Healthcare in Spain – how the Spanish healthcare system works

Spain is consistently ranked among Europe’s best for healthcare quality and life expectancy. The Spanish healthcare system combines a robust public network (SNS) with a wide private sector. For residents and many categories of expats, care is comprehensive, affordable, and accessible – provided you understand how to register and which route applies to your situation.

This guide explains who qualifies for public healthcare, how to register and get your SIP health card, when private health insurance in Spain is useful or required, and what costs to expect.

Public healthcare in Spain (SNS): who qualifies and what it covers

Spain’s public healthcare system – the Sistema Nacional de Salud (SNS) — is managed nationally and delivered by regional health services. Funding comes primarily from social security contributions and taxation. Coverage includes general practitioners (GPs), specialist referrals, hospital care, emergency services, maternity, and preventative programs.

Who typically qualifies for public care:

• Employees registered with Spanish social security through their employer.

• Self-employed (autónomos) paying into social security.

• Legal residents who qualify under specific schemes (e.g., convenio especial) or EU rules.

• Dependents (spouse/children) of insured persons.

• EU/EEA citizens with an EHIC for temporary stays (not a long-term solution).

Prescription medicines are subsidized, with co-pay depending on income and status (pensioners pay reduced rates).

📌 Related overview: Living in Spain

How to access the system: registration, SIP card, and documents

Even if you are eligible, you must formally register to use the system in your region and obtain your SIP health card (tarjeta sanitaria individual). The SIP gives you a GP (family doctor) and access to referrals and hospital care.

Typical steps:

1. Register your address at the local town hall (empadronamiento).
2. Obtain your NIE (foreigner ID) and ensure your residency status is in order.
3. Enroll with social security (through employer or self-employment).
4. Book an appointment with your regional health center to apply for the SIP card. Bring passport, NIE, padrón certificate, social security number, and residency docs.
5. Choose your primary care center and family doctor.

If you will work in Spain, your employer typically registers you with social security. Self-employed individuals register via the RETAsystem.

Related: Working in Spain

Private health insurance in Spain: when and why you need it

While public care is solid, many expats choose private health insurance for shorter waiting times, access to English-speaking doctors, and wider provider choice. For some visa categories (e.g., non-lucrative visas, student visas, or during initial residency), private insurance is mandatory. Golden Visa investors often maintain a private plan even if they later qualify for public coverage.

When private insurance makes sense:

• You are new to Spain and not yet in the social security system.

• You need faster specialist access or elective procedures.

• You want bilingual care and a specific hospital network.

• Your visa/residency route requires full-coverage private insurance with no co-pays.

Typical monthly premiums (indicative):

• Basic plans: €40–€70 per adult (younger, healthy profiles).

• Comprehensive plans: €90–€150+ depending on age, co-pays, and coverage add-ons.

Related costs: Cost of living in Spain

Tip: Get a health insurance quote (compare a few providers for coverage, networks, and waiting periods).

What to expect for public and private care

Public system (SNS):

• Primary care and hospital services: covered when you’re registered.

• Prescriptions: co-pay based on income and status (pensioners have reduced rates).

• Dental care: limited in public system (private dental plans are common).

Private system:

• Insurance premiums: generally €40–€150 per month depending on profile and coverage.

• Co-pays: vary by plan (some “sin copago” plans have higher premiums).

• Direct-pay visits: €50–€100 for GP/specialist; diagnostics and procedures vary.

For families, a mix of public coverage (for core care) and private insurance (for speed and choice) often delivers the best value.

Families, retirees, and students: specific routes to coverage

Families:

Dependents are typically covered through the insured parent. Pediatric care through SNS is comprehensive. Private family plans can add faster access and broader pediatric networks.

Retirees:

• EU pensioners may access the public system through coordinated arrangements (e.g., S1 form prior to residency).

• Non-EU retirees often start with private insurance to meet residency requirements and may later explore public routes depending on status and contributions.

  Related: Retirement in Spain

Students and digital nomads:

Student visas require private health insurance with full coverage and no co-pays. Remote workers’ visas typically require evidence of comprehensive coverage.

Working professionals:

Once employed or registered as self-employed, you’ll be included in the social security system and access public care through your SIP card.

Related: Working in Spain and Education in Spain

Quality, waiting times, and how to choose clinics

Spain’s health outcomes are strong by international standards, with high life expectancy and solid hospital performance in major cities (Madrid, Barcelona, Valencia, Malaga). Waiting times vary by region and specialty; elective procedures may have longer queues in the public system.

How to choose providers:

• For public care, choose your local health center and designated GP (you can usually switch).

• For private care, review insurer networks (clinics, hospitals, labs), language availability, claim processes, and waiting periods for specific treatments.

• In larger expat hubs (Costa Blanca, Costa del Sol, Balearics), you’ll find extensive bilingual private networks.

Quick checklist:

• Confirm your residency/visa route and whether private insurance is required.

• Register for social security (employee/autónomo) if applicable.

• Get your padrón, NIE, and apply for the SIP card.

• Compare private plans for waiting times, networks, and language support.

FAQ – Healthcare in Spain

Is healthcare free in Spain for expats?

If you are a legal resident and contributing to social security (employee or self-employed), public healthcare is covered. New arrivals or non-working residents often need private insurance.

How do I get a SIP health card?

Register your address (padrón), have your NIE and social security number, then apply at your local health center with required documents.

Do I need private health insurance in Spain?

It depends on your visa and status. Many expats choose private insurance for faster access and English-speaking providers.

How much does health insurance cost in Spain?

Indicatively €40–€150 per month per adult, depending on age, coverage, and co-pays.

Can retirees access public healthcare?

EU retirees may gain access via coordinated arrangements (e.g., S1). Non-EU retirees typically need private insurance for residency and may keep it long-term.

How long are waiting times?

It varies by region and specialty. Private care generally offers shorter waits; public care provides comprehensive coverage but elective procedures can take longer.