Spanish Healthcare & Health Insurance: Complete Guide 2025

Spain offers both public and private healthcare systems, both ranked among the best in the world. This comprehensive guide explains how to access Spanish healthcare as an expat, public vs. private insurance options, costs, and how to choose the right coverage in 2025.

Quick Facts:

• Public Healthcare Quality: World-class (ranked #7 globally by WHO)
• Private Insurance Cost: €50-€150/month (varies by age and coverage)
• Public Healthcare Access: Free if contributing to Social Security OR via private insurance for visa requirements
• Healthcare Card: Tarjeta Sanitaria Individual (TSI) for public system
• Best Private Insurers: Sanitas, Adeslas, ASISA, DKV, Cigna Global
• Emergency Care: Free for everyone (including tourists) via 112

Spanish Healthcare System Overview

Spain operates a dual healthcare system: public (Sistema Nacional de Salud) and private.

Public Healthcare (Sistema Nacional de Salud)

Coverage: Universal, taxpayer-funded healthcare available to all legal residents contributing to Social Security.

Quality: Excellent. Spanish public healthcare consistently ranks among the world’s best (top 10 globally).

Cost: Free at point of use (no copays for most services). Funded by Social Security contributions from employees and employers.

What’s Covered:

• General practitioner (GP) visits
• Specialist referrals
• Hospital treatment (surgery, emergency care)
• Prescription medications (small copay: €0-€4.24 per prescription, depending on income)
• Maternity and pediatric care
• Chronic disease management
• Mental health services (limited)

What’s NOT Covered:

• Dental care (except extractions, emergencies)
• Optometry (eye exams, glasses)
• Some specialized treatments
• Cosmetic procedures
• Certain medications

Wait Times:

• Emergency care: Immediate
• GP appointments: 1-7 days
• Specialist appointments: 2-8 weeks (varies by specialty and region)
• Non-urgent surgery: 1-6 months (varies significantly)

Private Healthcare (Sanidad Privada)

Coverage: Insurance-based system where individuals purchase health insurance from private companies.

Quality: Excellent. Private hospitals and clinics offer high standards with modern facilities.

Cost: €50-€150/month (premiums vary by age, coverage level, and insurer)

What’s Covered:

• Everything public system covers PLUS:
• Dental care
• Optometry
• Faster specialist access (days, not weeks)
• Private hospital rooms
• Alternative therapies (acupuncture, physiotherapy)
• International coverage (some plans)

Wait Times:

• Specialist appointments: Same day to 1 week
• Surgery: 1-4 weeks
• Dental, optometry: Same day to 3 days

Public vs. Private: Which Do You Need?

Many expats use BOTH:

• Public: For serious illness, hospitalization, emergencies (free, excellent)
• Private: For routine care, specialists, dental, avoiding waits

You ONLY Need Private If:

• Visa requirement (some visas require private insurance initially)
• You want faster specialist access
• You need dental/optical coverage
• You’re self-employed (autónomo) and don’t want to contribute to Social Security yet
• You’re a non-resident

How to Access Public Healthcare

Who Qualifies for Public Healthcare?

Automatic Access (Employees): If you’re employed in Spain (cuenta ajena), your employer registers you with Social Security. You automatically qualify for public healthcare immediately upon registration.

Autónomos (Self-Employed): When you register as autónomo, you contribute to Social Security (€80-€600/month). This includes healthcare access.

Retirees:

• EU retirees can use EHIC (European Health Insurance Card) or S1 form from home country
• Non-EU retirees must have contributed to Spanish Social Security OR purchase private insurance

Dependents: Your spouse and children (under 26) qualify for public healthcare if you’re registered and contributing.

Who Does NOT Automatically Qualify:

• Non-Lucrative Visa holders (no work allowed = no Social Security contributions)
• Digital Nomad Visa holders (first year—must have private insurance)
• EU citizens not working or registered
• Non-residents
• Tourists

How to Get Your Healthcare Card (Tarjeta Sanitaria)

Step 1: Register with Social Security Your employer registers you automatically. If autónomo, you register yourself when starting self-employment.

Step 2: Register with Regional Health Service Spain’s healthcare is managed regionally. Register at your autonomous community’s health department:

• Madrid: Servicio Madrileño de Salud (SERMAS)
• Catalonia: CatSalut
• Andalusia: Servicio Andaluz de Salud (SAS)
• Valencia: Conselleria de Sanitat

Required Documents:

• NIE or TIE (residence card)
• Social Security number (número de afiliación a la Seguridad Social)
• Padrón certificate (proof of address)
• Passport

How to Apply:

• Book appointment (cita previa) at health center (centro de salud)
• Submit documents
• Assigned GP (médico de cabecera/médico de familia) at your local health center
• Receive healthcare card (Tarjeta Sanitaria Individual - TSI) in 2-4 weeks (temporary paper given same day)

Processing Time: 2-4 weeks for card; temporary certificate issued immediately.

Cost: Free.

Using Public Healthcare

General Practitioner (GP/Médico de Familia):

• Your first point of contact for all health issues
• Book appointments via phone, online portal, or in-person
• Walk-in for urgent issues (not emergencies)
• GP provides referrals to specialists

Specialists:

• Require GP referral (except private)
• Wait times: 2-8 weeks
• Appointment at public hospital or specialist center

Emergencies (Urgencias):

• Go directly to hospital emergency room (urgencias) OR
• Call 112 (Spain’s emergency number—equivalent to 911/999)
• Free for everyone, including tourists
• Triage system: serious cases seen immediately, minor issues may wait

Prescriptions:

• GP or specialist prescribes medication
• Take prescription to pharmacy (farmacia)
• Copay: €0-€4.24 per medication depending on income
  • Pensioners: €0 (free)
  • Low income: 40% copay
  • Standard: 40-50% copay
  • High income (€100k+): 60% copay

Public Healthcare Quality by Region

Healthcare quality varies slightly by autonomous community:

Top-Rated Regions:

• Basque Country (País Vasco): Best healthcare in Spain
• Navarra: Excellent hospitals, short wait times
• Madrid: Very good, modern facilities
• Catalonia: Good, but wait times longer in Barcelona

Good-to-Average Regions:

• Andalusia, Valencia, Galicia, Castilla y León

Important: Even “average” Spanish public healthcare is world-class by global standards.

Private Health Insurance in Spain

Private insurance is common—approximately 25% of Spaniards have private coverage (often alongside public access).

When You Need Private Insurance

Required for Visas:

• Non-Lucrative Visa: Mandatory (minimum €30,000 coverage)
• Digital Nomad Visa: Mandatory first year
• Student Visa: Mandatory (some universities accept public insurance after registration)

Recommended (But Not Required):

• You want faster specialist access
• You need dental/optical coverage
• You prefer private hospitals
• You’re self-employed and want to minimize Social Security costs initially
• You live in a rural area (private may have better access)

Best Private Health Insurance Companies

Sanitas (Best Overall)

Type: Spanish insurer (owned by Bupa UK)

Monthly Premiums: €60-€120 (age 30-50), €120-€200 (age 60+)

Pros:

• Largest network in Spain (hospitals, clinics)
• Excellent reputation
• English-speaking customer service
• Comprehensive coverage
• Accepted for all visa types

Cons:

• Higher premiums than some competitors

Best For: Expats wanting best overall coverage and widest network.

Adeslas (Most Affordable)

Type: Spanish insurer (owned by SegurCaixa)

Monthly Premiums: €50-€100 (age 30-50), €100-€160 (age 60+)

Pros:

• Lower premiums
• Good hospital network
• Dental plans available
• Well-established (largest insurer by enrollment)

Cons:

• Customer service mostly Spanish
• Smaller network than Sanitas

Best For: Budget-conscious expats, Spanish speakers.

ASISA (Good Value)

Type: Spanish mutual insurer

Monthly Premiums: €55-€110 (age 30-50), €110-€180 (age 60+)

Pros:

• Competitive pricing
• Good coverage
• Wide network

Cons:

• Customer service in Spanish
• Less known among expats

Best For: Those wanting value, comfortable with Spanish.

DKV (German Quality)

Type: German insurer (owned by Munich Re)

Monthly Premiums: €70-€130 (age 30-50), €140-€220 (age 60+)

Pros:

• German engineering/service standards
• Excellent coverage
• International perspective
• English support

Cons:

• Higher premiums
• Smaller network than Sanitas

Best For: German expats, those prioritizing service quality.

Cigna Global (International Coverage)

Type: US-based global insurer

Monthly Premiums: €150-€400 (varies widely by plan)

Pros:

• Global coverage (Spain + worldwide)
• Excellent for frequent travelers
• Direct billing (no upfront payment)
• English service

Cons:

• Expensive
• Overkill if you’re staying in Spain

Best For: International executives, frequent travelers, high earners.

Coverage Comparison

Feature	Public	Sanitas	Adeslas	Cigna Global
GP Visits	Free	Included	Included	Included
Specialists	Free (wait 2-8 wks)	1-7 days	1-7 days	Same day
Hospital	Free	Private room	Private room	Private room
Surgery	Free (wait 1-6 mo)	1-4 weeks	1-4 weeks	1-2 weeks
Prescriptions	€0-€4 copay	20-30% copay	20-30% copay	Often 100%
Dental	Not covered	Add-on €10-€30/mo	Add-on €10-€30/mo	Included (some plans)
Optical	Not covered	Add-on €5-€15/mo	Add-on €5-€15/mo	Included (some plans)
Mental Health	Limited	Limited sessions	Limited sessions	Comprehensive
International	EU only (EHIC)	Spain + EU	Spain only	Worldwide

How to Choose Private Insurance

Consider:

1. Visa Requirements:

• Check minimum coverage (usually €30,000)
• Ensure insurer is approved by Spanish consulates (Sanitas, Adeslas, ASISA always accepted)
• Confirm no deductibles or minimal (some visas reject high-deductible plans)

2. Your Health Needs:

• Healthy, young (20-40): Basic plan sufficient (€50-€80/month)
• Chronic conditions: Ensure coverage (some insurers exclude pre-existing conditions)
• Dental/optical needs: Add these riders
• Frequent travel: Consider Cigna Global or international add-ons

3. Budget:

• Basic coverage: €50-€80/month
• Comprehensive: €100-€150/month
• Premium with dental/optical: €150-€200/month

4. Network:

• Check insurer’s hospital/clinic list in your city
• Ensure convenient locations

5. Language:

• Sanitas, Cigna: English support
• Adeslas, ASISA: Mostly Spanish

How to Purchase Private Insurance

Direct Purchase:

• Visit insurer websites (Sanitas.es, Adeslas.es, etc.)
• Request quote (cotización)
• Complete online application or phone
• Provide: NIE/passport, health questionnaire (pre-existing conditions)
• Payment: Monthly direct debit

Through Insurance Broker:

• Brokers compare multiple insurers
• Help navigate options
• Assist with claims
• Fee: Usually commission-based (no cost to you)

Find Insurance Brokers →

Processing Time: 1-7 days approval, coverage starts immediately or on chosen date.

Pre-Existing Conditions

Important: Most Spanish insurers exclude or limit coverage for pre-existing conditions.

Typical Exclusions:

• Diabetes
• Heart disease
• Cancer
• Chronic respiratory issues
• Mental health conditions

Waiting Periods:

• General coverage: Immediate
• Specialist visits: 0-6 months
• Surgery: 6-12 months
• Maternity: 8-12 months

Solution for Pre-Existing Conditions:

• Some insurers cover after 1-2 years of enrollment (without claims for that condition)
• Public healthcare covers pre-existing conditions (if you’re contributing to Social Security)
• International insurers (Cigna, Allianz) may offer coverage (higher premiums)

Healthcare Costs in Spain

Public Healthcare

Free if you’re contributing to Social Security:

• GP visits: Free
• Specialist visits: Free
• Hospitalization: Free
• Surgery: Free
• Prescriptions: €0-€4.24 per medication

What You Pay:

• Social Security contributions (included in salary deductions—6.35% for employees)
• Autónomos: €80-€600/month (includes healthcare + pension + other benefits)

Private Healthcare (Without Insurance)

Out-of-Pocket Costs:

• GP visit: €50-€100
• Specialist visit: €80-€150
• Diagnostic tests (MRI, CT): €200-€800
• Emergency room visit: €100-€300
• Surgery: €2,000-€20,000 (depends on procedure)
• Dental cleaning: €50-€80
• Dental filling: €60-€120
• Eyeglasses: €100-€400

Prescription Medications:

• Without insurance: Full price (€10-€200 depending on medication)
• With insurance: 20-30% copay

Private Insurance Premiums by Age

Age	Basic Plan	Comprehensive	With Dental/Optical
18-30	€40-€60	€70-€100	€90-€120
30-40	€50-€80	€90-€120	€110-€150
40-50	€60-€100	€110-€150	€140-€180
50-60	€80-€140	€150-€210	€180-€250
60-70	€120-€200	€200-€300	€250-€350
70+	€180-€350	€300-€500	€400-€600

Note: Premiums increase with age. Lock in lower rates by enrolling young.

Dental Care in Spain

Not covered by public healthcare (except emergency extractions).

Options:

1. Private Dental Insurance (Seguro Dental):

• €10-€30/month add-on to health insurance
• Covers: Cleanings, fillings, X-rays (often 100%)
• Covers: Crowns, root canals (50-80% coverage)
• Orthodontics: Partial coverage (20-50%)

2. Dental Clinics (Out-of-Pocket):

• Cleaning: €50-€80
• Filling: €60-€120
• Root canal: €200-€500
• Crown: €300-€800
• Implant: €800-€2,000
• Orthodontics (braces): €2,000-€5,000

Tip: Dental tourism—Spain is cheaper than UK/US. Many expats travel to Spain specifically for dental work.

Pharmacies (Farmacias)

Pharmacies are everywhere: Identified by green cross (cruz verde).

Services:

• Fill prescriptions (recetas)
• Over-the-counter medications
• Basic health consultations (pharmacists are highly trained)
• Blood pressure checks
• Some vaccines

Prescription Process:

• GP or specialist writes prescription
• Take to any pharmacy
• Show healthcare card (public) or pay full price (private, then claim reimbursement from insurer)

24-Hour Pharmacies:

• Rotating schedule (farmacia de guardia)
• Check online or look for green cross with “Guardia” sign

Emergency Healthcare

Emergency Number: 112

• Ambulance, police, fire brigade
• English operators available
• Free for everyone (residents and tourists)

Emergency Rooms (Urgencias):

• Located at all public hospitals
• Open 24/7
• Triage system: Serious cases first, minor issues may wait 2-6 hours
• Free for residents with healthcare card
• Free for tourists (emergency treatment only—ongoing care requires insurance)

Urgent Care Centers (Centros de Atención Primaria):

• For non-life-threatening urgent issues (minor injuries, infections, flu)
• Faster than emergency room for minor issues
• Located in most neighborhoods

Healthcare for Specific Groups

Retirees

EU Retirees:

• Use EHIC (European Health Insurance Card) for temporary stays
• Apply for S1 form from home country for permanent residence (transfers healthcare rights)
• Access Spanish public healthcare through S1

Non-EU Retirees:

• Must purchase private insurance OR
• Contribute to Spanish Social Security (difficult if not working)
• Non-Lucrative Visa requires private insurance (€30,000+ coverage)

Digital Nomads

First Year:

• Digital Nomad Visa requires private insurance
• After contributing to Social Security for 1 year (if paying autónomo fees), can access public healthcare

Students

EU Students:

• Use EHIC from home country
• Some universities require additional insurance

Non-EU Students:

• Student visa requires private insurance
• Some universities offer group plans (€200-€400/year)

Families

Children:

• Covered under parent’s public healthcare (free)
• Covered under parent’s private insurance (small additional premium—€10-€30/child/month)

Maternity:

• Public healthcare: Fully covered (prenatal care, delivery, postnatal)
• Private insurance: Usually covered after 8-12 month waiting period

Common Healthcare Problems and Solutions

Problem 1: Long Wait Times for Specialists (Public)

Issue: GP refers you to specialist, wait is 6-8 weeks.

Solutions:

• Purchase private insurance (see specialist in 1-7 days)
• Go private out-of-pocket for one-off visit (€80-€150)
• If urgent, stress to GP—they can mark as preferente (faster)
• Emergency room for immediate issues (though may still wait if non-urgent)

Problem 2: Denied Coverage for Pre-Existing Condition

Issue: Private insurer excludes your chronic condition from coverage.

Solutions:

• Enroll in public healthcare (contribute to Social Security as autónomo) - covers pre-existing conditions
• International insurers (Cigna, Allianz) may cover (higher premiums)
• Some Spanish insurers cover after 1-2 years without claims

Problem 3: Private Insurer Doesn’t Cover Specific Treatment

Issue: Your private insurance doesn’t cover the procedure you need.

Solution:

• Appeal to insurer (sometimes they make exceptions)
• Pay out-of-pocket (negotiate cash discount—hospitals often give 20-40% off)
• Use public healthcare if you qualify (covers most procedures)

Problem 4: Difficulty Getting GP Appointment (Public)

Issue: Your centro de salud is overbooked, can’t get GP appointment for 7-10 days.

Solutions:

• Use “consultas sin cita” (walk-in hours—usually 8-10am)
• Call health center early morning (8-9am) for same-day cancellations
• Go to urgent care center (CAP) for non-emergency urgent issues
• Use private insurance (GP same day)

Problem 5: Language Barrier with Spanish Healthcare

Issue: Doctors, nurses, administrators speak limited English.

Solutions:

• Bring Spanish-speaking friend/partner
• Hire medical interpreter (€50-€100/visit)
• Use translation apps (Google Translate has camera feature for documents)
• Private insurance (Sanitas, Cigna) has English-speaking staff
• Large cities/expat-heavy areas have more English-speaking healthcare professionals

Get Expert Help

Navigating Spanish healthcare, especially choosing private insurance, can be complex.

Recommended Services:

• Insurance Brokers → - Compare policies, handle claims, advise on best coverage (commission-based, no cost to you)
• Healthcare Providers → - English-speaking doctors, clinics catering to expats

When to Use Broker:

• First time buying Spanish insurance
• Visa requires specific coverage (broker ensures compliance)
• Pre-existing conditions (broker knows which insurers are lenient)
• Comparing multiple policies

Related Guides

• NIE Number Application → - Required for healthcare registration
• Empadronamiento → - Needed for healthcare card
• Digital Nomad Visa → - Insurance requirements for visa
• Non-Lucrative Visa → - Insurance requirements
• Autónomo Self-Employment → - Social Security includes healthcare
• Cost of Living in Spain → - Healthcare costs in budget

FAQs About Spanish Healthcare

Is healthcare free in Spain?

Public healthcare is free if you’re contributing to Spanish Social Security (employees, autónomos, retirees with S1 form). Free includes GP visits, specialists, hospitalization, surgery, and most prescriptions (€0-€4 copay). Not covered: Dental, optical, some specialized treatments. Private insurance costs €50-€150/month. Emergency care (112) is free for everyone, including tourists.

Do I need private health insurance in Spain?

Required for: Non-Lucrative Visa, Digital Nomad Visa (first year), Student Visa. Not required for: Work visa holders (access public healthcare via Social Security), EU citizens working/registered in Spain, autónomos (if contributing to Social Security). Recommended (but optional) if: You want faster specialist access, dental/optical coverage, or prefer private hospitals. Many expats use both: public for serious issues, private for routine care.

How do I access public healthcare in Spain?

Step 1: Work in Spain (employed or autónomo) = automatic Social Security registration. Step 2: Register at regional health service (SERMAS in Madrid, CatSalut in Catalonia) with NIE, Social Security number, and padrón. Step 3: Receive healthcare card (Tarjeta Sanitaria) in 2-4 weeks. Step 4: Use card at GP appointments, hospitals, pharmacies. Free at point of use. EU citizens can use EHIC temporarily or S1 form (retirees) for permanent access.

What is the best private health insurance in Spain?

Best overall: Sanitas (€60-€120/month)—widest network, English support, accepted for all visas. Best value: Adeslas (€50-€100/month)—lowest premiums, good coverage. Best for internationals: Cigna Global (€150-€400/month)—worldwide coverage, excellent service. Best for German expats: DKV (€70-€130/month)—German quality standards. Choose based on: budget, language needs (English vs Spanish), network in your city, visa requirements.

How much does private health insurance cost in Spain?

Age 30-40: €50-€120/month (basic to comprehensive). Age 40-50: €60-€150/month. Age 50-60: €80-€210/month. Age 60+: €120-€350/month. Add-ons: Dental (+€10-€30/month), Optical (+€5-€15/month). Factors: Age, coverage level, pre-existing conditions, deductibles. Cheapest: Adeslas €50/month (young, healthy). Most expensive: Cigna Global €400+/month (comprehensive international). Average expat: €80-€120/month.

Does Spanish public healthcare cover dental?

No, public healthcare does NOT cover routine dental care (cleanings, fillings, crowns). Only covered: Emergency extractions, acute infections. Options: (1) Private dental insurance (€10-€30/month add-on), (2) Pay out-of-pocket (cleaning €50-€80, filling €60-€120), (3) Dental tourism—Spain is cheaper than UK/US. Most expats pay out-of-pocket for dental or add dental insurance to their health plan.

Can I use my home country health insurance in Spain?

EU citizens: Use EHIC (European Health Insurance Card) for temporary stays (tourism, short visits). For permanent residence, apply for S1 form (if retired) or contribute to Spanish Social Security. Non-EU citizens: Home country insurance typically doesn’t cover Spain. Exceptions: International policies (Cigna, Allianz). Solution: Get Spanish private insurance (€50-€150/month) or access public healthcare via Social Security contributions.

What happens if I have a medical emergency in Spain?

Call 112 (Spain’s emergency number—free, works from any phone, English operators available). Ambulance dispatched to your location. Emergency room (urgencias): Go directly to nearest public hospital. Free for everyone (residents and tourists)—emergency care is never denied. Show healthcare card (if resident) or passport (if tourist). Non-emergency urgent care: Visit CAP (Centro de Atención Primaria) for minor injuries, flu, infections.

How long are wait times for specialists in Spain?

Public healthcare: 2-8 weeks for specialists (varies by specialty—dermatology faster, orthopedics slower). Non-urgent surgery: 1-6 months. Private insurance: Specialist appointments 1-7 days, surgery 1-4 weeks. Emergency care: Immediate (triage system—serious cases first). GP appointments: Public: 1-7 days. Private: Same day to 3 days. Wait times vary by region—Basque Country and Navarra fastest, Andalusia and Valencia slower.

Can I switch from private to public healthcare?

Yes. To access public healthcare: Start contributing to Spanish Social Security (get employed or register as autónomo). After registration, apply for healthcare card (Tarjeta Sanitaria) at regional health service. Can you keep both? Yes, many expats maintain private insurance alongside public access for: faster specialists, dental, private hospital rooms. Switching from public to private: Just purchase private insurance anytime (no enrollment restrictions except age/pre-existing conditions).