Public healthcare and health insurance in Spain

Since 2018 the universal right to public healthcare has been restored for all residents in Spain, including foreigners in an irregular situation under conditions of actual residence and municipal registration, and in general emergencies, pregnancy and minors are always treated.

• Workers contributing to social security and their families have a direct right, as do pensioners and the unemployed entitled to benefits, and EU students with the European card.
• For residents without contribution or income the right can be obtained through a declaration of no coverage under income conditions, and the method differs by region.
• And the right to care includes children from birth.
• Ask your health centre or social services about your exact situation.

The steps: first register with the town hall (padrón), then obtain the social security affiliation number (número de afiliación) if you work or submit a request through the social security office (INSS/TGSS) to determine your eligibility.

• Then go to the health centre (centro de salud) belonging to your address with your passport, NIE, registration certificate and work contract or proof of eligibility, and ask to be registered and assigned a family doctor and card.
• The card may be given at once or sent by post, and bears your health number (CIP).
• In some regions it is requested through the region's website.
• Keep the card always and present it at every visit.
• And tell the centre when you move to another region, since you need a new card.

Public healthcare covers visits to the family doctor and paediatrician, tests, x-rays, specialists by referral, hospitals, surgery, childbirth, emergencies, vaccination programmes and mental health.

• Dental care for adults is limited (extraction and infection treatment) and most services need private payment, with wider coverage for children in programmes.
• Prescribed medicines are partly paid (copago) at a rate often between forty and sixty per cent for workers depending on income, and ten per cent for pensioners with a monthly cap, and free for some groups and severe chronic illness.
• Waiting lists may be long for specialists and non-urgent surgery.
• Interpretation and language services are available in many centres, so ask about them.

Many Spaniards and residents buy private health insurance (seguro médico privado) from companies such as Sanitas, Adeslas, Asisa, DKV and Mapfre to reduce waiting, choose the doctor and specialists, get private rooms and dental cover.

• Premiums vary by age and cover and may start from about fifty to one hundred euros a month for an adult.
• Read the exclusions, waiting periods (carencia), pre-existing conditions (preexistencias) and cover limits before buying.
• Some new migrants need private insurance as a condition of the residence permit (such as residence without work or the study visa).
• And some employers offer it as a benefit.
• Compare several offers and do not buy what you do not need.

For residents not contributing to social security and not meeting income conditions a special agreement (convenio especial) can be concluded with social security for a monthly premium of about sixty euros for those under sixty-five and more for those above, which gives care similar to public under a previous residence of at least a year.

• Applications are submitted to the social security office.
• In an emergency anyone is treated regardless of status, and is not asked about legal status before ambulance care.
• For those in a difficult situation non-governmental clinics and organisations such as Médicos del Mundo and the Red Cross provide free care.
• Do not avoid the doctor for fear of being reported, since health data is confidential.

What is a tarjeta sanitaria?