Getting health insurance in Spain: A complete guide

Healthcare isn’t usually straightforward and when you add insurance into the mix, it gets even more complicated. When you’re headed to a new country, there are going to be new rules, new regulations and new forms to fill out before you can receive treatment.

If you’re headed to Spain, you’re in luck: they have one of the best public healthcare systems in the world. But just because they have a strong public health system doesn’t mean you can’t or shouldn’t get insurance. Whether you’re packing up to move or have already settled in, this article will help you understand how to access and use health insurance while living in Spain.

What kind of healthcare system does Spain have?

Spain is known for having one of the top healthcare systems in the world. The country has a universal healthcare system and also offers private insurance options for those who want to expand their coverage. The overwhelming majority of Spaniards and expats use the public Spanish National Health System (SNS, which stands for Sistema Nacional de Salud)

SNS doesn’t cover every health expense though. For example, ambulances, dentists and pharmacy costs are additional out-of-pocket expenses, where individual payments are used to supplement the full price of the services.

Private insurance can be an alternative to cover these added expenses, but it’s good to keep in mind that the insurance company will often limit the list of services that are available and also have a list of prefered care providers you can visit. Make sure to check with your insurance company about this before you visit a specialist.

People sometimes turn to private insurers because there’s some concern about the lengthy wait times to see public health providers. Still, by all accounts and comparisons, the public Spanish healthcare system is robust and high-quality. This are some average wait times for procedures in Spain:

Who needs to be covered by health insurance, by how much, and what’s actually covered?

Spain’s universal healthcare system, SNS, ensures that no citizen or long-term resident goes uninsured. Spain’s constitution actually requires that the state provides medical care for all basic and preventative care.

For European travelers, the European Health Insurance Card (EHIC) will enable you to access the necessary SNS healthcare in Spain at a reduced cost, or sometimes for free if you’re on a temporary stay. Once you plan on staying in Spain for a long-term basis, you should register for their SNS coverage or purchase private insurance.

If you’re a visitor, remember that all non-EU or UK travelers (US and Canada) should already have valid health insurance coverage prior to obtaining a residency visa.

How long can I be uncovered by health insurance?

Because Spain’s health insurance system is considered universal, there are no citizens or long-term residents without access to emergency health care. All foreigners and citizens have a right to be served for emergency or urgent treatment in Spanish hospitals, no matter your insurance coverage or whether or not you have a general practitioner.

EU residents can have free healthcare for the first three months under their EHIC. After that, you’ll need to look into either private insurance or registering for the public option. You can register into the public option by starting to contribute to the social security system.

Cautious travelers are always welcome to purchase travel insurance. Having travel insurance will protect you in the event of an emergency. These plans can be tailored to your needs, so if you’re just visiting for school or vacation, they may work out to be your cheapest and most risk-free option.

Are there any penalties for not being covered by medical insurance?

While there’s always access to healthcare for all Spanish citizens and residents, not having the right coverage can cause some delays in needed services. For example, some providers may not serve long-term stay foreigners who have yet to transition from their EHIC coverage to Spain’s universal SNS coverage. Additionally, there’s a distinction between private doctors and health centres versus public facilities. Only the public facilities will provide free care; the private providers will add extra fees if you don’t have the correct insurance.

Private or public health insurance, which should I choose?

Private insurance

Because of Spain’s widely recognised free and universal healthcare coverage, not many citizens or long-term residents use private insurance. However, the coverage can be helpful for those with special health needs, to aid in additional coverage with prescription drugs, for dental care, or for expats who don’t qualify for the public healthcare (for instance when you don’t work or haven’t reached the retirement age yet).