Health Insurance in Spain for Expats: Public, Private & International Options
Expats moving to Spain have the option to purchase private health insurance or enroll in public health insurance. Not every expat will be eligible for Spain’s public health insurance system, making private health insurance the primary choice for many foreigners.
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Are you an expat moving to Spain? You will want to know the different health insurance requirements in Spain as well as the eligibility rules for public health insurance. This article will act as a guide to help expats understand their health insurance options in Spain.
We will explain why health insurance matters in Spain, share an overview of the healthcare system, compare health insurance, and more. Keep reading to learn more about your choices for health insurance in Spain.
Why Health Insurance Matters in Spain
Health insurance is mandatory for all residents in Spain. In 1986, a General Health Law was put in place that established the mandate for all residents in the country. This mandate applies to both temporary and permanent residents in Spain and extends to foreigners and expats.
Health insurance also matters as it fulfills visa requirements for Spain. Expats staying longer than 90 days in the country will need a long-term visa, which may require health insurance coverage that meets Spanish visa regulations.
Expats coming to Spain on a Digital Nomad Visa and retirees coming to Spain with a Non-Lucrative Residence Visa are required to have private health insurance. Private health insurance can help expats navigate and access Spain’s healthcare system.
Spain’s Healthcare System Overview
Spain has a top-quality healthcare system that comprises public and private sectors. The country has a decentralized healthcare system, meaning each region oversees the implementation of healthcare policy. This causes healthcare costs and facilities to differ slightly across the 17 regions.
Private Healthcare in Spain
The private healthcare system in Spain is excellent, with modern and updated hospitals and clinics spanning the country. Many of the providers in these facilities speak English, and private hospitals often cater to international patients.
Expats will find private hospitals throughout the country, though the density of clinics and hospitals may vary by region. Madrid has the most private hospitals in Spain.
Public Healthcare in Spain
Public healthcare in Spain is accessible through Spain’s national health system, Sistema Nacional de Salud (SNS). Residents enrolled with SNS can go to any public hospital or clinic and receive free or low-cost medical care. Public healthcare facilities in Spain are modern and clean.
Public healthcare in Spain offers quick access to emergency services but may have longer wait times for specialist care. Expats who do not qualify for SNS will have to pay for any medical care they receive at a public hospital or clinic out of pocket.
Another public healthcare option in Spain is Convenio Especial, a paid, voluntary scheme that is offered by the regional healthcare authorities within the SNS. It’s aimed at people who do not qualify for the SNS, but are still legal residents and have been in Spain for a year.
This option allows expats to buy into Spain’s public healthcare coverage for a monthly fee, but it has limitations. Some of these include limited prescription, dental, and vision coverage.
Who Qualifies for Public Healthcare in Spain
Expats can qualify for public healthcare in Spain if they are self-employed, employed by a Spanish employer, or permanent residents. By contributing to social security, expats in Spain are eligible for the public health insurance scheme, SNS.
SNS covers many medical services, with the following being some of the benefits:
- General practitioner and specialist visits
- Pregnancy and childbirth
- Emergency care
- Diagnostics
- Palliative care
- Medical transport
This public health insurance does not cover all medications, dental services, and eyeglasses. Expats looking for a more comprehensive option of coverage can purchase supplemental private health insurance.
Private Health Insurance for Spain
Expats purchasing private health insurance for Spain should ensure it has adequate coverage that complies with visa requirements. This includes the following:
- Comprehensive coverage for inpatient and outpatient services
- No deductibles or copays
- No waiting periods
- Remains valid for the entirety of the stay
- The insurance provider must be recognized by the Spanish authorities
Foreigners can purchase health insurance from local Spanish providers like Sanitas or Adeslas or international health insurance providers in Spain. Local health insurance can offer expats strong local access, but international health insurance can provide higher limits and worldwide networks.
International Health Insurance in Spain
International health insurance in Spain can offer expats coverage that fulfills visa requirements and protects them as they travel outside of Spain. International health insurance is popular with expats who plan to live in Spain but travel to other countries frequently for work or leisure purposes.
International health insurance can help cover the cost of healthcare services in Spain and grant expats access to private hospitals and clinics. International health insurance for Spain can cover a variety of healthcare services, such as:
- Inpatient and day-patient treatment
- Surgical costs
- Physician visits
- Mental health treatment
- Vaccinations
- Prescription drugs
- Medical evacuation and repatriation
- Repatriation of remains
- Dental and vision coverage
- Pre-existing conditions
- Maternity coverage
Popular international health insurance plans for Spain can be purchased from providers like Cigna, Allianz Care, and AXA. If you’re interested in learning more about recommended health insurance companies for Spain, read our article Top 10 Health Insurance Providers for Expats in Spain!
Comparing Public vs. Private vs. International Insurance in Spain
Public, private, and international health insurance all have their own strengths and weaknesses depending on cost, coverage area, and other factors. See our table below to compare these health insurance options side by side.
Public vs. Private vs. International Health Insurance in Spain |
|||
|---|---|---|---|
| Public | Private | International | |
| Eligibility Criteria | Must be contributing to Social Security or a Permanent Resident | Must be at least 18 years old | Must be at least 18 years old |
| Provider | Spanish government through the SNS | Private health insurance companies in Spain | Global health insurance companies |
| Cost | Funded through social security deduction of around 4 to 4.7% of gross salary | Monthly premiums range in price depending on the policy | Monthly premiums range in price; typically higher than local private companies |
| Choice of Doctor | Expats must choose public system doctors and hospitals | Expats can choose from a wider network of private doctors | Expats can choose from a global network of private doctors |
| Coverage Area | Only in Spain | Primarily in Spain | Coverage across many countries |
| Wait Times | Longer for non-urgent medical care and specialist visits | Typically shorter wait times | Typically shorter wait times |
| Language Spoken | Mostly Spanish | Often Spanish and sometimes English | Often multilingual |
Digital Nomad Visa Health Insurance Requirements
Spain’s Digital Nomad Visa requirements include proof of adequate health insurance coverage. This health insurance coverage must be comprehensive and provide coverage for inpatient and outpatient care and cover the risks covered by Spain’s public health insurance system.
This coverage must be valid for the entire duration of the applicant’s stay in Spain, and the insurance company must be licensed in Spain or recognized by Spanish authorities. Health benefits provided by travel insurance do not fulfill this requirement.
Interested in moving to Spain on a Digital Nomad Visa? Read our guide below to learn how to apply!
Choosing the Right Spain Health Insurance Plan for You
Choosing the right health insurance plan for your time in Spain requires considering your residency status, where you need coverage, and more. We will share a list of factors to consider to help you decide which health insurance option is the right fit for you.
Your Residency Status
Consider what your legal status will be in Spain, as this status will determine what health insurance options are available. Working residents will qualify for the public system through the SNS, and non-working residents will need private health insurance to meet visa requirements.
If you’re a non-working resident in Spain who plans to travel outside of the country frequently, you may be more interested in an international health insurance plan that can protect you with a global network.
Where You Need Coverage
Consider where you need coverage to determine the type of health insurance you need. If you are only staying within Spain, you could look into the SNS or local private Spanish health insurance. Are you traveling outside Spain? International health insurance can cover you worldwide.
Wait Times vs. Cost
Expats moving to Spain should ask themselves if they are willing to pay more for faster access to healthcare services. Different healthcare systems balance cost and access differently, such as the SNS offering affordability but longer wait times for specialists.
Private health insurance can help expats secure faster appointments. This greater access also comes with higher premiums, so consider how much you would like to spend on your health insurance.
Doctor and Hospital Choice
Consider how important doctor and hospital choice is to you in Spain. Do you want flexibility in choosing doctors and hospitals? With public health insurance, you will be assigned to only the doctors and hospitals within the public network.
Private health insurance can provide expats with access to private hospitals and clinics and larger provider networks. Some of the best hospitals in Spain are partnered with international health insurance providers, making direct billing and claims processing easy.
Language Support Needs
Consider if you need healthcare services available to you in your language. Are you an American expat in Spain who only speaks English? Or an EU citizen who is not fluent in Spanish? Providers in the private healthcare system are more likely to offer multilingual support.
Language accessibility can strongly affect your experience with healthcare in Spain and can cause frustration when navigating Spain’s public system, as services are primarily in Spanish.
Frequently Asked Questions:
How much does international health insurance cost in Spain?
The cost of an international health insurance policy depends on different factors, such as the coverage level, your health history, and other factors. In 2024, the average price for an individual international health insurance policy was USD $5,193 (around EUR €4,411).
How can expats get health insurance for Spain?
Expats can get health insurance for Spain by enrolling in public SNS health insurance or Convenio Especial or by purchasing private health insurance from a local or international company. If you’re employed in Spain, your employer will enroll you in public health insurance automatically.
Can expats enroll in Spain’s public health insurance?
Expats can enroll in Spain’s public health insurance if they are working and contributing to Spain’s social security or if they have lived in the country for five years and have received permanent residency. Working expats can be both self-employed and traditionally employed.
Conclusion:
Health insurance options in Spain include the SNS or private health insurance. Expats looking for private health insurance in Spain have the option to choose between local and international providers. International health insurance offers the unique benefit of being globally portable.
Are you ready to begin shopping for health insurance in Spain? Let the insurance experts at Pacific Prime help you find the right fit. As a global health insurance broker who specializes in expat health insurance, Pacific Prime can offer a wealth of professional expertise.
We offer free and unbiased advice to our clients. Contact Pacific Prime to discuss a range of Spain health insurance plans available for you, your loved ones, or your group. To get a no-obligation, free price comparison quote, visit our website today!
Interested in reading more guides for expats in Spain? Check out our articles below:
- The Cost of Living in Spain in 2026
- Finding Jobs in Spain for American Expats in 2026
- The Ultimate Guide to Retiring in Spain
- Health Insurance for British Expats in Spain: Post-Brexit Guide
- Health Insurance for Latin American Expats in Spain
Serena earned her Bachelor’s Degree in Psychology from the University of British Columbia, Canada. As such, she is an avid advocate of mental health and is fascinated by all things psychology (especially if it’s cognitive psychology!).
Her previous work experience includes teaching toddlers to read, writing for a travel/wellness online magazine, and then a business news blog. These combined experiences give her the skills and insights she needs to explain complex ideas in a succinct way. Being the daughter of an immigrant and a traveler herself, she is passionate about educating expats and digital nomads on travel and international health insurance.
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