Spanish coast


Health insurance in Spain for foreign expats

Spain has a thriving expat community. Aside from its great weather, vibrant Mediterranean cuisine and laid-back way of life, Spain also offers expats access to one of the best healthcare systems in the world.

In Spain, all citizens and residents have guaranteed access to universal healthcare. This includes any expats and short-term residents who pay social security contributions. The National Health System, or Sistema Nacional de Salud (SNS), provides people with free public healthcare for many services. It’s thought that around 90% of the Spanish population uses the public health system¹. With so many people relying on it, the Spanish government allocates a healthy percentage of the country’s GDP (between 9% and 10%) to healthcare.2

So, whether you’re retiring to the Spanish coast or moving to start a new job in metropolitan Madrid, you’ll be well looked after if anything goes wrong. If you’re moving to Spain, or planning an extended visit, this overview of the Spanish healthcare system is designed to help you understand it a bit better and prepare for your move.  


The Spanish healthcare system is considered to be one of the very best in the world. It consistently appears high up on various surveys and world healthcare rankings, but one of the best indicators is the country’s life-expectancy statistics. Spain’s average life expectancy of around 83 years is one of the highest in the world and a testament to the quality of their healthcare services³.

But, while there’s no doubt that Spain’s public healthcare is of the highest quality, it’s not always perfect. One of the main issues is that there can be lengthy waiting times to see specialists or book a surgical procedure particularly elective or non-emergency procedures. Over recent years, an increasing number of people have chosen to take out private health insurance in Spain to supplement the public system. This can significantly reduce the amount of time and frustration involved in getting an appointment with the right specialist

Spain has universal healthcare, which guarantees all citizens and residents access to healthcare services. The healthcare system is called the Sistema Nacional de Salud (SNS) which simply means ‘National Health System’. 

It was set up in 1986, to replace a mandatory health insurance system that was connected to employment taxation. While performance and policies are overseen by the Spanish Ministry of Health, the administration, management and delivery of healthcare services are decentralised. This means that Spain’s hospitals and care facilities are run on a local level. There are 17 regional health ministries, so some elements of the care you receive could differ, depending on where you are.

The SNS is available to any Spanish citizen or resident that pays (or has paid) monthly social security contributions, as well as their partners and dependant family members. This includes expats, freelancers and the self-employed. 

Under this system, all basic medical services are free. These include:

  • emergency hospital and doctor visits
  • doctor consultations
  • paediatric visits
  • midwife appointments and services
  • inpatient and outpatient care

There are some services that aren’t covered, such as certain dental treatments for adults. And there are other costs, like medications, which aren’t always fully covered but are heavily subsidised, so only incur a small fee.

When you legally live and work in Spain, and pay social security contributions, you’re eligible to use the state-funded public Spanish healthcare system. But everyone’s situation is different, so there are different factors that can affect your eligibility and the registration process. 

It’s worth noting if you’re a retiree, or you cannot find work right away, you’ll need to have private healthcare cover when applying for a visa. This is to show the Spanish authorities that you’re covered in case of an accident.

As an employee

A Spanish employer should automatically register you for social security contributions. This will eventually give you access to the public healthcare system, but there are a couple of other bits of administration to complete.

You’ll need to register your residency at your local city or town hall and get your residency certificate (certificado de empadronamiento or padrón). It’s advisable to do this as soon as you arrive in the country as you’ll need it to register for other services and permits.

You’ll then need to obtain a medical insurance card (Tarjeta Sanitaria Individual- TSI). Depending on which region you’re in, you can either apply for this online or by visiting a local health centre (Centro de Asistencia Primaria, or CAP) with your passport, tax and social security numbers as well as various certificates you’ll receive as part of your residency registration.

If you’re self-employed

The process for self-employed expats is similar to that of an employee, but you’ll need to register for your social security number yourself. You can do this by visiting a Spanish Social Security office (Tesorería General de la Seguridad Social, or TGSS) with relevant documentation, including your passport and certificate of registration from the town hall.

Awaiting residency status

If you’ve registered at your local town hall, but you’ve not yet met your region’s requirements for permanent residency, the Spanish government offers a state insurance program (known as convenio especial). You can apply for this after a certain amount of time in the country, and it’ll give you access to public healthcare via a small monthly fee. The administration of this insurance scheme varies depending on the region.

If you’re retired

If you’re an EU or EEA retiree, you’re automatically eligible for cover under the SNS when you become a permanent resident in Spain. 

It’s a bit less straightforward if you’re not an EU citizen, however. If your country of origin doesn’t have a reciprocal agreement with Spain, you’ll need to take out private healthcare cover or voluntarily register with the aforementioned state insurance scheme (convenio especial). 

EU citizens 

If you’re a citizen of an EU or EEA country, your GHIC card will give you access to free public healthcare for the first three months of your stay. If you’ll be staying in Spain for longer, though, you’ll need to register for Spain’s public health insurance or take out a private policy to ensure you’re covered after the first three months.


In an emergency, the standard European emergency number is 112; this will be free of charge from any local landline or mobile. Other emergency numbers include 061 for an ambulance (ambulancia) and 1003 for an emergency doctor.

Pharmacies and medicine

You can take your prescription to any Spanish pharmacy (farmacia). Pharmacies are easily identified by the large green cross displayed outside and are usually open Monday to Friday, 9.30am–2pm and 5pm–9:30pm, while on Saturdays they operate from 9:30am–2pm. There are also 24-hour pharmacies in operation (farmacia de guardia).

When it comes to medication, Spain operates a co-payment system for some prescriptions. So, while some medications are covered, others aren’t and you may need to pay a percentage of the cost. The amount you’d pay very much depends on your situation. For example, if you’re of working age, you could pay between 40% and 60% of the cost of certain medications, depending on your income. Meanwhile, pensioners and people suffering from chronic conditions or serious illnesses might pay 10% for the same prescription.

Dental care

Children under the age of 15 receive free dental care in Spain. After that, routine dental care isn’t covered by the SNS (Sistema Nacional de Salud). You’ll either need to pay for each visit or take out a separate insurance policy that covers dental care and procedures.

Eye care and optician appointments

While some specialist eye care and emergency treatments may be covered under the public system, general eye care tends to be separate. Opticians and optometrists will usually offer a free initial eye test, but the expectation is that you’ll then purchase glasses or contact lenses from them. These aren’t covered by the SNS, and the costs can vary depending on what you choose. 

When you first move to Spain, it can take a number of months to register for the public healthcare system while you register at the town hall, apply for residency and set up your social security account. You’ll need to take this into account when you’re planning your move and take out a suitable insurance policy to cover you in the meantime. 

Private healthcare cover is also popular among expats as a top-up to the public healthcare system in Spain. This is partly to help avoid longer waiting times, and partly because there are some healthcare services that are not as easily accessible for expats. 

And if you’re a retiree, or you cannot find work right away, you’ll need to have private healthcare cover when applying for a visa. This is to show the Spanish authorities that you’re covered in case of an accident.

Annual Cover

Long-term cover

There’s a lot to consider when moving to Spain. But with our annual healthcare plan, you’ll have one less thing to worry about. We’ll help you settle into your new life with the peace of mind that comes from knowing you’ve always got somewhere to turn for help.

Virtual doctor service

Virtual Doctor Service from AXA. See a real doctor, virtually anywhere.

With the Virtual Doctor service, you can have a medical consultation with a real doctor wherever you are in the world – from the comfort of your home, hotel or office. Better still, there are doctors on call and available 24/7.4


Spain is an ideal place to visit or start a new life in the sunshine. To make sure you enjoy every minute of it, our comprehensive healthcare cover can help you get the most out of one of the world’s best healthcare systems.

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Virtual Doctor

Our Virtual Doctor service lets you speak to a real doctor from anywhere in the world in a number of languages. It can help point you in the right direction and complement Spain’s leading healthcare system.4

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Claims and settlement

We think settlement should be simple. Provided we have all the right information, over 80% of all eligible claims are paid within 48 hours.5

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Emergency cover

From overnight hospital stays to ambulance transport, our comprehensive plans offer emergency cover as standard. And, with optional extras like dental care and out-patient services, you can choose a package that suits you.

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Evacuation and repatriation

Whether you’re exploring the countryside or relaxing by the coast, you don’t want to have to worry about what might happen in an emergency. Our team can arrange for your evacuation and repatriation if things don’t quite go to plan.

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Mind Health service

To help support you and your mental health with your new life in Spain our Mind Health service is here to connect you to qualified psuchologists for support when you need it.6

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Second Medical Opinion service

If you feel unsure about a diagnosis or treatment plan, want a better understanding of local healthcare practices, need details explained to you in another language, or you’d like to make sure you’ve explored every option – our Second Medical Opinion service can help bring you peace of mind.7

Who we help

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Whether you’re starting a new role in bustling Madrid or on a temporary work assignment, we offer comprehensive cover, as well as optional benefits that you can tailor to your needs.

family on the beach

Spain is a popular destination for families from all over the world. It has great schools, friendly communities and a laid-back way of life, so the last thing you want is to let a health worry interfere with your experience. Discover our range of short and long term international health insurance plans, which will cover you and your family’s general health as well as emergencies.

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Depending on the level of cover our international health insurance plans include cover for prescriptions, annual health checks, palliative care and disability compensation.

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Calls may recorded and/or monitored for quality assurance, training and as a record of the conversation.

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The Virtual Care from AXA service is now available to all Individual and SME members (excluding those whose health plan is insured by AXA General Insurance Hong Kong Limited). 

All information in this article was correct at the time of publishing

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3 Spain Life Expectancy 1950-2023 | MacroTrends

4 The Virtual Doctor service is part of our Virtual Care from AXA service. Appointments are subject to availability. You do not need to pay or claim for a consultation but you will be charged for the cost of the initial phone call when using the call back service. You won’t be charged if you request a call back using the app or online portal. Telephone appointments are available 24/7/365 and call-backs are typically within 24 hours. Video appointments in English, Spanish and Mandarin are available between 08.00 and 00.00 UK time, Monday to Friday. Video appointments in German are available between 08:00 -20:00 CET, Monday to Friday

5 80.6% of eligible claims submitted online between July 2022 and June 2023 were paid within two days. 

6  Mind Health psychologist appointments are available in English and Spanish between Monday and Friday, 09.00 - 17.30 (UK time). If you are calling from the UAE, appointments are available between Saturday to Thursday, 09.00 – 20.00, and Friday 09.00 – 16.00 (UAE time). The service, provided in partnership with Teladoc Health, provides access to six sessions with a psychologist, per mind health concern, per policy year. The Mind Health service is part of our Virtual Care from AXA service.

7 Our Second Medical Opinion service is here for you anytime you’re unsure over a diagnosis or recommended course of treatment. It’s part of our Virtual Care offering, along with the Virtual Doctor and Mind Health services, so you might have already seen it on your plan or on the Virtual Care from AXA <app> or <portal>. Provided in partnership with Teladoc Health, the service unlocks access to a network of over 50,000 world-leading specialists and connects you to a doctor who will review your case alongside an expert. They’ll work with you to help you understand your diagnosis, make sure you know your options and support you throughout any treatment, wherever you are in the world.