Healthcare in Spain for Expats: Public vs Private Options Explained

Spain’s healthcare system is among the best in Europe — and expats are fully eligible to access it under the right conditions. Whether you’re moving on a Digital Nomad Visa, Non-Lucrative Visa, or EU residency certificate, this guide explains how to register for public healthcare, when private cover is required, and what legal documents you’ll need.

Table of contents

• Public healthcare eligibility
• Private insurance for expats
• Registering for public healthcare
• Tarjeta Sanitaria and Social Security
• Healthcare for retirees and families
• Switching from private to public
• FAQs
• Related guides

Public healthcare eligibility

Spain’s Sistema Nacional de Salud (SNS) covers residents registered with Social Security. To qualify:

• You must be registered on the padrón (see Empadronamiento in Spain).
• You must contribute to Social Security (Seguridad Social) — either through employment, autónomo registration, or dependent status.
• EU citizens can access care immediately with a European Health Insurance Card (EHIC) while registering locally.
• Non-EU residents must show proof of comprehensive health insurance when applying for visas or residency cards.

Private insurance for expats

Private insurance is mandatory for:

• Non-EU visa applicants (Golden Visa, Non-Lucrative, and Digital Nomad permits).
• Anyone not yet contributing to Spanish Social Security.

Policies must:

• Be issued by a Spanish provider such as Adeslas, Sanitas, Mapfre, or Asisa.
• Offer zero co-payments and no exclusions.
• Cover full medical, hospital, and repatriation services.

Avoid travel insurance — Spanish consulates reject policies without full national coverage.

Registering for public healthcare

Once you’re resident in Spain:

1. Obtain your Social Security number (via TGSS office or online with Cl@ve).
2. Gather the required documents:
   • NIE or TIE card
   • Empadronamiento certificate
   • Work contract or autónomo certificate
   • Passport
3. Register at your local health centre (centro de salud).
4. Receive your Tarjeta Sanitaria Individual (TSI), which grants access to doctors and hospitals.

Tarjeta Sanitaria and Social Security

The TSI links your Social Security contributions to the regional health service. Each autonomous community (Andalusia, Catalonia, Madrid, Valencia, etc.) manages its own healthcare portal for appointments and digital medical records.

Keep your padrón current — expired certificates can delay renewals or access.

Healthcare for retirees and families

• EU retirees can use the S1 form from their home country to access Spain’s public system.
• Non-EU retirees under the Non-Lucrative Visa must initially maintain private cover, then transition to public healthcare after one year of contributions.
• Dependants (spouses, children) can be added under your Social Security registration.

Switching from private to public

• Once you contribute to Social Security, you can cancel private insurance.
• Keep both policies active for one overlap month to avoid coverage gaps.

FAQs

Do I need private insurance to apply for residency?
Yes. Until you’re officially registered with Social Security, comprehensive private cover is mandatory.

Can I use my EHIC for long-term stays?
No. EHIC only covers temporary visits; you must register locally once resident.

What if I move regions?
Re-register with the regional health service and update your padrón certificate.

Related guides

• Empadronamiento in Spain
• Spain Digital Nomad Visa Guide
• Spain Non-Lucrative Visa Guide
• Registering as Autónomo in Spain
• Buying Property in Spain

This guide is informational; for tailored advice, book a call.