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Your Healthcare - People who are resident

Updated: Feb 29

Who is this guide for? 

This guide gives an overview of options for healthcare for English speakers who are resident in Spain. That means people who have officially applied for and been granted residency and who have either a green residency certificate, the new biometric TIE or other valid residency document (depending on their nationality). This guide is primarily aimed at UK citizens who live in Spain but much of the information is equally applicable to people of other nationalities who live here. 

The following information will help you understand what you need to do to make sure you have access to the healthcare that best suits you and which meets other requirements. This overview document is supported by more detailed resources available on this website


Healthcare options for people living in Spain 

Public healthcare 

Spain’s state health service is run by the individual autonomous regions of Spain. Services are generally free at the point of delivery (exceptions where people are required to pay some or all of the costs include some prescription medicines, orthopaedic supplies, prostheses and dietary supplements) and the standard of care offered is excellent. Of course, as with state health provision in most countries, waiting times and access to specialist services can vary between different locations and with the overall level of demand. 

There is a basic level of dental treatment available through the state system but most people use a private dentist or have medical insurance that covers dental treatment. 

As a resident in Spain there are different ways in which you may qualify to access state health care.

These are: 

1. If you are working in Spain 

If you are employed or self-employed (Autonomo) you will be paying social security which entitles you to access State healthcare in Spain. 

You will need to register with your local health centre, giving your Spanish social security number. As someone who is employed or self-employed in Spain your dependants also have the right to access state healthcare provision on the same basis as you but they will need to register separately with the Institute of National Social Security INSS to get their own social security number and then also register at the local health centre. 

2. Through an S1 form 

If you receive a UK state pension (or another UK benefit which you are able to continue claiming in Spain) you may be able to access Spanish state healthcare by registering an S1 form. This means that the UK government will pay for your treatment by the Spanish health service. You can find out if you are eligible for an S1 form by visiting the Planning Your Healthcare Abroad page on the NHS website(HERE)

The Age in Spain detailed guide on the procedure for registering your S1 form with the Spanish social security system is available as part of this series of guides. (HERE) 

It should be noted that, while the majority of UK nationals living in Spain who have registered an S1 form will be in receipt of the UK state pension, the S1 is also used in some cases for frontier workers to ensure that they have access to appropriate healthcare while in Spain.

3. As permanent resident in Spain 

Once you have been legally and continuously resident in Spain for five years you can apply for permanent resident status. Along with other advantages this means that you will be able to access healthcare on the same basis as a Spanish national – i.e. you will still be able to access the state health system even if you are not paying into the social security system. When you become a permanent resident in Spain you will need to register at your local INSS office to be able to access healthcare on this basis. You will be asked to show a document which is called “de no exportación”, and which states the UK does not cover the costs of your public healthcare in Spain. You can request this document from the NHS Overseas Healthcare Service - Telephone: +44 (0)191 218 1999 . 

If the UK pays for your healthcare through an S1 form then you cannot register for healthcare as a permanent resident. 

4. The Convenio Especial 

The Convenio Especial allows people who have been resident and registered on their local padrón for at least one year to access the state Spanish healthcare system by paying a monthly fee. This can be an alternative to taking out private medical insurance for those who do not otherwise qualify to use the state healthcare system in Spain. You can find out more about registering for the Convenio Especial on the healthcare pages of your autonomous region’s website. 

You cannot pay into the Convenio Especial if the UK is paying for your healthcare, for example through an S1 form.

5. Private medical insurance 

While it is important to understand your options for accessing and using state healthcare services, many people choose to take out private health insurance as an alternative to using state healthcare or as a valuable supplement to it. The advantages may include convenience and speed of access to health services as well as being able to access services that are not covered by the state system. For UK citizens and many other nationalities living in Spain, another advantage of private health insurance is that you may be more able to specify that you need to see a doctor who understands and speaks English. Needing to see a doctor can be stressful enough at the best of times and negotiating the language barrier can make that much worse. Even if your Spanish is very good, medical terminology can be confusing and it is important to understand everything your doctor tells you. 

Age in Spain’s healthcare advisor can help you with your public and private healthcare options, instant quotes and comparisons to suit your requirements, including people over 70 and those with pre-existing conditions. Also, if you want an English speaking medical service or the option for international travel cover. 

Contact for free help in selecting the policy that is best for you and comparison with other insurances. 

NB. For those people applying for residency in Spain who are not already employed or self employed (and who do not qualify to register an S1 form) then a private healthcare policy is really the only way to demonstrate that you have access to appropriate healthcare. If you are taking out private health insurance as part of a residency application in Spain it is important to remember that it must not include “co-payments“ or a policy excess.


Comparison between public and private healthcare in Spain 

Public healthcare 

The pros: 

The cons:

Full medical cover in the whole of the country, even in remote areas 

You cannot choose your GP, specialist or hospital

No exclusions for pre-existing medical conditions

You may not have access to medical staff who speak English 

No age limit 

Longer waiting times (often months or years) for doctors , specialist visits and non-urgent or life-threatening surgeries 

Reduced Government budgets have meant a decrease in service levels

Private healthcare 

The pros:

The cons: 

You can choose your GP/specialist - You can access specialist visits directly without having to be referred by your GP - You can choose English speaking health professionals

Pre-existing medical conditions may not be covered

You can choose the hospital

There is usually an age limit for new members

Much shorter waiting times for doctor/ specialist visits or treatments

Not all insurance companies can offer services in all areas - important to check what services are available in your area

You can easily get a second or even a third opinion

Often includes international travel insurance for medical costs abroad 


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