This is our complete guide to health insurance in Spain in 2024.
So, if you want to find the best plan for you and your family, this guide is packed with practical advice you’ll love.
Let’s get started.
Spanish healthcare system: how does it work?
In Spain, every resident must have health insurance.
You’ll need to pay for your health insurance every month. But the good news is that your insurance covers (almost) all the necessary healthcare costs. It takes care of things like medical operations, medication, and checkups.
There are 2 main types of health insurance in Spain: public and private.
How public health insurance works
The government’s Spanish National Health System (SNS) runs public health insurance. Here’s how it works:
- Cost: A portion of your income tax helps cover the cost of the SNS. So, you’re helping to pay for your treatments and everyone else’s.
- Flexibility: You don’t get to choose your provider; the government is the only one available. Unless it’s an emergency, the government will put you on a waitlist, and you must wait for your turn to access healthcare.
- Coverage: It is limited to necessary care. If you want specific treatment, you must pay for it.
This system provides equal coverage to everyone, making it one of the fairest systems in Europe.
How private health insurance works
Companies (like Feather) manage private health insurance. Here’s how it compares to public insurance:
- Cost: The price depends on your age and health when you sign up. Younger, healthier individuals get a better price.
- Flexibility: Private insurance offers more flexibility. You can usually choose your doctors and hospitals.
- Coverage: Private insurance can offer more comprehensive coverage than public insurance.
There are multiple types of private insurance, such as expat health insurance. It’s a temporary solution for people who move to Spain. It offers better coverage than travel insurance and more flexibility than traditional private health insurance plans.
Over 11.5 million residents hold private insurance policies. This option is especially popular among expats who may not yet qualify for full coverage under the public system or prefer English-speaking services.
However, unlike in Germany, private health insurance in Spain is supplementary to public plans rather than a standalone policy. This means you’ll still be covered by the SNS, even with a private insurance plan, from when you become a resident and start paying taxes in Spain.
Who needs health insurance?
It’s mandatory for all residents, and you are automatically registered to public coverage if you pay taxes. In fact, 99.5% of residents participate in the Spanish National Health System. Here’s what you need to know, depending on your situation.
European citizens
Your European Health Insurance Card (EHIC) allows you to access healthcare in Spain. You can obtain one if you’re a citizen of an EU or EFTA country.
It’s designed for short stays, which is why, according to the Medical Tourism Index, Spain is the most popular destination in Europe for cross-border treatments.
However, if you plan to stay longer or move permanently, you should register with the SNS to get a Spanish Health Card (SIP). Here’s why:
- The EHIC is fine if you plan to stay for less than 3 months. But, it won’t cover ongoing treatments, regular check-ups, or non-emergency services.
- If you plan to stay for over 3 months, you’ll always need health insurance, regardless of nationality.
- Registering with the SNS and getting a SIP facilitates access to more medical services and specialists.
Staying less than 2 years? You should get an S1 Form.
The S1 form is essential if you’re an expat paying for state healthcare in another EU or EFTA country and plan to stay in Spain for less than 2 years. Here’s why it’s important:
- The S1 form allows you to access healthcare in Spain while remaining insured in your home country. Thus, you can ensure continuity of care without switching healthcare systems entirely.
- Retirees collecting pensions can use the S1 form to access healthcare without losing access to healthcare benefits from their home country.
- This form offers students, trainees, and researchers access to healthcare services during temporary stays.
Non-European citizens
Your visa application insurance will initially work well. It covers your basic needs, but you must join the SNS or private insurance to stay long-term.
Visa applicants
Health insurance is a requirement for most visas in Spain. However, since you’re not a resident, you won’t be able to sign up for either public or general private insurance, the latter usually not complying with all visa requirements as it is intended for Spanish residents.
You will likely have only one option: expat health insurance (some companies call this incoming insurance).
Public health insurance
If you’re a resident of Spain paying taxes, you’ll be covered for necessary care under this plan.
What is the cost of public health insurance?
It’s a common misconception that Spanish healthcare is free. However, nothing is really free.
Spain spends 7.85% of its GDP on healthcare, so someone (you) is paying for it. Indeed, taxes fund this system, so technically, the “price” is proportional to your income.
This means public facilities require no upfront payments. However, relying solely on the SNS could still incur some costs. Research shows that 73% of households in Spain are expected to pay some expenses out of their pocket. Depending on your income level, you may be required to pay a medication copay.
The pros of public health insurance
Every taxpayer is accepted
As we’ve mentioned, every taxpayer contributing to social security is eligible for public insurance. You just have to apply for the recognition of the right to healthcare.
Your taxes cover its cost
Your income tax funds public health insurance, so its cost is proportional to your earnings. If you make more, you pay more. This is the opposite of private health insurance; even if you become unemployed, you must continue paying for your policy.
Cover dependants for free
If you’re paying into social security, certain family members can also get healthcare coverage:
- Your spouse or partner, even if they are a former partner.
- Your children are covered, too, if they’re under 26.
- Your siblings can also get coverage.
However, there are a few rules to follow:
- These family members must live legally in Spain
- They must live with you unless you’re legally separated or divorced.
- They must also be financially dependent on you, except for your spouse or partner.
- Your children’s and siblings’ income must not exceed twice the IPREM (a public income indicator in Spain).
Easy access to care
When you go to the doctor, you show your insurance card and are all set. There’s no need to worry about getting reimbursed or paying deductibles.
This makes it easy to focus on your health instead of stressing over the details.
Pre-existing conditions
Even with serious health problems, the SNS will always cover you. You don’t pay more because of your bad health. This is one of the best things about the SNS—it ensures everyone gets the care they need.
On the other hand, private health insurers’ costs depend on the current state of health when applying. Serious existing health problems can make coverage more expensive.
The cons of public health insurance
Longer wait times
The high demand for Spain’s public health system often leads to longer wait times for non-emergency procedures. Here are some figures based on new research to put things in perspective:
- The average wait for the first consultation with a specialist was 101 days.
- More than 56% of patients wait more than 60 days to see a specialist for the first time.
- Almost a quarter of the patients waiting for surgery had been waiting more than 6 months.
- The average waiting time for surgery is 128 days.
Some treatments are not included
Public health insurance may not cover certain advanced treatments or therapies.
Non-essential procedures are often excluded from the system, meaning patients must pay for themselves.
Appointments with specialists must be signed off
Patients typically need a referral from their general practitioner (GP) to see a specialist. This additional step can delay access to specialist care, adding to the already long waiting time.
Poor continuity of care
Due to high patient loads and frequent staff changes, care can be fragmented between healthcare professionals.
As a result, patients encounter inconsistencies in their treatments and management.
No choice of doctors
In the public healthcare system, patients do not have the flexibility to choose their doctor or specialist.
Doctors are assigned based on availability rather than patient preference, and switching doctors if dissatisfied is challenging.
Additionally, you have to get lucky to find English-speaking staff in public hospitals.
Out-of-pocket expenses
Despite public coverage, patients may still face out-of-pocket expenses for pharmaceuticals and non-covered services.
Recent policies in Spain have increased co-payments and introduced measures to reduce pharmaceutical spending, shifting some costs to patients.
These expenses amount to around 403€ per year, which varies significantly depending on your income.
Public health insurance coverage
Treatments
You can receive medical care at public health centers and hospitals. As of 2019, there were 467 public hospitals in Spain,
If you’re elderly or have a disability, you can also get home care.
Additionally, social security helps cover the cost of surgical prostheses, orthopedic equipment, and wheelchairs.
Emergencies
You can go to any medical center for care, and if you need to be admitted to a hospital, that’s covered, too.
The SNS also takes care of ambulance services.
Rehabilitation
If you need rehabilitation, it’s covered as long as you have a medical prescription.
Medication
Public health insurance covers most prescription medications. Most people share the cost, so depending on your income, you’ll pay between 10% and 60% of the total price.
Some people get their medicines for free:
- Non-contributory pensioners
- People on basic income for job seekers
- Unemployed individuals who have exhausted their benefits
- Victims of occupational illnesses or accidents
- Hospital patients
For these patients, there’s also a small copay for some prescriptions, ranging from 5€ to 10€.
Dentistry
Dental care under public health insurance is quite limited. It’s mainly for:
- Children under 15
- If you need surgery.
- Essential dental care (like removing wisdom teeth)
You also get 2 free dental check-ups a year.
Unfortunately, dental prostheses and most other treatments aren’t covered. Many residents choose to get additional dental insurance for better coverage.
Vision
Regarding vision care, public health insurance rarely covers glasses or contact lenses. So, you’ll usually need to pay for these yourself.
Mental health
For mental health treatment, you’ll need a referral from your family doctor.
However, due to the long waiting lists (3 to 4 months on average) and limited capacity (sessions are restricted to 30 minutes), public health insurance may not provide the best care in this area, so many people opt for private health insurance to get better mental health services.
Sexual and reproductive health
Contraception is widely available in Spain. However, the SNS does not cover most:
- Condoms – they’re available in supermarkets or pharmacies.
- Hormonal contraception – you’ll need a prescription for those.
- Emergency contraception – it’s available at pharmacies.
- Tests for STDs or STIs – you can get them for free with a referral from your doctor.
Private health insurance
How much does private insurance cost?
The cost of private health insurance can vary depending on:
- Your age
- Your health
- Your desired coverage
- The region you live in
- Your insurance provider
However, the latest research shows that the average cost of private health insurance premiums in Spain for 2024 is approximately €698 per capita or €58.2 per month.
Remember, these are just averages and may vary depending on your situation. Students usually pay less than €60 per month, while foreign residents pay under €100.
The pros of private health insurance
Faster access to healthcare
Private insurance allows you to skip waiting lines and access care more quickly than the public system.
Also, you don’t need a referral from a family doctor to see specialists. This will save you time in getting the care you need right away.
Access to private hospitals and clinics
Private insurance provides coverage in a wide network of private healthcare facilities. These often offer greater flexibility when choosing the hospital, as well as comfort and privacy (e.g., a private hospital room for yourself).
English-speaking healthcare providers
Private insurance makes it easier to find doctors and staff who speak English. Some private hospitals offer translation services.
Customizable coverage
Your insurance can cover dental care, travel insurance, special treatments, etc. You can choose the minimum coverage to pay less.
You can also opt for copay, where you’ll have to pay a certain amount on any invoice but get a lower premium. If you don’t get sick, this can save you money.
Choice of doctors
You have more freedom to choose your healthcare providers, unlike with public insurance, where you must accept the doctor attributed to you.
The cons of private health insurance
Cost
Private health insurance typically costs between €50 and €100 per month. It’s an additional expense, especially considering you already have access to a free public healthcare system.
Limited doctor network
Most private insurance plans come with a list of preferred care providers, restricting your choice of specialists or facilities.
If you visit out-of-network doctors or medical centers not approved by your insurance company, your insurance might not cover the costs if you choose a policy that does not offer reimbursement.
Please note that this does not apply to you if you sign up with Feather. We do not have network requirements.
Coverage overlaps
Private insurance might seem redundant, considering public insurance’s coverage.
Private health insurance coverage
Private health insurance covers the same things as public health insurance and more. Essential healthcare is always included.
With private health insurance, you have more control over what is covered. For instance, it may cover home births, which the SNS does not.
Some private plans also offer coverage for alternative therapies as an add-on. You can save money by covering less or opting for copay options.
How to choose your private health insurance provider
Different private health insurance companies offer a wide range of options, and the best one depends on your specific needs: Each company provides unique plans and coverage.
To find the right fit, always look at online reviews. What is their reputation? For reference, at Feather, we are only satisfied with a rating of 4.9 or above.
Additionally, an insurance broker can provide personalized guidance based on your situation.
Expat health insurance
Expat health insurance is a private insurance policy for foreigners living in or moving to Spain.
Why you would need expat health insurance
Temporary solution before qualifying for public healthcare
If you’re new to Spain, expat health insurance can be a great option before you become a long-term resident and qualify for the public healthcare system (SNS).
It’s a temporary solution to ensure medical coverage during the waiting period.
Visa requirements for non-EU/EFTA nationals & students
If you’re a non-EU/EFTA national, you may need health insurance for your visa application. Most visa processes require proof of health insurance, and expat health insurance can fulfill this requirement.
English-speaking services
Feather designed its expat health insurance for expats seeking English-speaking services.
Ineligibility for public healthcare
If you’re not working or have yet to reach retirement age, you might not qualify for public healthcare in Spain.
How much does expat health insurance cost?
The insurance cost for expats in Spain is generally lower than in other EU countries.
For foreign residents and students, you’ll usually pay less than €100 per month, with students paying less than €60 per month.
If you opt for a family package, you also get lower premiums
Keep in mind that these factors influence your premiums:
- Insurance company and offered benefits: Different providers offer varying plans and benefits.
- Age of policyholder: Older policyholders may face higher premiums.
If you’re applying for a visa, note that opting for the cheapest policy can risk your visa being canceled if the minimum benefits are not covered.
What does expat health insurance cover?
The coverage for expat health insurance can vary drastically between providers.
At Feather, our policy meets all the requirements for health insurance and complies with the Schengen visa regulations– Regulation (EC) No. 810/2009 and Article 7(1c) of Directive 2004/38/EC (EC Free Movement Directive).
Specifically, the coverage includes:
- Full coverage: emergencies, consultations, diagnostic tests, surgeries and hospitalizations.
- No maximum cover limit.
- No copayment or deductible: expenses are covered without any out-of-pocket costs.
- No waiting period: Coverage starts immediately without any waiting time.
Even if the insurance functions as a reimbursement policy, it does not impact the maximum coverage limit. This comprehensive plan fully protects expats under Spanish and EU regulations.
Conclusion
This is it – our definitive guide to health insurance in Spain.
Let’s turn it over to you.
What did you think about this guide? What health insurance are you opting for?
Or do you still have some questions?
Let us know by leaving a comment below or booking a call with one of our agents. We’d be happy to help!
Please note that this is a general overview and does not replace expert advice taking your own individual circumstances into account. If you would like to book and appointment with our expert we are happy to help.
