Healthcare System in Spain: An Overview
Spain operates a high-quality healthcare system characterized by a dual-pillar structure: the public National Health System (Sistema Nacional de Salud or SNS) and a robust private sector. The SNS is decentralized, meaning that while the central government sets national standards and budgets, the actual delivery of care is managed by the 17 Autonomous Communities.
The Public Healthcare System (SNS)
The Spanish public healthcare system provides universal coverage to all residents who contribute to the Spanish Social Security system, as well as their dependents. It is primarily funded through tax contributions rather than direct insurance premiums.
Eligibility for Public Healthcare
Access to the SNS is generally granted to the following groups:
- Employed workers and self-employed individuals (autónomos) paying Spanish Social Security contributions.
- Foreign nationals residing in Spain with a "permanent residence" status.
- State pensioners (including those from EU/EEA countries or countries with bilateral agreements).
- Dependents of the individuals mentioned above (spouses and children).
- EU/EEA citizens staying temporarily who hold a valid European Health Insurance Card (EHIC).
The Convenio Especial
For foreign residents who are not working, not yet permanent residents, and do not have coverage from their home country, the Spanish government offers a "pay-in" public health scheme called the Convenio Especial. This provides access to the SNS for a fixed monthly fee, regardless of pre-existing conditions.
As of January 2026, the standard rates for the Convenio Especial are:
- Individuals under 65 years: Approximately 60 EUR ($63 USD, Jan 2026) per month.
- Individuals aged 65 and over: Approximately 157 EUR ($165 USD, Jan 2026) per month.
Note: Participation in this scheme usually requires having been registered on the municipal census (padrón) for at least 12 consecutive months.
Private Healthcare in Spain
Private healthcare is widely used by both locals and foreigners in Spain. It is often a mandatory requirement for certain visa types, such as the Non-Lucrative Visa (NLV) or the initial stages of the Digital Nomad Visa.
Why Residents Choose Private Insurance
- Visa Compliance: Many residency permits require private insurance with no co-payments (sin copagos) and no waiting periods (sin carencias).
- Speed of Access: Faster access to specialists and shorter waiting lists for non-emergency surgeries compared to the public system.
- Direct Access: The ability to see a specialist without a referral from a General Practitioner (GP).
- Language: A higher likelihood of finding English-speaking doctors in private hospitals in major cities and coastal areas.
Pharmaceutical Costs and Prescriptions
Spain utilizes a co-payment system for prescription medications. The amount a patient pays depends on their age, income level, and whether they have a chronic condition.
- Working Adults: Generally pay between 40% and 60% of the medication cost.
- Pensioners: Generally pay 10% of the cost, usually capped at a small monthly maximum (approximately 8 EUR to 18 EUR / $8.40 to $19 USD, Jan 2026).
- Private Patients: Those using private insurance without SNS coverage usually pay 100% of the medication cost at the pharmacy.
How to Register for Healthcare
For foreigners moving to Spain, the process of accessing the public system involves several administrative steps:
- Empadronamiento: Register at the local town hall to obtain a certificate of census (Padrón).
- Social Security Number: Apply for a Social Security number at the Tesorería General de la Seguridad Social (TGSS). Information can be found at the Official Social Security Portal.
- Health Insurance Card (TSI): Take the Social Security document and the Padrón certificate to the local primary health center (Centro de Salud). You will be assigned a GP and receive your Tarjeta Sanitaria Individual (TSI).
Emergency Services
In the event of a medical emergency, the national emergency number is 112. This service is free of charge and available 24/7. Public hospital emergency rooms (Urgencias) are required by law to treat anyone in a life-threatening situation, regardless of their insurance status or nationality.
Summary of Access by Resident Status
Working/Self-employed: Full access to SNS via Social Security contributions.
Non-working (EU): Access via EHIC (temporary) or S1 form (pensioners/long-term residents).
Non-working (Non-EU): Usually requires private insurance or the Convenio Especial (after 12 months of residency).
Undocumented: Coverage is generally limited to emergencies, pregnancy, and pediatric care, though regional laws vary.