Healthcare in Spain

Written by Lais Cattassini Moderated by Oleksandra Dosii

Lais Cattassini

Lais is a Brazilian journalist and copywriter with over 17 years of experience, writing about things she knows really well (travelling, cinema, social media trends) and things she loves learning about.

Oleksandra Dosii

Oleksandra is a dedicated marketer with a passion for growing HR-tech products. She believes content marketing is about delivering high-quality content that provides value—not just generating leads. Since 2016, Oleksandra has been involved in tech talent relocation.

Last update: September 14, 2024

Next update: Scheduled for February 1, 2025

Interesting facts:

• Healthcare in Spain is public and universal, ensuring every citizen has access to health services.
• The National Health System in Spain is decentralised, meaning each of the 17 autonomous regions in Spain manages its own health services.
• Life expectancy in Spain is 86 years old for women and 80 years old for men.

Overview of the Spanish healthcare system

The Spanish healthcare system, known as the Sistema Nacional de Salud (SNS), is universal and provides comprehensive coverage to all residents, including citizens, legal immigrants, and some categories of undocumented immigrants. It is primarily funded through taxation.

Responsibility for healthcare lies on each of the 17 autonomous communities (regions). This decentralisation allows for healthcare services to be tailored to regional needs but can also vary in service quality and access across regions. At the national level, the Ministry of Health (Mresultinisterio de Sanidad) sets general health policies, coordinates public health initiatives, and ensures overall system cohesion. However, most operational and budgetary control is in the hands of regional governments.

Access to healthcare in Spain is divided into two different levels. The first one, Primary Care, provides basic services for more frequent health issues. The second level, Specialized Care, refers to hospitals and specialists whose patients are referred to by their primary care doctors.

The SNS is primarily financed through general taxation, making it a single-payer system. The Spanish government allocates a portion of its budget to healthcare, with funding distributed to the autonomous communities to manage their healthcare services.

While many services are free, there are some co-payments (copagos) for prescriptions, certain medical devices, and dental care. The level of co-payment is income-dependent, and vulnerable groups such as pensioners or low-income individuals often pay reduced rates.

How to access the healthcare system in Spain as an expat

Obtaining a residency card

To access the public healthcare system (SNS), you need to be a legal resident of Spain. Residency is proven through registration with the local municipality (padrón) and obtaining a residency card (TIE).

Before applying for a TIE, non-EU/EEA/Swiss nationals generally need to obtain a long-stay visa from a Spanish consulate or embassy in their home country. This visa allows you to enter Spain and apply for a residency card. Upon arrival in Spain, you typically have one month from the date of entry to apply for your residency card.

Before applying for the TIE, you must register your address with the local town hall (ayuntamiento). This process is known as empadronamiento and results in you receiving a certificate of registration (certificado de empadronamiento).

You must book an appointment to apply for the TIE. This can be done online through the Sede Electrónica of the Ministry of the Interior. Choose the nearest Oficina de Extranjería or police station that handles residency cards. Ensure you select the option related to TIE or initial residency card application.

During the appointment, your fingerprints will be taken, and you will submit your application and supporting documents. You will receive a receipt (resguardo) that confirms your application. This document may serve as temporary proof of your legal status until you receive your TIE.

Processing for your TIE can take from a few weeks to a couple of months, depending on the region. Once your TIE is ready, you will need to collect it in person from the same office where you submitted your application. Some offices require you to make an appointment for collection, while others allow you to collect it without an appointment.

If your stay in Spain extends beyond the validity of your initial TIE, you will need to renew it. The renewal process generally starts 60 days before the card expires.

Registering for Spanish Social Security

Expats need to register with the Spanish Social Security system (Seguridad Social). You will need to present your passport or national ID card (for EU citizens), residency certificate or TIE, your Empadronamiento Certificate, work contract or proof of self-employment, and your Spanish bank account details to the Social Security office.

Locate your nearest Social Security office (Tesorería General de la Seguridad Social) and make an appointment. When you visit the office, you will need to complete a registration form. This form is typically known as TA1 (for obtaining a Social Security Number).

Once your application is processed, you will be issued a Número de Seguridad Social. This number is unique to you and is used for all social security-related matters, including healthcare.

If you are employed, your employer will usually handle your registration with Social Security, including paying contributions. However, if you are doing it yourself, you will need to fill out an "alta" form (TA2) that declares your employment status.

If you are self-employed, you will need to register as an autónomo by submitting a TA0521 form. This registration obliges you to pay monthly social security contributions, which entitle you to public healthcare, benefits, and pensions.

Registering with a Local Health Centre

Once you have a Social Security Number, you can register with a local health centre (Centro de Salud) and choose a general practitioner (GP). This GP will be your first point of contact for most healthcare needs.

If you are from another EU/EEA country or Switzerland, you can use a European Health Insurance Card (EHIC) for temporary stays. For long-term residency, you must register with the Spanish system.

Each resident is assigned to a specific health centre based on their address. You can find your local health centre by visiting the regional health service's website or by asking at your town hall. You can usually find a list of health centres on your region's healthcare authority website. For example, in Madrid, it's the Servicio Madrileño de Salud (SERMAS), and in Catalonia, it's Servei Català de la Salut.

Upon arriving at the health centre, go to the registration or administration desk and inform the staff that you would like to register with the health centre and choose a General Practitioner (GP). In some cases, you may be assigned a GP based on availability, but you can request to change doctors later if necessary.

Once registered, you may receive a temporary document or receipt indicating that you are registered and can access healthcare services. Your official health card (tarjeta sanitaria) will be mailed to your registered address within a few weeks. This card is essential for accessing services at health centres, hospitals, and pharmacies.

Types of health insurance in Spain

Since Spain has universal access to healthcare, health insurance in the country can be classified as public and private.

Public Health Insurance (Seguridad Social)

Spain's public healthcare system is funded by the Spanish Social Security system. It covers primary care, specialist consultations, hospitalisation, surgery, emergency care, and maternity services. Prescription medications are usually subsidised by the government, with patients paying a portion.

Public healthcare is generally comprehensive but may have long waiting times for specialist care and elective surgeries.

Private Health Insurance

Private health insurance is used either as a supplement to the public healthcare system or as the primary means of healthcare access, especially among those who prefer faster access to specialists, shorter waiting times, and more personalised care.

• Full coverage insurance offers comprehensive healthcare coverage, including access to private hospitals, specialist consultations, diagnostic tests, surgeries, and sometimes dental care.
• Supplementary insurance is used in conjunction with public health insurance to cover services not fully covered by the public system, such as dental care, physiotherapy, or private hospital stays.
• International health insurance is targeted at expatriates; these plans often cover healthcare services in multiple countries, including Spain, and may include repatriation services.

Voluntary Health Insurance (Convenio Especial)

Convenio Especial is a public health insurance scheme available in some autonomous regions of Spain. It's designed for those who are not automatically covered by the Spanish Social Security system, such as non-working residents or early retirees.

This type of insurance covers services similar to those provided by the public healthcare system, including primary care, specialist consultations, hospitalisation, and emergency care.

How much does health insurance in Spain cost?

Public healthcare is funded through social security contributions, which are automatically deducted from your salary if you are employed. Approximately 4% of your salary will go towards funding public healthcare.

Self-employed individuals must pay their own social security contributions, which is around 31% of their monthly income.

For private health insurance, premiums vary depending on age, health status, coverage level, and the insurance provider. Basic plans typically range from €50 to €100 per month. Sanitas, Adeslas, and DKV are some of the top private health insurers in Spain.

Expat health insurance in Spain

If you are an EU/EEA/Swiss citizen staying in Spain temporarily, you can use your European Health Insurance Card (EHIC) to access necessary medical care under the same conditions as Spanish citizens.

If you plan to reside in Spain long-term, you are required to register and get access to the Spanish public healthcare system if you are employed or self-employed in Spain or hire private health insurance.

Non-EU/EEA/Swiss nationals are typically required to have health insurance as part of the visa application process.

English-speaking doctors in Spain

It is not as common for Spanish doctors to speak English as it is in other European countries. If you need medical assistance, you can search for English-speaking professionals on online platforms, such as Doctoralia or Top Doctors.

It is also possible to find specialised clinics for foreigners, particularly in the private health care system. Madrid has its own clinic, and Valencian residents can easily find doctors who speak a different language.

What to do in an emergency?

In case of a medical emergency, call 112, the general emergency number in Spain. The operators can assist in multiple languages, including English.

If possible, head to the nearest hospital with an emergency department (urgencias). Public hospitals are well-equipped to handle emergencies, and you will be treated regardless of your insurance status. If it's a less critical situation but still urgent, you can go to a local Centro de Salud, which often has an emergency service or urgent care unit.