28 Jun, 2016 @ 09:00
1 min read

Sussing out the system: Spain’s healthcare service

leon column

leon columnREGISTERING for state health care in Spain one of the hardest but most important things to get your head around – especially as the services offered depend on which region you live in.

Having lived only in Andalucia this past 23 years, I can only speak for this region and can testify that in all my dealings I have been treated well by highly-skilled and articulate professionals.

OK, these past years has seen some cutbacks in services, longer waiting lists and staff shortages but overall this has not affected the general treatment of the patient.

You may even find some staff speaking your language and, in some cases, the employment of translators. It’s widely acknowledged that even the private sector uses public services where they lack the latest medical equipment.

Expats access the Seguridad Social (National Health Service) via a Tarjeta Sanitaria (Social Security Card). You can only get this from the Tesoreria de la Seguridad Social IF you are registered in El Padron and have an N.I.E. (green document) number (see my previous blog relating to these matters).

Normally, once you have received your card you need to register at your local clinic i.e nearest to where you live.

Other conditions may have an influence on whether you receive assistance from the Spanish Health Service, such as if you are:

  1. A worker in Spain making Social Security payments
  2. A pensioner
  3. On state benefits
  4. Were previously on Spanish jobseeker’s allowance and are no longer entitled to it, but are still registered as a jobseeker at the Oficina de Empleo(INEM)
  5. Registered as a stateless foreign national resident in Spain (Registro de Extranjeros) with a valid residency permit and not earning in excess of €100,000
  6. Related to someone affiliated to the S. Security partner or ex-partner, with a dependent under 26 years of age or a dependent who is at least 65% disabled .

Those from outside the EU, including Switzerland and Andorra, should check with their countries to see what social security agreements with Spain are in vigour.

With regard to pills and potions, Spain operates a co-payment system requiring the patient to pay a percentage of all medication prescribed by their doctor.

For more information on Spanish healthcare see the government website (which is obviously in Spanish) https://www.msssi.gob.es/profesionales/prestacionesSanitarias/CarteraDeServicios/

To conclude I would like to briefly mention the private health sector.

Most expats feel safer having an insurance policy covering their various needs but this does not guarantee a better or more professional service.

Before taking out private health cover, seriously look at your personal/family needs in depth and discuss the policy fine print with an independent advisor before signing. Check out competitors as well.

Remember there are many cases where the insurers have refused to pay out due to lack of transparency for cases that ‘seemed’ to be covered in the policy.

Stay well and don’t hesitate and drop me a line if you have any queries.

Leon Cohen (OP Columnist)

Leon Cohen has set up Facilitator Spain to help ease the pain for expats moving abroad. The former fashion/textile designer-cum-developer-cum-hotel owner offers Olive Press readers the best advice on relocating to sunny Spain.


  1. Your information on the Social Security Healthcare is very interesting. Could you advise me please? I am a UK citizen and a pensioner and as of yesterday I was issued with a small green card (the size of the average visitor’s card) by the Police in Marbella when I applied for Residencia. Does this card now entitle me to register with the Social Security or do I have to wait for a further document before doing so. I have an NIE and NIF number, my Padron certificate and the S1 forms from the UK.

  2. If you are resident in Spain, under 60 but not paying social security into the Spanish system you must have private health insurance. If you are a part timer in Spain (obviously non-resident) regardless of your age, you definitely need private health insurance. The EHIC card is only for dire emergencies and suitable for very short holidays, not longer stays.

    As far as I know, all residents who are over 60 are entitled to free state health care, based on the reciprocal agreement between Spain and their country of origin.

    I have to disagree about private health insurance in Spain, I think it is brilliant and not very expensive either. The policy we have covers everything and only costs us €50.00 per month each and yes, we have checked it out, including checking out the competition – we used to be with another company. We don’t use it much but when we have, it is very good and offers stuff we would never get on the UK NHS.

    For any Brits reading this, please note the Spanish state healthcare system is not the same as the UK system. Being resident alone, or having an NIE number alone, is not enough to get free healthcare if you are under the age of 60. The Spanish system is contribution based, the UK system is residency based. I have known so many people who have come seriously unstuck with this over the years.

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