Understand how the healthcare system in Spain works…

Qualifying for Healthcare in Spain

Qualifying for healthcare through the social security system

Any person who is not affiliated with the Spanish social security system may choose to take out private health insurance or pay the full amount of any medical costs.

In April 2012, Spain introduced a healthcare reform law that affects who is entitled to free treatment under the social security system. Restrictions apply to both residents and non-residents.

The following residents are entitled to free healthcare under the Spanish system:

  • State pensioners resident in Spain, including state pensioners from a country that has a mutual agreement with Spain. This includes all countries in the European Economic Area (EEA)
  • Employees and self-employed workers registered with social security and paying Social Insurance
  • Residents in receipt of certain social security benefits in Spain, or in countries that have a mutual agreement with Spain
  • Those who had registered for social security payments, but whose entitlement has now expired
  • Those recently divorced or separated from a partner who is registered with social security and paying into the Social Insurance fund

Non-registered foreigners from the EU and countries that have reciprocal agreements with Spain are eligible for treatment, provided they meet one of the above conditions. The spouses and children of people in the above categories are also eligible for free medical treatment, even if the partners are divorced or separated. Their children will only be eligible if they are under the age of 26.

Residents who do not belong to the above categories remain eligible for free healthcare services in Spain as long as their pre-tax income from all sources does not exceed €100,000 per year. There are exceptions, including early retirees whose social security contributions to an EU country have met certain levels defined by regional authorities. For more details, residents unsure of their status should contact their embassy.

The following non-residents are also eligible for free healthcare:

  • Students under the age of 26 studying abroad in Spain
  • EEA citizens temporarily visiting Spain with a European Health Insurance Card (EHIC). This entitles the bearer to free emergency medical treatment for three months. The hospital or clinic treating the visitor will decide whether the treatment qualifies as an emergency

Emergency care remains free regardless of an individual’s status, as does pregnancy care. This includes prenatal and postnatal care, as well as giving birth.

Applications should be made at a local social security office (INSS) and the following documents must be presented:

  • Valid passport or national identity card
  • Residency certificate
  • Padron certificate
  • A signed declaration stating that the applicant is not covered by health care by any other means
  • Copies of all of the above documents

Claiming healthcare through the social security system

Once registered with social security, a certificate entitling medical assistance is issued. This document can be used to apply for a health card (Tarjeta Sanitaria Individual – TSI) at the local health centre. Once registered at the local medical centre a SIP card will be allocated. A SIP card (Sistema de Informacion Poblacional) is issued to each person registered with the Spanish state health system and should be presented whenever attending a clinic, hospital or collecting prescribed medication from the chemist.

Social security pays a percentage of the cost of treatment and hospitalisation; the patient pays the remaining amount or takes out supplementary health insurance. Spain uses a co-payment system for prescriptions, meaning residents must pay a certain percentage towards prescription charges.For workers with an annual income of less than €18,000, prescribed medicines are covered up to 40 percent by social security and 10 percent for pensioners with a cap of €8 per month. Those with an annual income of €18,000-€100,000 are covered for 50 percent of the cost and pensioners 10 percent with a cap of €18 per month. Workers and pensioners with an income of over €100,000 must contribute 60 percent to the cost of prescribed medicines, with a cap of €60 per month for pensioners.

  • A guide to co-payments for UK pensioners and those of working age can be found on GOV.UK

Official prescriptions are green, when part of the cost must be paid by the patient; pensioners prescriptions are red.

Cards are individual – children and adults each have their own – and are valid for four years. The SIP card carries the following information: full name of card holder, social security number, NIE number (DNI for Spanish citizens), type of user (such as worker or pensioner) and the expiry date.

To get a SIP card, apply at the local health centre taking the social security certificate, passport and NIE/DNI certificate. The health centre issues a receipt, which has the same function as the card itself and can be used immediately; the SIP card is sent to the applicant and their beneficiaries by post. Beneficiaries are family members who are dependent on the worker or pensioner.

Qualifying for healthcare outside of the social security system

People who are not entitled to access free healthcare in Spain must take out comprehensive private medical insurance or join the Special Agreement (Convenio Especial). The Convenio Especial is a health insurance scheme run by the Spanish Government which allows people to access the state-run healthcare service by paying a monthly fee, not including prescription costs. Applicants need to be registered residents for one year before they can qualify for the scheme. The scheme costs 60 Euros for under 65s and 157 Euros for those aged over 65 and above. It is not yet available in all regions. More information about the Special Agreement can be obtained from a local social security office.

There are many international companies providing health insurance to foreign residents. International health insurances offer basic policies, as well as comprehensive policies, normally with a 24-hour help line in English.