Healthcare in Spain for Americans: public, private and who gets what

Spain has a well-regarded public health system and a large private sector, and many residents use both. For Americans the first question is which of them you are allowed to use, and that depends on how you are resident.

How the system is organised

The public system (Sistema Nacional de Salud) is funded by taxes and run by the regions, so the health service has a different name and health card in each one. You register with a local health centre, are assigned a family doctor, and are referred to specialists and hospitals from there. Care is free at the point of use, and prescriptions carry a copayment that depends on income and age.

The private sector runs alongside it: insurers with their own networks of clinics and hospitals, and doctors you can pay directly. Private care offers shorter waits for specialists and tests, and more doctors who speak English.

Who can use the public system

Your situation	Public healthcare
Employed in Spain, or self-employed and paying social security	Yes, with your dependants
Digital nomad visa holder registered with Spanish Social Security	Yes, once registered and contributing
Non-lucrative visa holder	Not at first. Private insurance is a visa requirement. The paid buy-in is usually open after a year.
Long-term resident with no other cover	Depends on the region and your circumstances. Ask locally.
Visitor	Emergency care is given, and you may be billed. Carry travel insurance.

Entitlement rules are applied by the social security office and the regional health service, and they are not identical everywhere. Confirm your own position once you are registered at the town hall.

The convenio especial

This is a scheme that lets residents who aren’t otherwise entitled pay a monthly fee to use the public system.

• You generally need to have been registered as living in Spain for at least a year.
• The fee has been about €60 a month for people under 65 and about €157 a month for people 65 and over.
• It covers the public system’s services but not subsidised prescriptions, so you pay full price for medicines.
• Existing conditions don’t exclude you.
• It is run by the regions, and the application process differs between them.

For retirees with health conditions that make private insurance expensive or unavailable, this is often the long-term answer. Check with a lawyer how switching to it affects your visa renewal, because non-lucrative renewals have required proof of cover.

Private insurance

You will need a private policy if you are applying for a non-lucrative visa, and many people keep one afterwards. The points that matter:

• Visa policies must have no copayments and no waiting periods, and must come from an insurer authorised in Spain.
• Age limits. Many insurers stop accepting new customers somewhere between 65 and 75. Once you hold a policy you can usually renew it.
• Existing conditions may be excluded or surcharged on ordinary policies.
• Spanish policies cover care in Spain. Cover in the US is limited to emergencies or absent.

See health insurance in Spain for how to choose one.

What care costs if you pay directly

Approximate private prices, without insurance:

	Typical cost
GP visit	€40 to €80
Specialist visit	€60 to €150
Dental check and cleaning	€40 to €80

Hospital stays and surgery cost much less than in the US but can still run to many thousands of euros. Dental care is mostly outside the public system for adults, so most people pay for it directly or through a dental plan.

Pharmacies and prescriptions

Pharmacies are marked with a green cross, and pharmacists give advice on minor problems. Many medicines cost far less than in the US. Bring a supply of your prescriptions and a letter from your doctor with the generic names, since brand names differ. Some drugs that are common in the US, including certain ADHD and pain medicines, are more tightly controlled or unavailable in Spain. Check before you move.

Emergencies

The emergency number is 112, and operators in many areas can take calls in English. Public hospital emergency departments treat everyone. If you have private insurance, your insurer’s hospitals also have emergency departments, often with shorter waits.

Medicare and keeping US cover

Medicare doesn’t pay for care in Spain. Many retirees keep Part B anyway, because dropping it and re-enrolling later brings a permanent premium penalty, and it covers them on visits to the US. Whether that is worth the cost depends on how likely you are to return.

What most Americans end up doing

• Retirees on a non-lucrative visa: private insurance from day one, then either staying private or moving to the convenio especial after a year, sometimes keeping a cheaper private policy alongside.
• Remote workers and employees paying Spanish social security: public care, often with an inexpensive private policy for faster specialist access.
• Everyone: paying directly for dental care.

See retiring in Spain and the cost of living in Spain for how this fits your budget.

Common questions

Does Spain have free healthcare?

Spain has a public health system funded by taxes and free at the point of care for people who are entitled to it, mainly those who work and pay Spanish social security, their dependants, and Spanish pensioners. It isn't automatically free for Americans who move on a non-lucrative visa.

Can Americans use public healthcare in Spain?

It depends on how you are resident. People who work in Spain and pay social security are covered. Non-lucrative visa holders need private insurance at first, and can usually pay to join the public system through the convenio especial after a year of residence. Anyone can get emergency treatment, though visitors may be billed.

Does Medicare cover me in Spain?

No. Medicare generally doesn't pay for care outside the United States. Some Medicare Advantage and Medigap plans include limited emergency cover abroad, which isn't a substitute for insurance when you live in Spain.

How much does private health insurance cost in Spain?

Much less than in the US. As a rough guide, policies run from about €50 to €200 a month per person depending on age and cover, and more for people in their seventies. Policies without copayments, which visas require, cost more than basic ones.