Spain’s decentralised public system delivers comprehensive care through regional health services, complemented by a well‑developed private sector. This update sets out how residents, pensioners, students, and new visa holders can access public healthcare, how to register for a health card, and when private insurance is required.
Public and private healthcare in Spain
Spain’s public healthcare is administered by the country’s Autonomous Communities through regional services (for example, CatSalut in Catalonia, SERMAS in the Community of Madrid, and SAS in Andalusia). Residents who work or are self‑employed and contribute to Spanish social security are generally covered, and eligible dependents can be added as beneficiaries.
Many residents also hold private health insurance to reduce waiting times or expand provider choice, though uptake varies by region and year. Public and private providers coexist, and referral pathways differ, so it is important to confirm whether a clinic or hospital is part of the public network before an appointment.
Who can access public healthcare in Spain
As a general rule, state (public) healthcare in Spain is free of charge to any individual who is a resident, living and working in Spain. Eligibility is grounded in residence status and social security affiliation, with administration handled at the regional level. The main routes are:
- Residents working or self‑employed and paying social security
- Dependants and beneficiaries
- Pensioners with an S1
- Unemployed people receiving state benefits
- EU/EEA visitors can use a valid European Health Insurance Card (EHIC) for medically necessary state‑provided care during a temporary stay in Spain. UK visitors use the Global Health Insurance Card (GHIC)
- Long‑term residents who do not qualify through the above routes may be able to join the regional Convenio Especial, a pay‑in scheme offering access to the public system for a monthly fee.
How to register for public healthcare in Spain
Processes and document names can vary by region and by route to entitlement. In broad terms:
- Social Security Number
New workers and the self‑employed who do not yet have a Spanish Social Security Number apply through TGSS and will need:- a passport or national ID
- a Spanish foreigner number (NIE) or a residence permit
- a proof of address/padrón registration.
- a filled-out TA1 form
- Entitlement recognition (INSS) where applicable
Entitlement is automatic for most people in employment or registered as self‑employed. INSS recognition is generally needed for pensioners, registered dependants and people whose right derives from certain benefits. - Register with your regional health service
With identity documents, Social Security details and, where required, a padrón certificate and INSS confirmation, registration takes place at the local Centro de Salud to obtain a tarjeta sanitaria and a primary care doctor. - Notes for specific groups
- Workers/self‑employed: Ensure you are in alta (active) with social security via your employer or autónomo registration before seeking your health card.
- Students: EU/EEA students may rely on an EHIC for temporary stays. Non‑EU students usually need comprehensive private health insurance for their visa and residence.
Health insurance in Spain: when you need private cover
Private health insurance in Spain sits alongside the public system. It is often chosen by residents seeking faster access or broader provider choice and is required for many non‑EU residency routes:
- Most Spanish consulates require comprehensive private health insurance for non‑EU students and non‑lucrative visas.
- Spain’s digital nomad visa generally requires comprehensive private health insurance on similar terms to the non‑lucrative route.
- New arrivals waiting to begin employment, people between jobs, or residents not yet meeting public eligibility criteria often rely on private cover temporarily.
Regional differences to be aware of
Spain’s healthcare system is decentralised. Terminology, required documents and online procedures differ across regions, including how beneficiaries are registered, how quickly a health card is issued, and whether online GP selection is available.
Regional portals set out eligibility for the Convenio Especial, fees by age band, and any prerequisites such as time on the padrón. Always check the guidance of your regional health service and, where relevant, TGSS (Importass) and INSS for the latest process steps.
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