Expat Essentials

Irina Greensitt: My expat guide to everything you need to know about healthcare and health insurance in Spain

For those of us who are residents, or thinking of becoming a resident, of Spain there are two possibilities when it comes to healthcare provision and insurance – public healthcare and private healthcare. 

Public health care 

The World Health Organisation has Spain at No. 7 on its list of the best and most efficient healthcare services, consistently outranking the United Kingdom at No. 18 (and the less said about the USA’s ranking the better).

Gaining access to Spain’s public healthcare system can be achieved in one of a number of ways:

• By virtue of your employment or self-employment (autónomo) in Spain. 

Not only does the employed/self-employed person gain access to healthcare, their spouse and children also gain access the Spanish health system.  

• Voluntary payments into the convenio especial para asistencia sanitaria scheme.  

This isn’t available everywhere and it does depend on the region in which you live. And of course there are some conditions that you will need to meet. For example, you need to have been resident in Spain (and on the Padron – a register of people living in a particular area) for 12 months. The monthly cost of convenio especial is 60 euros for those aged under 65 and 157 euros for those 65 years and over. 

Convenio especial is a great alternative to private medical insurance (PMI) in instances where a person has pre-conditions, because generally speaking, insurers will not cover pre-conditions (new applicants).

Importantly, convenio especial does cover pre-conditions. One area where scheme falls down slightly is in relation to outpatients, because the cost of medicines are not subsidized. That means that if you are an outpatient you will have to bear the full costs of any drugs (medicines you buy from the chemist). Fortunately, the cost of medicines in Spain is relatively affordable, so this isn’t a major issue. 
(Useful link: Special agreements for the provision of health care | Andalusian Health Service.) 

* S1

Many of us were expecting S1 (for UK citizens) to disappear as a result of the UK’s exit from the European Union. Surprisingly – and it was a welcome surprise at that – it did survive, meaning that individuals in receipt of a UK state pension, other exportable benefits, and frontier/cross border workers could still gain access to Spain’s health system. 

Except … there is one huge fly in the ointment as far as S1 is concerned; to obtain S1 you need to be residing in Spain. But to be able to live in Spain (for those of us from outside of the EU) you need a visa ….

And yes, you’ve guessed it: To qualify for a visa, you need healthcare coverage!

So regardless of S1, those people looking to apply for the non-lucrative visa will need private medical insurance for the first year. 

Private Healthcare 

If you are unable to access the public healthcare system, then private healthcare is a surprisingly affordable option … so affordable 13.5 percent of Spanish residents opt to have private insurance even though they have access to the public system.  

Shortly after our arrival in Spain, my husband had reason to visit the doctor. It was a same-day appointment, as all visits generally were. It was immediately apparent he had a hernia (umbilical); he was seen by a consultant at the hospital the next day and within three days he’d been operated on.  

So, there are significant benefits to having private health care, even if you have access to public healthcare. Speed, convenience, the ability to pick and choose which doctors you use, and you can easily seek more than one opinion!  

Healthcare and Visas 

Since Brexit, the vast majority of UK passport holders wanting to move to Spain require a visa of one description or another. (The same applies to other third-country citizens.) One of the conditions laid out when applying for a visa is that the applicant is required to have health cover for duration of the visa, as previously mentioned.

The routes to obtaining public healthcare in Spain are somewhat limited, especially if you are not already living in Spain, and so private medical insurance is the only route for the vast majority of applicants.

However, it isn’t quite that simple because not all insurance policies qualify for residency purposes. For example, the insurance you take out should be on the same (or better) terms as public healthcare.

There can be no waiting times for treatment; no co-payments and – strictly speaking – the policy premiums must be paid in full for the whole year. 

Things to consider when purchasing insurance 

It’s important to understand that not all policies are equal, and cheap isn’t always the cheapest.

Many providers will increase premiums as you age, some as much as 6 percent per year on top of the annual inflation increase. In the short term, it’s okay because generally these are the providers that have a lower initial price. However, in the medium-to-long term, they often work out to be far more expensive. 

This next one might come as a shock to you: Some providers retain the ability to cancel a contract (or not renew it) in the event that you are diagnosed with a serious illness or you become too expensive for them.

It is so important that you take this into consideration because if that happens, you’ll be left looking for a new provider and – depending on circumstances – it may not be so easy to find one. Not all insurers are exactly truthful …. (“Now there’s a surprise,” I hear you saying.)

One of the conditions relating to visas is that there should be NO waiting periods. It is standard across the industry that new applicants have in their policy waiting times of anywhere between three months and 24 months. This usually relates to oncology, hospitalisation, oxygen therapy, laser treatment, physio and more – it’s a long list.

Some providers genuinely have no waiting times because they have had to change their policy due to residency requirements. On the other hand, others will issue residency applicants with a certificate stating that the policy is visa compliant and yet if you read the policy documents, low and behold waiting times are included! 

Cost of private healthcare

Private medical insurance in Spain is relatively affordable. Typically, if you are aged between 25-and-50 years old, you can expect to pay anywhere between 450 euros and 670 euros per annum for a standard policy that will qualify you for residency.

Between 50 and 60 years, it will be in the region of 800 euros to 900 euros; and 60-to-70 years anywhere between 1,000 euros and 1,400 euros.

It is possible to obtain insurance well into your 80s. 

My advice is to double-check, ask questions of your provider, or email Linden at info@gospain services for free advice (it’s his day job!). You can also visit www.gospain.co.uk for more information on insurance and other residency and visa-related things.

About the author:

Irina Greensitt is from the far eastern city of Khabarovsk in Russia, but lived in the United Kingdom for seven years before moving to Spain in 2014 with her husband and two young children.

Irina now runs an internet business and lists walking, travel and sailing (passing her skipper’s exam in 2016) amongst her hobbies. If you are in Granada and need direction, feel free to drop her a line. See her Facebook consulting page here.

See all of Irina’s posts here.

See more from Dispatches’ Spain archive here.

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