Healthcare in Spain For Expats: Health Insurance for British in Spain

The Spanish healthcare system is the one to be trusted. According to the Bloomberg Healthiest Country Index, Spain has the highest life expectancy among all of the European Union nations. Learn about various aspects of the Spanish healthcare system, including insurance, hospitals, dentists, childcare, and more with our guide.

In Spain, public opinion on healthcare institutions is positive overall, and expats won't find it hard to find sufficient, quality care. The healthcare industry is decentralised, which is why autonomous communities are responsible for providing services.

The majority of Spanish nationals and residents use the public healthcare system, with only a fraction of the people signing up for a private plan to combine the benefits of both systems. In total, practically everyone is insured.

The public healthcare system in Spain is free in local health centres or public hospitals if you are:

• a resident with an employment contract
• a freelancer or self-employed making social security contributions
• a resident with certain government benefits
• a resident whose ex-spouse is registered with social security
• a pregnant woman residing in Spain
• a child residing in Spain
• a student under the age of 26
• a resident receiving the state pension, or
• a holder of the EHIC (see below)

To start receiving public healthcare benefits, residents should simply register at their local health centre with their social security number. In some cases, they should also provide additional documentation, for example, to confirm they are receiving government benefits.

As an alternative to social security contributions, Spanish residents can pay out of pocket for medical procedures or go for private healthcare. Generally, there are not many reasons to switch to the private system.

These might only include full dental coverage and an opportunity to skip the queues. People who have chronic or ongoing conditions may benefit from reduced waiting time. Those EU citizens often travelling outside of the EU might also choose private plans for worldwide insurance coverage. Lastly, it may be cost-effective for family members to have a comprehensive package.

Spain has free universal health care.

The type of insurance depends on the living and working situation of the resident.

In some situations, they will need to set up the EHIC or TSI card.

However, if you would like to obtain a non-lucrative residence permit (for non-EU citizens) or register as a resident by proving adequate financial resources (for EU citizens), it will require you to provide a comprehensive insurance policy before approval.

The European Health Insurance Card (or EHIC) allows anyone from the EU, EEA, and Switzerland to access medical treatment on the same terms as a Spanish citizen. The distribution of the EHIC is carried out by the member states. However, the card is only available to those who are covered by a statutory social security scheme in their home country.

The EHIC can only be used for urgent care such as for serious injuries, broken bones and fractures, poisoning, etc. Other circumstances include conditions that require ongoing treatment by a health care provider, such as diabetes. Generally, the EHIC does not include any coverage for planned treatments.

When you are affiliated with the Spanish social security system, you can obtain the TSI health card (Tarjeta Sanitaria Individual) that accredits the right to receive public medical assistance. The validity of the TSE will coincide with the Foreigner Identification Card (TIE) or the Citizen Registration Certificate. To apply, you will need either of the two documents mentioned above, a registration voucher issued by a local town hall, a document confirming your right to healthcare and an ID.

The TSI entitles you to free healthcare in public hospitals and provides a 40-60% discount for prescription drugs. The senior discount can cover up to 90% of all medication costs.

If you require a service that public insurance does not offer, you can purchase a private healthcare plan. Having private insurance gives you more flexibility and options, in terms of hospitals and doctors, and you can choose from a range of different packages. However, less than 20% of Spanish residents choose this type of insurance, and they mostly do so for specialty or prescription coverage.

Sanitas is the oldest and by far the largest health insurance company in Spain. You can compare the packages for monthly services, which range from €23 to €102. Ultimately, the price will vary depending on:

• Age
• Type of coverage
• Co-payments
• Reimbursement policies

Before going to the hospital, or making an appointment to see a specialist, you are required to register with a designated doctor (médico de cabecera). The consultations and treatments you can choose depend on the type of insurance you have. So, when registering, you will have to specify. Before you can see a specialist to discuss any kind of treatment, you will first have to see a general practitioner, unless you have private insurance.

Whether you go to a state or public hospital, you must provide a government-issued health card or private insurance documentation and an ID.

See the ranking of the best hospitals in Spain compiled by the Jiménez Díaz Foundation or this interactive map for more specific information on specific types of treatment. Other information on hospitals and health data is available on the Health Ministry website.

There is a high demand for English-speaking doctors in Spain, and large cities and busy tourist destinations perfectly meet that need. If you want to make sure your specialist speaks English, you can check with the registration office before your visit. The private sector is much more likely to have English-speaking staff, but public hospitals are a good bet as well.

In case you need medication after being discharged from a Spanish hospital, you will have to ask for a medical examination in order to get a prescription. Hospitals don't provide prescriptions. That step is done through a pharmacy.

If a person needs emergency medical treatment, they can go to a hospital A&E or ER (Urgencias). If they cannot get to the emergency department on their own, they can call 112, the European emergency phone number. It is available everywhere in the EU free of charge and can be called from either a landline or mobile phone.

There are more than 34,000 registered dentists and more than 25,000 dental clinics in Spain. You can look up the Directory of Dentists via the Consejo Dentista de Colegios de Odontólogos y Estomatólogos (General Council of Colleges of Dentistry and Stomatology of Spain or General Dental Council). The website also offers oral hygiene advice and clinical information.

There are different types of dental insurance plans available at a reasonable rate. Some of them are stand-alone plans (ranging from €7 to15 on average), and others are included in comprehensive health insurance. They typically fully cover the costs of preventive care and diagnostics such as checkups, gentle cleaning, fluoride, and x-rays. Some of them include treatments such as fillings, root canals, or crowns. For example, fillings may cost around €60-80 without the discount.

When you arrive at the clinic, all you need to do is present your insurance card(s) and an ID to the receptionist, discuss the treatment with the dentist, and complete the form. If there are additional fees, you pay the clinic directly.

Emergency dental treatment is free, as is the treatment for children aged 6-15 (if they are registered with the public healthcare system).

Keep in mind that medication is not available for sale in supermarkets. But it's not hard to find a pharmacy in Spain since a large green neon cross hanging on the building will lead you to the nearest 'farmacia'. They work on weekdays and weekends without exception. Moreover, there are thousands of pharmacies that are open during evening hours, which are listed on all local pharmacy windows.

The Spanish government does not set strict rules in terms of what medications are available without a prescription. For example, many other countries have strict prescription-based policies for antibiotics; Spanish pharmacies are much more relaxed about over-the-counter sales. Not to mention, prices are affordable due to limited artificial constraints by the government.

Social security contributions should cover most of the services needed in regards to maternity care. This, of course, only applies to legal residents working in Spain with health insurance. Private or specialized facilities are only available with private insurance or when paying out of pocket.

Public hospitals and health centres facilitate maternal and fetal health assessment after the initial visit and registration. Regular visits are normally held every four weeks for the first 32 weeks if there are no complications. After that time, women have to visit a midwife once every two weeks.

The first tests include checking the urine for protein, sugar, or signs of infection and blood for diabetes, toxoplasmosis, and HIV. This is done to determine key things about a mother's health that can potentially have a serious effect on the baby's development. As the birth draws nearer, the mother will also be tested for streptococcus B. Ultrasound examinations are offered once every trimester.

Childbirth and breastfeeding classes start at 25 weeks, usually they are held in Spanish.

The process of labor and birth is considered fairly safe and straightforward. Everything is done according to the approved standards unless the mother has chosen an alternative route. Other, non-traditional birthing techniques and methods are accepted but not common. If that is the case, women can provide their birthing plan in Spanish to the hospital.

The details and costs vary according to the type of insurance but usually, costs begin at €2,000 and increase depending on the facility chosen. Upon arrival at the hospital for delivery, the European Health Insurance Card will usually be enough.

After delivery, residents must register the baby within eight days from the time of birth at the Local Civil Registry Office of the city/municipality where the birth occurred. In order for the baby to be eligible for citizenship, at least one parent must have Spanish nationality. This is the way the state regulates birth tourism.

Those born in Spain, to non-Spanish parents, must apply for a non-Spanish passport. In that case, parents should ask for a full birth certificate (certificación literal). They should also provide their insurance papers and marriage certificate to the Registry Office. All documents should be officially translated into Spanish.

Healthcare coverage is provided by either social security or insurance. The state healthcare programme for underage Spanish residents provides free care. The services under the programme include:

• Free immunization according to the approved schedules up to age 14
• Pediatric care up to age 15
• Dental services up to age 15
• Free emergency services including ambulances and first aid stations
• Services provided by 23 different specialties and types of physicians
• Extended coverage for all types of healthcare for physically or mentally challenged children
• Physical and dental health programmes

In some cases, families residing in Spain purchase private healthcare for all family members as a package offer so the children will also be included.

Spanish laws do not establish vaccination requirements for children. However, comprehensive immunization is considered a vital component of public health and is therefore highly recommended.

Provided children under the age of 14 have social security; they can get free vaccines for the following diseases:

• Hepatitis B vaccine, diphtheria, tetanus, acellular pertussis, IPV, Haemophilus influenzae type b, PCV, meningococcal B and C, MMR, varicella, and human papillomavirus.
• Chickenpox, pneumococcus, and influenza for children with certain risk factors.

The optimal vaccination calendar for child residents in Spain, as suggested by the current evidence, can be found on the Ministry of Health, Social Services, and Equality website.

The Spanish National Health System (Spanish: Sistema Nacional de Salud, SNS) covers EU and UK pensioners once they become permanent residents in Spain. The rules are similar to those who are currently employed – you need to register at a local community services center.

A person who can claim the UK state pension, illness or injury allowance or bereavement support, can also confirm eligibility for medical care on the same terms as Spanish nationals. This is done through the International Pension Centre, where you can get an S1 form and present it to your local social security office. You should also bring the Certificado de Empadronamiento (resident certificate) and Certificado de registro (registration certificate).

The rules for state nursing homes are also friendly towards EU citizens, who will simply need to go through a certain application process. However, state-run establishments have long waiting lists, which prioritize Spanish nationals. While you don't technically pay for state homes, still, there are fees in place.

As for private residential care, it is significantly more expensive and is not always consistent with average pensions. Mostly, only pensioners with sufficient income, long-term care insurance, or financial assistance from family members can afford the costs. They vary between €1700 and €5000 each month per person, depending on the type of care.

Hopefully, you won't need hospital services, but at least you will know that you will be in good hands in case anything happens (call 112). Knowing the ins and outs of the Spanish healthcare system is important for all residents and especially for those people who are considering relocating.

For additional information on how to relocate to Spain successfully, use these resources:

• Seguridad Social (Social Security)
• Ministry of Health, Social Services, and Equality
• Sanitas Health Insurance
• Virto Property