Disclaimer: I am not a medical professional so the following guide is merely informative. I am not liable for any advice that you follow or any misinterpretations of this post’s content. The purpose of this guide is to share the knowledge I have gained as a resident of Spain who has used both the public and private healthcare systems in the last decade.
The Spanish National Healthcare System (Instituto Nacional de Salud, INS) has 451 public hospitals located all around Spain. Healthcare (asistencia sanitaria) is available to anyone who is paying into the Social Security system in Spain and also anyone who meets certain age requirements, regardless if they are working or not. It is ranked 14th in the world according to World Health Systems Facts. Tourists, unemployed persons and children also have the right to access public healthcare and are not required to be actively contributing to the system to receive treatment or care. Usually, these visits come with little to no additional costs in terms of prescriptions and additional treatments or purchases (such as bandaids, gauze, creams and ointments, eye drops, etc).
On a personal note, I recently came to the conclusion that people who have access to a good, working public healthcare system must have more general knowledge when it comes to their health and staying healthy. The goal of the public healthcare system in many European countries -as I was pleasantly reminded by a doctor at my last visit – is to get well and stay in good health for as long as you can. But there is also the added benefit of tracking a condition you suspect you might have or are already showing symptoms for and monitoring it throughout your lifetime.
And possibly the biggest realization in all my years of living in Spain is that (everywhere but the United States) your medical history is just your medical history.
In the private insurance arena, there may be a bit more focus on “pre-existing conditions” (see pregnancy below) but it is not practically a death sentence when it comes to insurance premiums in Spain or any other European country as it can be in my homeland. Pre-existing conditions simply stem from your medical history, something everyone in the world who can afford to see a doctor regularly has.
Anyway, I know how difficult and daunting doctor’s visits can be. I still have to study up a bit on my medical and technical Spanish when I go see the doctor to talk about a new concern or get an additional test. Hello, regular visits to the gynecologist that I used to never think were possible until moving to Spain!
When I was in the early stages of becoming fluent in the language, I studied more and tried to practice and memorize the vocabulary I needed to use with the doctor just so I would sound like a competent adult in my mid-twenties at the time.
Nowadays I am more than familiar with the vocabulary I use in various appointments such as my annual blood analysis and checkups of the female variety.
You will get there too but just know that there are doctors, medical professionals and dentists who speak very advanced English if you need that extra support. Remember not to limit yourself to only English-speaking professionals and try and practice your Spanish with more simple aches and pains. The more you practice, the more familiar and comfortable you’ll be during the time you live here, whether it’s for a short while or the long haul.
And rest assured, there are plenty of hospitals, health clinics and urgent care facilities in each major city in Spain so chances are you won’t have to walk far (yes, walk!) to get help or assistance. Also side note: it doesn’t cost $2,000 to ride in an ambulance here…say what?!
Let’s get cracking on this very complex topic: healthcare in Spain.
What are the differences between health clinics, hospitals and urgent care?
Health clinics (centros de salud)
Keep in mind that this question often pertains to the public system which is what I’ll be talking about in this section. Health clinics in Spain are equipped with nurse stations where you can get regular appointments with your general practitioner (GP; médico de cabecera), go in for blood and urine analysis (usually from 8-9 am), vaccines and receive other non-urgent health tests and checks.
A minor downside to the public healthcare system in Spain is that you cannot choose your own clinic or doctor.
A facility will be assigned to you based on your zip code (where you are registered as living) and you are only allowed to be registered with one per person in your household. Once you are assigned a doctor, you will make appointments at the reception area on the main floor and the staff member generates a ticket for you with the exact time and day you can see the doctor (usually something like 9:12 am to be exact). Make sure you arrive early because the doctor will come out a few minutes before your appointment time to call out a few names on the list, giving you the chance to visually see who you are ahead of and who is behind you.
Some general checkups can be performed here but the main idea is that you go here for non-threatening or urgent procedures. And depending on the line of people ahead of or behind you, the doctor may rush you a bit so that he/she can see other patients. This has been my experience as someone who has been using the system since her late twenties and onward.
Along with being assigned a health clinic, the staff will connect you with the public hospital closest to your residence. For some surgeries, you can opt for a hospital of your own choosing. Besides that requirement, you will see all of your specialists at this assigned medical center whenever you make an appointment and get referred to one.
If you need to see a specialist for a new type of evaluation or procedure, you must go back to your designated health clinic and get the referral from your GP first. You cannot make an appointment at the hospital directly unless it is a follow-up appointment (or surgery) with the current specialist you are seeing. In some emergencies or urgent cases, you can be attended to by hospital staff after you go in, inform them of your symptoms or condition and sit in the nearest waiting room for a little while.
At hospitals, doctors perform surgeries, specialized evaluations and procedures and pregnant women can give birth at them if they are choosing to do so at their assigned location. (If a woman ends up giving birth away from her assigned hospital, she will just have to go to her nearest one.) The major difference here is that none of these things happen at health clinics. They are also pretty humungous inside so make sure you ask someone or carefully follow the maps and/or signs until you reach the wing you need.
Otherwise, you won’t be able to hear your name once they call you!
Urgent care/ER/A&E clinics
The health clinics are only open from Monday-Friday (usually 8 am – 8/9pm) which means they do not offer weekend hours. If you need to be seen quickly by a doctor and it is not life-threatening, you will take a look at the back of your health insurance card and take note of your nearest Urgencias clinic that will be printed on the back. You can also search for the one closest to you at the time on Google or Apple Maps.
Urgent care centers look really similar to health clinics on the inside but are oftentimes much emptier, especially on weekends. One thing you will be extremely grateful for is that urgent care visits are covered by your monthly Social Security contributions by either you or your employer. No surprise $2,000 bills will come in the mail if you’re used to how things work in the United States.
In fact, you won’t receive a bill at the end of your visit either. It’s all covered! I hate that this is such a novelty for someone like me (a US passport holder) but it is a great feeling that you can walk out of any type of public health facility and know that your largest out-of-pocket cost that day might only be the subsidized prescription that you will be going to go fill.
What role do pharmacists play in Spanish healthcare?
Many years ago, I was given the advice to always go to the pharmacy first before I took time out of my day to go make an appointment to see a doctor.
You might be thinking: if healthcare is both free and universal in a modern European country like Spain, why wouldn’t you go to the doctor?
Well, there are some reasons not to. At least not yet anyway.
This is a good time to remind you that some prescriptions we’d get in the US can be administered over the counter. And some small annoyances or aches and pains can be treated by receiving a pharmacist’s recommendation. Some examples are: getting allergy medicine, granulated ibuprofen for cramps, cough syrup, cold sore medicine (still the tiniest tube of medicated cream I’ve ever seen!), medicated lotion for callouses, wart cream and buying a dentist-recommended mouthwash because I saw it in the window…
These are just to name a few.
What I have learned the hard way a couple of times is that you can’t get UTI medicine without a prescription. This means you will have to head over to your health clinic, request a urine analysis and if you test positive, get the doctor’s signature on the prescription (and have them load it onto your card) and voilà!
You can now go make another trip to the pharmacy and get that filled.
The good thing is most medications and prescription creams will only set you back 2-10€. Paying so little for necessary medicine never gets old for this American here…
But, as a general rule of thumb, if you’re young and healthy for the most part, small ailments like the ones I mentioned above aren’t worth the hassle of getting an appointment and then waiting in line to see a doctor (oftentimes not on the same day).
However, if you’re concerned enough or have any doubts about what is going on, ask the pharmacist whether or not you should go see a doctor about what you’re experiencing. Or go to your local health clinic and make an appointment to talk to a doctor face-to-face. You know your body best so listen to it and go with your instincts.
What are the different types of healthcare systems?
Spain, like most developed European countries, has two types of healthcare systems available: a public and a private system.
I will elaborate on each type of system and give you an inside look at how they both work. I had private insurance included with my stipend for being a language assistant for 3 years (2014-2017) but ever since I applied to and successfully modify my student visa to a work permit, I’ve been paying into (cotizando) the Spanish Social Security. Because the first few years of being in business are usually some of the toughest (read: leanest) and I knew I wasn’t going to be getting pregnant any time soon, I have opted not to buy additional private health insurance for most of it.
Let’s get started by breaking down how the public healthcare system works in Spain.
The public Spanish healthcare system
Spain has one of the best public healthcare systems in the world. As much as I don’t like seeing my monthly contribution come out of my bank account as a direct debit charge, I do love the fact that I can get medical assistance anywhere in the country. If you are a resident and you apply for an EHIC card, you can receive medical care in other European countries free of charge. Another realization I’ve had in the past few years is this: I don’t think medicine and life-saving treatments are supposed to cost that much. And thanks to everyone contributing to the system the Spanish government has set up, we all get access to care. I know it’s not perfect but I will take this type of working public healthcare over anything the US government has tried to set up (and convince people to use).
As a side note, Spain is the world’s number one in organ transplants. This is something I have indirect experience with over the last couple of years. A story for another day, but in the summer of 2021, my dad received a heart transplant in the Midwest that was completely covered by the United States government. The surgery would’ve cost a regular civilian citizen a cool $1.25M (figure accurate as of 2021) but thanks to his valuable service in the Air Force many years before, he has close to 100% coverage in terms of health insurance. I don’t even want to imagine what my family’s life could be like if he didn’t have that amount of coverage.
So on a more personal note, I am incredibly grateful to have chosen (and been able) to live somewhere where I can receive the same type of care – but not have to serve in the military in order to become a recipient of it.
Who can pay into the public system?
This is a very short section but this may be something you are wondering as you familiarize yourself with Spain’s healthcare systems. Who has access or the right to public healthcare?
Any man or woman who is working and paying into the Social Security system. However, children, pensioners, retirees and the unemployed also have the right to care because they have paid in for a period of time before or their parents have (in the case of children). Tourists or visitors (non-residents) can also receive medical treatments and see a doctor for free through the public system (but some people have told me that they had to pay) while in the private system, they may have to pay a small amount. I’m not talking thousands of euros but maybe around one hundred or so.
It’s not going to get you into an insane amount of medical debt, thank God.
If you do not meet the criteria to sign up for public healthcare but still want to use it, Spain’s Social Security entity offers a special pay-in option. This is called the Convenio Especial. What it does is it gives eligible applicants access to the public healthcare system for a monthly fee. Be sure to read the requirements first, download the TA-0040 form, fill it out and submit it at your nearest Social Security office.
The monthly rate for the Convenio Especial is around 60€/month but if you are over the age of 65, this rate increases to a little over 150€/month.
How does the public system work?
If you go scroll back up to my description of health clinics, you will kind of get the gist of how seeing a doctor through the public system works. In this section, I will go into a bit more detail about the ins and outs of the system.
A general rundown would go like this:
Each person who receives a public healthcare card (which only works in the region where you live) is assigned a health clinic. At your appointed health clinic, you are then assigned a general practitioner (GP) but in times of absence, you can see other doctors at the clinic. If you have any ailment that you deem appropriate for the practitioner to see you about such as requesting bloodwork, updating your prescription (they have expiration dates as to how long you can keep one on your card) and other smaller things, you can do all of that at your clinic.
If your appointment stops there, you will simply return to make an appointment with your GP again whenever you have something else you want them to evaluate or check on.
Download the Comunidad de Madrid’s app Cita Sanitaria Madrid either from the Spain App Store or Google Play to make an appointment more conveniently. The Android version of the app seems to be the preferred user choice based on over 1M downloads. If you live in a different part of Spain, simply search for your city’s Tarjeta Sanitaria Virtual or Cita app to be able to see all of your records and appointments from your phone.
Remember, in a universal healthcare setting, the doctor’s primary goal for you is to stay well. But their secondary objectives are also to track the progress or deterioration of any conditions you already have and monitor how you’re doing. If you are younger like me and between the ages of 18-35, you will likely be going to your health clinic for general aches and pains, infections, minor injuries and for refills on prescription meds (ie: birth control or other as-needed, over-the-counter medicines).
However, to see a specialist, you need to first get the OK (or referral) from your GP, who will then make an appointment with the specialist at your assigned hospital. From the first appointment and onward you will communicate and make appointments directly with the specialist to whom you’ve been assigned.
What about prescriptions?
Prescriptions are partially subsidized by the Spanish government which can reduce the cost of any medicine you need to get post-appointment, treatment or surgery. As an American who has seen skyrocketing prices for life-saving and generic medicines over most of my life, the price you pay in Spain is insanely low.
The most I’ve ever paid for one individual prescription medicine was at or just under 10€ so that is saying something.
Your prescriptions get loaded onto your healthcare card (which will vary by region in terms of design and color) and you will give it to your pharmacist to swipe into the system. They can also tell you if any regular prescriptions have expired or if you need to get an updated consent form from your doctor soon. Generally, long-term prescriptions (think birth control, heart or diabetes medication, acne pills, etc) have a year’s validity and need to be reevaluated annually by your doctor. This will usually entail a routine blood work analysis and your GP digitally signing off for the medicine. Pharmacists can see all of this just by scanning the QR code on your card or swiping it.
How do I apply for a Spanish public health card?
I will add a longer post to give you a step-by-step look at how to apply for a public health insurance card because it is a bit of a lengthy process to write out.
To preface, I only have experience with how things are done in the Comunidad de Madrid and what the process is like here. Just keep in mind that if you move to another region or register for a health card in a different part of Spain, you will deregister yourself from your current where you hold residence. If you are away from your home base but still in Spain and need to go to a health clinic, ask your local authorities or even pharmacist to become informed on how to do that.
(I say this because I don’t have direct experience with this and don’t want to steer you in the wrong direction.)
You need to show the staff at your nearest health clinic (the one that matches your zip/post code) the following items in order to apply for a public health insurance card:
- A completed application form (given at the time of applying)
- Current (non-expired) TIE
- Proof of registering or having been registered with the Social Security Office (ie: duly employed)
And that’s pretty much it! They will give you a confirmation page that proves you have applied for the card (a resguardo of sorts, see definition #3 according to the RAE) and you will have to show that each time you want to make an appointment to see your GP or get a prescription filled at the pharmacist. The card can take about 4-6 weeks to be ready before you need to return to the health clinic to pick it up in person (bring your ID!)
Personally, I remember it only taking somewhere between 3-4 weeks based on my own experience.
Possible downsides to only using public healthcare providers, clinics and hospitals
As with other public healthcare systems, none is perfect but Spain’s is ranked one of the top systems in the world.
Here are a few of the downsides to only using the public system (which is what I have done for the last few years):
- Long waits for general appointments, which could be anywhere from 10 days to 2 weeks for certain tests)
- Extremely long wait times to see specialists and to schedule surgeries, especially if you are not labeled as urgent/priority (but you can request this status)
- Fewer private room options (could be especially bothersome for certain surgery recoveries and labor and delivery
- Not as many ultrasounds are given to pregnant women
- Changes in doctors and lack of opportunity to build a relationship with the same doctor
- Midwives assist with all the checkups in pregnancy but the OB/GYN delivers the baby (see pregnancy section)
The private Spanish healthcare system
On the one hand, you may not need private health insurance if you work in Spain and are generally healthy. On the other hand, if you are trying to manage an illness or are planning to start a family and live in Spain for a longer period of time, it would be a good idea to get private health insurance. There are many different plans to choose from and the private system works well overall. It’s also good to know how both systems work in case you need to rely on one more than the other (or just want to avoid the long waits for surgeries and specialist appointments under the public system).
It’s a good rule of thumb to also have travel health insurance if you’re planning to spend a lot of time outside of Spain and outside of your passport country. Some health insurance plans offer this protection in addition to full coverage but you will want to know this type of information before you sign a contract and start paying.
What is private health insurance and what does it cover?
In private healthcare, insurance plans must cover all the services that the public Spanish healthcare system already covers (which excludes eye exams, glasses and dental care).
The major difference between the private and the public healthcare systems in Spain is the speed and sometimes the quality of services rendered. It honestly depends on the doctors and specialists you are assigned and how proactive you are as an individual when it comes to the public system. Depending on the area, your regional services may be overwhelmed or understaffed, which can play a huge role in how quickly your needs are taken care of. This is why the private healthcare system is relied upon as a backup for when the public system is overrun and you want to get your issue or questions resolved faster.
Private healthcare is essential when you are applying for or maintaining a stay on a visa and you don’t have direct access to the public system. Spaniards supplement their coverage by paying for private insurance and they spent a record amount on it in 2022, according to AP News. About a quarter of the population has private insurance mainly due to a wide variety of issues they are experiencing with funding getting cut for the public system in their region (primarily the Comunidad de Madrid, which spends the most on both public and private care).
Are prescriptions covered?
As it is under the public healthcare system, you will still have to pay for the prescriptions the doctor writes you. While you won’t automatically get a percentage of the price discounted, you can send in your doctor’s prescription and receipt to claim part of the cost. I have heard that this is a bit of a hassle to do and that the time you will spend waiting for the reimbursement isn’t worth it. I would advise you to proceed with caution and decide for yourself (and/or your family) if this is something you want to pursue. If you find you are going to the doctor regularly to get treatments or get a condition under control, then maybe it could be worth your while.
That’s totally your call!
How long does it take to get your card and when can you start using it?
As a language assistant, I received my health insurance card (from MAPFRE for all three years from 2014-2017) a few days into the start of my contract. It came in the mail to my then-current school’s address. I think when the Ministry of Education signed me up as the health insurance recipient on my policy each year, they put my school’s address at the time. The same will likely happen to you if you are participating in a language assistant program and receiving private health insurance coverage.
If you are moving to Spain on another visa or if you are an EU citizen who simply wants to add private insurance in addition to your right to access the public healthcare system, this might work a little differently for you. There are a lot of ways to buy policies and pay online or through a wire transfer (even using Wise*) making it even easier to get this step out of the way before your big move to Spain. Some health insurance companies do not even require you to list a mailing address on your initial application but they will come back and follow up with you on that once you are settled in about 4-6 weeks. You can also take the initiative and contact them if you find your permanent residence (even if it is, in fact, temporary). I highly recommend doing this as it demonstrates to them that you are proactive, which is just the kind of image you want to portray in your new home.
In the event that you arrive late for your school placement or your card simply takes longer than usual to arrive, it is likely you can use an approved form as ID from your health insurance provider. You would simply show this to the receptionist at the doctor’s office nearest to your apartment/home and they could see all of your important info like policy number, DOB, address and policy length.
And when can you start using it?
Most private health insurance policies don’t have a waiting period but double-check the terms and conditions of the one you’re signed up with.
*If you use my link and create a Wise account to make a transfer of at least 250€ or more, you will benefit from a fee-free transfer and I will receive a small reward for referring you. This comes at no extra cost to you and you will directly play a role in offsetting my website’s operating costs. Thanks for helping out!
Possible downsides to using only private healthcare providers, hospitals and clinics
Here are a few of the downsides to only using the private system:
- Long waits for general appointments
- Waiting longer than you would like at times to see specialists and to schedule surgeries (but you don’t have to get a referral to see one)
- You have to pay upfront for the year with some companies and it is an extra expense (in addition to your Social Security contributions -more so a downside for self-employed workers)
- Changes in doctors and lack of opportunity to build a relationship with the same doctor
- Cleanliness could vary between hospitals
- The need to travel to a large city if you only have private insurance and can’t access visit the centro de salud
Which type of coverage should you use if you are pregnant or about to become pregnant?
A fellow American living in Spain -but certainly not the only one!- wrote a couple of posts detailing her experience of being pregnant and giving birth in a Spanish hospital during the height of the COVID-19 pandemic.
From what I’ve learned over the past few years as a newlywed -and even in the last few months-, I recommend using both the public and private healthcare systems in Spain if you are pregnant. However, the most important detail I’ve learned about pregnancy thus far (at the beginning of it all) is that it is considered a pre-existing condition. With that being said, you must already have private health insurance before you get pregnant if you want to use the system at any stage in your pregnancy (and of course, for labor and delivery).
Some couples have chosen to give birth at their locally assigned public hospital while others make appointments at both public and private facilities but ultimately choose to birth with their private doctor. You get extra ultrasounds (or scans as they’re often referred to) with private healthcare in Spain, which is the main draw when it comes to the public vs. private debate.
The quality of service and technology might be better at a private hospital or clinic but I encourage you to make the best decision for yourself, your and the baby’s health as well as for your husband. There are limitations in regards to how long your partner can stay with you post-birth but apparently in private settings, they can stay 24 hours so you won’t have to handle your new responsibilities alone. This might particularly be helpful if you both are not from Spain and are unable to have family come help out.
What about dental care?
Dental care, while still an essential part of general health, is not covered by the public Spanish healthcare system. It is largely seen as aesthetic medicine and the clinics all oddly contain some variation of “dent” in them. Some of the names sound quite silly but there are a lot of dental clinics around Spain so hence the need to stand out from the competition.
The only two procedures I got covered with private health insurance were a teeth cleaning (a free annual cleaning is typically included with your plan but that can run you about 40-80€ without insurance) and a cavity filling -my first and last one so far at age 28, pretty lucky, eh?-, which I think I got a 30% discount (total cost: ~75€) on the cost but the details are fuzzy because that happened a few years ago. Otherwise, I have paid for cleanings but the good news is that X-rays come included in the price if you or the dentist requests one.
My most recent visit, as I mentioned earlier, was wisdom tooth extraction surgery. I am still recovering from it at the time of publishing this post simply because I had a lot of built-up jaw tension in the lead-up to the procedure and wow, all I can say is thank goodness for the invention of local anesthesia. And I’m extra grateful that it took a total of 4-5 hours for it to officially wear off and I avoided some of the intense pain that comes after these types of surgeries. I paid 290€ out of pocket for X-rays and panoramas, the extraction itself, the anesthesia, painkiller administration post-surgery and 2 follow-up visits to see how my scar was healing and then to remove my stitches. With all of the care and attention I received, I felt the price was more than fair.
Applying for a visa? Learn more about visa-approved health insurance plans from SegurCaixa Adeslas
SegurCaixa Adeslas is part of the Mutua Madrileña Group and it is owned by CaixaBank (formerly La Caixa and Bankia separately). Their Expat Health Insurance plans offer applicants full medical coverage in compliance with Spanish Consulates requirements for the following visa application types:
- Student visa
- Non-lucrative/retirement visa
- Digital nomad visa
- Investment (Golden) visa
- Green NIE card*
- TIE**/NIE* renewal
*For EU citizens
**For anyone who has a student visa and wants coverage during the summer between their university semesters or school (teaching) years
No Spanish address is required to purchase a health insurance plan but you will need to update this information with your Adeslas agent once you find a fixed place to live. This is so the company can send you the physical card as soon as you are settled in your chosen city in Spain. They also give policyholders access to a digital card through their app, which you can find either on the App Store or through Google Play.
This coverage has no co-payments (or deductibles) and no waiting period. This means you can start using the insurance as soon as you land in Spain and need it.
In addition to this, repatriation is included and Adeslas plans offer full coverage, including emergencies, consultations, diagnostic tests, surgeries (inpatient and outpatient), physical therapy, hospitalizations and more with a minimum coverage of €30,000.00.
You can change or make adjustments to your plan no later than 3 business days before the policy’s start date and it can only be canceled if your visa application itself has been rejected. In the event your visa does get rejected, you must send in proof of rejection (typically a letter from the Consulate) along with a written cancellation request.
Visit their website and receive a non-binding quote on a health insurance plan that’s right for you.
Full disclosure: Should you purchase a plan with SegurCaixa Adeslas, I will earn a commission at no additional cost to you. In return, you will receive a discount on the monthly rate with savings of upwards of 30€ per person (depending on age) and each plan comes with travel insurance (to be used outside of Spain and not in your home/passport country).
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