Several health indexes indicate that Spain has one of the best healthcare systems in the world. Both public and private healthcare services are available in Spain. This means that hospitals and healthcare centers provide both private and public services. The use of the state healthcare system is very common among the Spanish. Around 90% of them benefit from the state healthcare system. The Spanish Ministry of Health manages this. The state healthcare system is the Spanish National Health System (SNS=Sistema Nacional de Salud), which is also called “Seguridad social”.
Below you can find all the details to benefit from the healthcare system in Spain.
Who is Eligible for Healthcare Services in Spain?
People who live and work or pay social security taxes in Spain can reach free access to state healthcare. Yet, it is important to note that the Spanish healthcare system is decentralized. So, if you are living on an island, you may need to travel to reach a state healthcare provider. You should also check the circumstances of how you can benefit from the healthcare services in your location.
Pensioners from the EU and UK are also eligible for state healthcare in Spain if they live there permanently. To benefit from this, they need to register with their local health center. They can also benefit from discounts on some of the medical costs such as some elective treatments and prescriptions.
If you are not from the EU or the UK, you need to maintain valid health insurance coverage before you get a residency visa. You can also benefit from private healthcare services in exchange for monthly payments. Also, Americans will find the monthly prices cheaper in Spain than in the US.
So, if you are an expat and if you want to benefit from the state healthcare system, you need to:
- Be a resident in Spain and you must work in employment or self-employment, and pay social security contributions as well
- Live in Spain and receive some particular state benefits
- Be a resident in Spain and be a recently-divorced or separated from a partner who is registered with social security
- Be a child resident in Spain
- Be a pregnant resident in Spain
- Be under 26 and studying in Spain
- Be a state pensioner
- Be staying temporarily in Spain and have an EHIC card.
Furthermore, if you are from certain countries such as Andorra, Brazil, Chile, Ecuador, and Peru, there is a chance that you can obtain free emergency service while in Spain for a short time. Spain has signed agreements with certain countries like the ones mentioned above. So, if you check with your Spanish embassy, you can learn if it also signed an agreement with Spain. If not, you need to obtain a private health cover.
Healthcare Costs in Spain
If you do not have medical insurance, you can still benefit from emergency services. However, you will need to pay for the treatment. The cost will depend on the treatment type. If you are not eligible for any type of state healthcare, then you can consider a special payment scheme. In this way, you can access the public healthcare system.The monthly fee will be around €60, and €157 for individuals over 65 years old. To apply for this scheme, you need to fill in a form named TA-0040. Then, you need to submit it to the social security office in your place of residence.
Other than this, most of the state healthcare is free in Spain. The social security contributions support the state healthcare system. If residents make regular payments of public health insurance, then they only pay a part of any prescription charges. In addition, they only need to pay for certain specialist medical procedures. In this case, they may need additional private insurance cover as well.
You can find other types of costs below:
|The average monthly medical premium for one person||€50|
|One-day hospital stay||€200|
|Primary Care visit||€100|
|12 months of prescriptions (max.)||A percentage of the full prescription cost, for each drug, depending on the individual’s social situation|
In addition to these costs, the prices for prescription also vary depending on individuals’ economic status. For example, for annual incomes up to €18.000, the contribution rate is 40% for individuals of working age. For the same income amount, state pensioners pay a rate of 10%, plus €8 each month as a contribution cap. For higher incomes, the contribution rates and contribution caps increase accordingly. Individuals of chronic or serious illnesses pay 10% of costs, in addition to a cap on each medication.
How to register for Spanish healthcare
Firstly, you need to obtain a social security number. To do this, you need to register with the Spanish social security, which is called “Dirección General de la Tesorería General de la Seguridad Social”, or “TGSS”. You can find its offices throughout the country. To be able to register with social security, you must bring:
- An ID card or passport
- Residency certificate
- Proof of registration of your address at your local town hall.
Following this process, you will obtain your Spanish social security number. Along with this, you will also receive a certificate that indicates that you are eligible for medical help. After this is complete, you can register for medical treatment and apply for a health card. The health card is called “Tarjeta Sanitaria Individual”, or “TSI” in short. You can obtain this card either through post or in person. You need to bring this card with you when you need a state healthcare service.
Private Healthcare System in Spain
Individuals choose private treatments as well, to not wait for long hours and days for treatment. They also consider this as an option to get a wider range of treatments. Mostly, expats choose private health insurance.
If you are not eligible for state healthcare in Spain, you need to obtain private health insurance. Otherwise, you need to pay the whole amount for each medical treatment.
Individuals from European countries can benefit from their EHIC (European Health Insurance Card) card though. With their EHIC card, they can access the state healthcare service either at a reduced cost or for free. This is valid for short-term stays. If you stay in Spain in less than three months, it will cover you. It is also important to be aware of which hospitals EHIC card covers. However, if you come to Spain just for a medical treatment, it will not cover you. It is better to check with your consulate to learn the requirements for this. If you are a non-EU citizen, it is possible that your private or public insurance will cover you in Spain.
Cost of Health Insurance in Spain
In Spain, the cost of private healthcare insurance is between €50 and €200 a month. If you want to choose private insurance to cover the services which are not covered by state healthcare, you can find affordable plans. These may include services of dental care and blood tests, but not surgeries and hospitalization.
Mostly, they will require you to make co-payments upfront for the services. Your insurance will cover the rest of the treatment. It is also important to check which types procedures your insurance plan covers.
Hospitals in Spain
You can have access to both private and public hospitals in Spain. Public hospitals offer free treatment. If you are not covered by state insurance, it is still at low costs. Some hospitals provide both private and public health services. It is also important to bring your social security card or proof of private insurance when you go to a hospital.
To visit a hospital, you must receive a referral from your doctor. This is valid for non-emergency situations.
Doctors and Specialists in Spain
Under the state healthcare system in Spain, a family doctor is assigned to you. They don’t charge you for consultation. To benefit from this, you need to make registration at your local clinic by bringing the necessary documents. After this is complete, they will assign you a family doctor, who is a GP (general practitioner).
If you need to see a specialist, you need to get a referral from your family doctor first. However, if you see a specialist without your GP’s referral, your insurance may not cover the costs. Also, a specialist may not treat you without a referral. It is worth noting that for some specialist services or analyses, the waiting times can be quite long. In this case, private health insurance offers faster service.
Dental Services in Spain
State healthcare does not cover dental services. Exceptions are available though. If you are under 15 years of age or if you need emergency treatment, then public healthcare covers those. Other than these circumstances, you need to find a private dentist. You can find dentists online. In general, the first dentist appointment and dental check-up are free. For further operations, they charge you.
Health Centers in Spain
Health centers in Spain provide primary healthcare. You can find health centers in every region of Spain. You can find various departments in these centers. These include GPs (general practitioners), nurses, physiotherapists, pediatricians, and gynecologists. Some centers offer you a booking option so that you can see a specific doctor. Specialist health centers are also available for specialist care. If you wish to search for a specific health center, you can visit the website of the Spanish Ministry of Health.
Mental Healthcare in Spain
If you need mental healthcare treatment, firstly, you will consult your GP or a health center. If you have a serious or ongoing illness, they will refer you to specialist treatment. Most of these treatments are provided at community mental health centers. Private treatments like psychotherapy are also available. However, your public health insurance will not cover this. In this case, private insurance will be a better option to not pay the full costs.
Women’s Healthcare in Spain
Women can easily access women’s healthcare facilities in Spain. They are more available in urban areas, though. Pregnant women can find gynecologists and midwives in both public and private institutions. Mostly, births take place in hospitals. On the other hand, home births are becoming popular in Spain as well. For birth control pills, women need a prescription.
Clinics are available across the country as well. They offer free STD tests and sexual health information, and advice. Some regional autonomous communities provide cancer screening programs. These offer testing for breast and cervical cancer.
You can give birth in Spain as a non-resident. The costs are not very high. Yet, if you want to get a visa, you need to have insurance. Your public or private insurance will cover the cost of having a baby. If you give birth as a permanent resident in Spain, you will benefit from several rights. For example, during your pregnancy, you and your child are covered medically, and then with prenatal exams, scans, and intervention during delivery and after childbirth. If you decide to give birth in a public healthcare institution, you will be assigned a state hospital. In this case, giving birth is free.
On the other hand, if you have private insurance, additional personal costs may come out. It will depend on your insurance plan. So, it is advisable to choose a plan covering childbirth.
Children’s Healthcare in Spain
Children have access to free healthcare coverage in Spain. It is free under the insurance of their parents or guardians. Free dental care and pediatric services are among them until the age of 15.
In Spain, you can find several specialist services for children. They provide services of mental healthcare by child psychologists and psychiatrists. Both public and private services are good. However, private health service can be a preferable option in areas where certain facilities may be lacking.
Vaccinations programs for children are also available in Spain. Vaccinations include against the diseases of:
- Hepatitis B
- Measles, mumps, and rubella (MMR), and
Emergency Services in Spain
You can dial 112 for emergency situations. It is free of charge. This includes ambulance, police, and fire department). They then direct you to the related unit depending on your circumstances. The cost of ambulance services varies depending on your condition. Public healthcare covers emergency services. If you are not eligible for public healthcare or if you have private healthcare, you may need to pay for the service, and then submit the invoice to your healthcare provider. However, they will charge you at an amount of between €20 and €120 for non-emergency situations. The cost will depend on the distance. If you are a chronically-ill person or you need regular transportation, you will pay around €10 a month for an ambulance.
Other important emergency numbers include:
- 061: For ambulance (“ambulancia”)
- 1003: For an emergency doctor
- 961 496 199: For emergency dentists
- 963 600 313: For on duty pharmacy
Pharmacies in Spain
Usually, between Monday and Friday, pharmacies are open from 9.30 am to 2 pm, and from 5 pm to 9.30 pm. On Saturdays they are open from 9.30 am to 2 pm. You can find the on-duty pharmacy list in their windows.
Waiting Times to See a Doctor in Spain
You should be ready for long wait times with public healthcare in Spain. You may need to wait about 57 days on average to see a specialist. For traumatologists, it can be as much as 68 days, and for ophthalmologists, 64 days.
The average wait time for surgeries is 93 days. The duration may vary in different areas of the country. In Madrid, La Rioja, and the Basque Country, the waiting time for surgery can be as short as 48 days. On the other hand, in the Canary Islands, Castilla-La Mancha, and Catalonia, it can be around 140 days.
Where to Use Private Health Insurance in Spain?
There are certain situations that you need to show proof of your private health insurance. These include when you:
- Apply for Golden Visa
- Apply for a residency card as a family member of an EU citizen
- Are reuniting a family member
- Are a non-EU citizen on a student visa
- Apply for a non-lucrative residency
- Apply for a tourist visa.
Contacts for Spanish Healthcare System
- Seguridad Social: Spanish Social Security Office
- Ministerio de Sanidad: Spanish Ministry of Health
- Farmacias de Guardia: Online directory of pharmacies in Spain
- Confederación Salud Mental España: Confederation of Mental Health in Spain