Private health insurance in Spain for expats

Medicare and most US health plans don’t pay for care in Spain. If you are applying for a non-lucrative visa you have to buy a Spanish private policy before the consulate appointment, and the policy has to meet specific conditions.

What a visa policy must include

Consulates check the insurance certificate closely. For the non-lucrative visa it should state that the policy:

• Is issued by an insurer authorised to operate in Spain.
• Has no copayments and no deductible.
• Has no waiting periods, so everything is covered from the first day.
• Gives full cover in Spain equivalent to the public system, including hospital care.
• Runs for at least the first year of the visa.

Insurers sell policies designed for this, and a broker can provide the certificate in the wording consulates expect. Most are paid for the year in advance. Ask what the refund terms are if the visa is refused.

The kinds of cover

• Spanish private insurance. The standard choice. It gives access to the insurer’s network of doctors, clinics and hospitals in Spain, and usually only emergency cover abroad.
• International insurance. Covers you in Spain and other countries, sometimes including the US at a much higher premium. Check with your consulate or lawyer that a particular policy is accepted for a visa.
• The public system. Free at the point of care for people who work and pay Spanish social security. Other residents can usually buy in after a year. See healthcare in Spain.

Many residents keep a private policy even when they have public cover, for faster access to specialists and tests.

What changes the price

• Your age. Premiums rise with age, and many insurers stop taking new customers somewhere between 65 and 75.
• Existing conditions. They can be excluded, surcharged or lead to a refusal. A policy with exclusions may not satisfy the consulate.
• Copayments. Policies with a small charge per visit are much cheaper, and are fine once you no longer need the policy for a visa.
• Extras such as dental cover, cover outside Spain and reimbursement for doctors outside the network.

As a rough guide, visa-compliant policies cost from about €50 to €200 a month per person, and more for people in their seventies.

When to arrange it

Get quotes before you commit to moving, especially if you are over 65 or have a health condition. Buy the policy four to eight weeks before your consulate appointment, with a start date that matches your planned arrival.

What to ask a broker

• Does the certificate state no copayments, no deductible and no waiting periods, in the wording my consulate accepts?
• How are my existing conditions treated, in writing?
• Up to what age can I renew, and how have premiums risen for people my age?
• Which hospitals and English-speaking doctors near where I’ll live are in the network?
• What is the refund if my visa is refused or delayed?
• Can I switch to a cheaper policy with copayments later?

Common questions

What health insurance do I need for a Spanish visa?

For the non-lucrative visa you need a private policy from an insurer authorised to operate in Spain, with no copayments, no deductible and no waiting periods, giving cover equivalent to the public system for the whole period of the visa. Travel insurance isn't accepted. The digital nomad visa also requires health cover, which can be private insurance or Spanish Social Security depending on how you apply.

Can I use Medicare in Spain?

No. Medicare generally doesn't pay for care outside the United States, so you need other cover while you live in Spain.

Can I get health insurance in Spain if I am over 70?

It gets harder. Many Spanish insurers stop accepting new customers somewhere between 65 and 75, and premiums rise with age. Some insurers and specialist expat policies do accept older applicants, so use a broker and get quotes before you commit to moving.