your relationship and, when applicable, a sworn declaration of economic dependence.

After the INSS confirms that you qualify as an insured person or beneficiary, you can apply for a tarjeta sanitaria individual. The health card will be issued by your regional health service and sent to your registered address. In some cases, it can also be picked up directly at your health center.

Costs for people who don’t qualify for public healthcare

People who don’t have medical insurance will be treated in case of an emergency, but they’ll be required to pay for the treatment. The costs vary depending on the type of treatment. As mentioned above, if you don’t meet the criteria for any type of public healthcare in Spain, the Spanish Social Security offers a special pay-in scheme.

Pros & cons of the Spanish healthcare system

Pros

• The Spanish public healthcare system is generally of high quality, with well-trained medical staff.
• Spain has a good network of hospitals 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, including spouses and dependents under 26 years of age.

Cons

• 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 always allow you to choose your specialist, although you can generally request a different family doctor than the one assigned to you.
• 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.

An overview of private health insurance

Generally, you don’t 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’s important to keep in mind that having health insurance is mandatory for most foreign residents and visa applicants. Most visa applications require proof of health insurance. It’s 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. Although generally accessible, some insurers may require legal residency, proof of address, or being physically present in Spain. Opting for it has many benefits, such as quicker access to specialists, the option to choose English-speaking providers in some areas, and more comfortable hospitals and clinics.

In general, private insurance is used by around 26.4% of households in Spain. Many Spaniards choose to add a private plan to their public healthcare to access quicker and more extensive treatments. 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. This trend began after legal reforms in 2012 limited public healthcare access for undocumented foreigners, although many restrictions were lifted by 2018.

Do you need to have private health insurance?

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
• if you’re a non-EU citizen on a student visa
• when applying for a non-lucrative residency visa
• when applying for a tourist visa

Types of private health insurance providers

When choosing private healthcare insurance, it’s 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 up for an insurance plan online.

Most popular private health insurance providers in Spain (Top 10):

• Sanitas
• Adeslas
• Asisa
• DKV
• FIATC
• Caser
• Mapfre
• Aegon
• AXA
• Cigna

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

Average cost of a private health insurance

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 private health insurance typically ranges from 45 to 80 EUR (approx. 55–95 USD) per month, depending on age, coverage, and provider. You can also find plans starting from 9 to 13 EUR (approx. 10–15 USD) per month for young people with basic insurance and copayments.

Primary care consultations usually cost between 30 and 50 EUR (approx. 35–60 USD), and specialists from 50 to 80 EUR (approx. 60–95 USD). Urgent care may cost around 200 EUR (approx. 235 USD).

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’ll be asked to 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 need to manage communication between your insurance provider and hospitals or medical centers, especially for authorization of procedures or reimbursements.

How to find a doctor or dentist

As part of the public healthcare system in Spain, you’re entitled to a family doctor if you’re registered with the Social Security system and hold a valid health card. To register, you must go to your local health center with documents such as your empadronamiento, official ID, and proof of your right to healthcare (such as a Social Security registration certificate).

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.

Some basic dental services are covered by public healthcare, especially for children and vulnerable groups, but most dental care requires visiting a private dentist. To find a dentist, you can look up dentistas online. You can also search for reviews and compare prices on platforms such as Doctoralia (in Spanish) or the websites of dental clinics in your area. Dental clinics may occasionally offer a free initial consultation, but this is not standard practice. Most check-ups and procedures are charged.

For reference, a dental filling in a private clinic typically costs between 60 and 150 EUR (about 70 to 175 USD), depending on the material and complexity.

How to find specialists

If you need a specialist, your general practitioner (family doctor) will refer you. This referral is important because, in the public healthcare system, specialists are only accessible through a referral from your assigned doctor. If you visit a specialist without a referral in the public system, the appointment may not be accepted or covered.

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?

Waiting times for public healthcare services in Spain can vary significantly depending on the region and medical specialty. On average, you may have to wait around 81 to 87 days to see a specialist. The longest delays are often found in specialties such as dermatology, neurology, psychiatry, and traumatology, where waiting times can exceed 100 days. For surgeries, the average national wait time is around 126 to 128 days.

However, these delays vary from region to region. Madrid, the Basque Country, and Galicia tend to have the shortest waiting periods for surgery, with average times around 63 to 75 days. The regions with the longest wait times are Extremadura (181 days), Andalucía (174 days), and Cantabria (173 days), according to the latest national data.

Hospitals in Spain

The public healthcare system covers emergency care, including hospital visits for urgent situations and medically necessary surgeries, although some non-urgent procedures may involve waiting lists. Some public and private hospitals in Spain are highly ranked internationally, particularly in major cities like Madrid and Barcelona. To find the nearest hospital, consult the website of your regional health service rather than the national Ministry of Health.

Ambulance services in Spain

To call for emergency assistance (ambulance, police, fire department) in Spain, you’ll need to dial the number 112. Ambulance crews may include an emergency physician, a nurse, and one or more certified emergency technicians, depending on the type of ambulance and the severity of the situation. 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 healthcare in Spain. If you have private health insurance or are not yet eligible for public healthcare, coverage of ambulance transport will depend on the urgency of the case and the terms of your insurance policy.

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

In Spain, there are fees for prescription medicine. Children may have to pay a portion of the cost of prescription medication, depending on their family’s insurance coverage and eligibility for exemptions.

Pensioners who receive a state pension usually pay 10%, but this percentage and the monthly cap vary depending on their income level, and some may be fully exempt or pay up to 60%. Employed Spanish citizens pay between 40% and 60% of the cost of prescription medication, depending on their annual income.

Giving birth in Spain

The Spanish public healthcare system provides free care during pregnancy, childbirth, and postpartum even for foreigners without residency. The costs for uninsured foreigners can be high if using private hospitals, ranging from several thousand euros, but public hospitals offer this care free of charge in most cases. However, it’s crucial to have insurance to obtain a visa, so most expats in Spain will have health insurance.

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.

The cost of having a baby in Spain

If you’re 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’s best to find a plan that covers childbirth in full.

Giving birth in Spain for citizenship

In Spain, the child of two 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 usually acquire their parents’ nationality, unless the child would otherwise be stateless. If either of the parents is a Spanish national, or was born in Spain, then the child automatically acquires Spanish citizenship from birth. 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.

Although a child born in Spain to foreign parents doesn’t automatically acquire Spanish citizenship, they can apply for it after legally residing in the country for one year. This represents a notable advantage, as most other foreign residents must wait ten years before becoming eligible to apply.