Health Insurance for expats in Spain: An inside look at Spain’s healthcare system

Spanish health insurance for expats

Around 5.5 million residents in Spain are expats. Life in Spain is extremely sought after. Its varying geography and climate, the Mediterranean lifestyle, and low cost of living are brought together with the cultural focus of living life just for life. One leading influence for this quality of life is Spain’s impressive health care system, ranking 7th out of 89 countries (2019 Health Care Index)!

Even with Spain’s impressive healthcare, choosing the right Spanish health insurance plan is a top priority. When moving for work or long-term travel anywhere in the world, it is important to learn about a country’s healthcare system and how your health insurance falls into it.

So, which are the best Spanish health insurance for expats living or moving to Spain? What options need to be considered when looking at Spain’s healthcare as a whole?

What are the Spanish healthcare policies? 

Spain’s health care system is one of the best in the world. The system includes a public health service called the Spanish National Health System (SNS) funded by social security payments. All Spanish citizens have free access to this health service, with regions taking separate responsibility for budgets allocated by the government. What makes the healthcare system so appealing to expats is that they can have access to the SNS, on the condition of also paying into social security!

To gain access to Spain’s public healthcare, expats must have a social security number. Expats can retrieve this by registering on the municipal register, which can then be shown to a local surgery to receive a medical card (TSI health card).

The SNS, used by 99% of the Spanish population, covers the basics:

  • Doctors
  • Hospitalisation
  • Medication / Prescriptions – heavily subsidized but not free, dependant on taxable income


Although appearing minimal, the Spanish government spends around 9.2% of its GDP on this healthcare system, meaning that everyone can have access to healthcare that actually benefits the people! For example, the SNS is ranked 6th in the EU for the number of doctors available – in other words, that’s averaging at 4 doctors per 1000 people.

Nearly 99% of Spain’s population has some form of health insurance, with 90% using the public health care system and 19% with private health insurance. Even the Spanish private health insurance is reasonably priced, providing people with the freedom of choice when it comes to their health.

Who has access to Spanish public health insurance? 

Once registered and obtained a TSI card, you can then register with an individual local doctor and receive free treatment at hospitals, as it provides proof of citizenship and employment.
So, can all types of expatriates have access to Spain’s public health insurance?

  • Employees: all employees must make social security contributions, meaning they automatically get health cover
  • Self-employed / freelancers / digital nomads / business owners: as not working for an employer, self-employed expats can still make social security payments themselves, gaining access to health cover
  • Spouses & children: if they live in Spain as well, they are also entitled to public health cover
  • EU / EEA / Swiss nationals: if received retirement in their home country, they are entitled to public health cover
  • Non-EU nationals: may be asked to provide proof of private health insurance to obtain a Spanish VISA
  • Students: EU nationals studying in Spain are covered by EHIC (European Health Insurance Card), whilst non-EU students may be asked for proof of private medical insurance


Expats need to investigate, before travelling to Spain, into their personal needs and circumstances, and to assess what type of Spanish health insurance suits them best and what they are entitled to.

What are the different options of Spanish health insurance for expats? 

Although the quality of Spanish public health care is incredibly high, residents and expats can also opt for private Spanish health insurance to ensure a more secure and comprehensive cover. Below are the different options expats living in Spain can choose for their health cover:

  1. Covered only by the Spanish public health system: a quality cover that is easily accessible for most residents and expats, doesn’t include dental cover
  2. Pay-in Scheme – Convenio Especial: for those with issues accessing benefits of the public health system, low-cost insurance scheme, cover in exchange for a low monthly payment
  3. Covered by the SNS and Local Spanish Private Medical Insurance: for people living in Spain permanently and do not plan to travel around Europe for longer than 3 months, basic policy from any of Spain’s insurers, will generally cover: hospital care, surgery, dental, consultation fees, cancer treatment, can be personalised
  4. International Health Care policy: providing you with a comprehensive broader plan, ensuring secure cover


(Find out what can be included in International Private Health Insurance.)

The most popular option is often International Health Insurance for expats, rather than following a Local Insurance plan. It ensures a wider range of insurance, enabling expats to be covered in Spain as well as other countries, including their country of nationality, and provides more options for choice regarding specific doctors and hospitals

On the other hand, some expats also choose the combination of public and private health insurance. This means that they would still have to enrol in the public system and then add on their own personalised private coverage. Combining the two can be appealing for expats, one reason being that they become more immersed in the community and culture, following the norm of Spanish residents.

Why do expats need a Spanish health insurance plan?  

Even with a high-end public health system in place, being an expat in Spain, or any country, still has its difficulties! Spanish expats still must face a range of issues when navigating their health insurance plans in Spain.

Listed below are some reasons why Spanish expats decide to purchase international and private health insurance:

  • Language barriers – more options for multilingual doctors, nurses, surgeons
  • “Spanish Hours” – many pharmacies close for the afternoon, re-opening after siesta into the evening
  • Waiting times for specialists and surgical procedures – less waiting time for non-emergency treatments
  • Understanding a different government system
  • Unable to access the public system e.g., retired early or not paying into social security
  • Better care in hospitals
  • Ensures comfortable private treatment facilities
  • Can include dental coverage
  • If you anticipate seeing multiple specialists, can save time and frustration

Obtaining International Private Health insurance as an expat in Spain ensures ease and comfort during a potentially tumultuous move to a different country. Of course, every decision around healthcare comes down to the individual in relation to affordability and specific health requirements. You can learn how to personalise your health cover in this blog post.

Better still, contact the expert team at Engage Health Group for free no-obligation advice and support.

Eleanor Chilvers

Eleanor Chilvers

Eleanor started at Engage in 2021, and is now a Digital Content Writer after studying BA English Literature at University of Sussex for the last 3 years.

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