Healthcare and Insurance: Recommendations for Expats Living in Spain
If you’re thinking of spending more time in Spain or even moving there altogether, then healthcare and insurance are things you’re likely already thinking about. Wherever you are, it’s important that you’re covered. You’ll be glad to know that Spain has one of the best healthcare systems in the world and offers (almost) universal medical coverage to those who are registered with the free public health system, the Sistema Nacional de Salud (SNS).
Roughly 90% of those living in Spain are registered with the SNS and some opt to take out private health insurance either instead of or alongside this.
But what does this all mean for expats? Can expats access national healthcare in Spain? Or do those from other countries need private health insurance? In this article, we’ve detailed everything you need to know about health insurance in Spain so you can access the correct healthcare as and when you need it.
How to Access the National Healthcare System in Spain
You need to be registered with the SNS to receive healthcare (or be privately insured). There are several conditions that you need to fulfil in order to be registered to receive public healthcare. Many people moving to Spain move there for work. Whether you’re employed or self-employed, you’ll need to make social security contributions or pay into a private health insurance scheme to fulfil the requirements.
Furthermore, residents in Spain who are entitled to their home government paying for their healthcare will receive public healthcare by filling out an S1 form. This, for example, applies to Spanish residents who are entitled to a state pension in their home country.
Dependents of someone entitled to Spanish state healthcare can also access it, which includes spouses and children.
Is the National Healthcare System in Spain Free?
When registered with the SNS, basic healthcare is free for expats in Spain. GP appointments, essential medical procedures and routine appointments are all (usually) covered. Emergency visits, surgery and treatment are also covered by state-funded care.
As is the case in other countries, there are some services which you’ll need to pay extra for, so make sure you’re aware of these before going ahead. These services include some types of physiotherapy and alternative therapies such as acupuncture. You may also need to contribute to certain medical equipment, such as wheelchairs.
Furthermore, you’ll have to pay for prescriptions. The SNS typically pays 40-60% of the cost and you’ll be expected to pay the difference. Retirees only pay 10% of the prescription charge. As is the case in other countries, you can pick up prescriptions from pharmacies and some are open 24/7.
Is Dental Treatment Included in the Spanish Health System?
Only emergency dental treatment is included in the national healthcare system in Spain. You’ll have to pay for checkups and all non-emergency dental treatments (not just aesthetic procedures). But, in comparison to other countries, dentist fees are relatively low in Spain and treatment is very good.
Opting for private insurance can be a cost-effective way to pay for non-emergency dental treatment. You can find some great dental add-ons to private health insurance which can cover non-emergency treatment too and that works out to be financially better long term.
What About EU/EFTA Nationals?
EU and EFTA nationals are covered by their European Health Insurance Card (EHIC) and can travel to Spain and be treated as a Spanish national (i.e. pay or not pay for the same medical treatment). However, some countries have a limit on the time you can stay in another country and use your EHIC card, so it’s worth checking. If you become a resident, it’s best to register with the SNS to get your own Spanish health insurance card by making contributions. You could also think about taking out private medical insurance. The European Free Trade Association (EFTA) currently consists of four countries: Iceland, Liechtenstein, Norway and Switzerland.
What About UK Nationals?
There’s no denying that Brexit has had an impact on Brits living and buying property in Spain. But healthcare is something else that British nationals need to think about post-January 2020. People visiting Spain for a short period can still use their EHIC card (as long as it’s valid) but once it runs out, you’ll need to get a Global Health Insurance Card (GHIC).
If you’re planning on staying in Spain for longer than 3 months you’ll need to apply for an appropriate visa (depending on your circumstances) or register as a resident. But, before either of those, you have to have proof of healthcare coverage.
Once you are registered with the Spanish healthcare system, you may be issued with a Spanish EHIC card which you can use to travel.
What About if You’re Not Working in Spain?
Non-workers can still have access to healthcare in Spain. Those entitled to an S1 form, such as pensioners, can receive healthcare based on the fact they’re receiving a pension from their home country. Those who have lived in Spain for more than 5 years, even without working, can apply for permanent residency and therefore have the same access to healthcare as a Spanish national.
If you’re not a permanent resident and are not working but have lived in Spain for over a year, you can apply to join the public health insurance scheme, something called Convenio Especial. You’ll then pay monthly contributions to healthcare.
Should Expats Get Private Health Insurance in Spain?
Private health insurance is popular amongst expats from all over the world. Some prefer to pay for it and others can’t access public healthcare, so it’s their only option. As is the case in many countries, the big advantage of private health insurance is that you can beat the queues. The main criticism of the public Spanish healthcare system is the waiting times and, with private health insurance, this isn’t an issue.
Private health insurance also covers more types of treatments than public healthcare. You have more say over the doctor who treats you, so you’re free to choose an English one or one that speaks your language.
So, Is It Really Necessary to Get Health Insurance in Spain as an Expat?
Yes. It absolutely is. Those who do not have health insurance in Spain will have to pay 100% of the costs which can be an extortionate amount of money. It’s essential to apply and make contributions to the SNS so that you’re covered whenever you need medical treatment. The healthcare service is excellent and residents and those visiting temporarily can have the same access to healthcare as Spanish nationals.