ANKE TIPS: What you should know about your health insurance in Spain

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Welcome to Spain! We would like to explain the Spanish healthcare system, which differs significantly from those in other countries, such as the UK or Germany.

Firstly, there is a major distinction between public and private healthcare, with a combination of both systems offering the best form of coverage:

Public healthcare is provided by social security: If you are employed under a Spanish work contract or self-employed, you are automatically covered by the social security system, regardless of your income. There are also other ways to qualify for public healthcare*. Through the social security system, you have access to primary care in so-called PACs, located near your place of residence. Here, a general practitioner is assigned to you. To see a specialist, you must first make an appointment with your GP, who will then refer you. Medication (wholly or partially), diagnostic tools, surgeries, and hospitalizations are included, but only in social security’s own hospitals.

Private healthcare consists of private doctors and hospitals, which you can either pay for directly or cover through private health insurance. Costs included depend on the terms of your policy (as private insurance offers various options). Private insurance doesn’t replace social security but rather complements it. You can choose your own specialist (without needing a GP referral) and select the hospital yourself.

So, which is better?

The social security system boasts excellent technical and personnel resources. For severe and complex illnesses, it’s undoubtedly the best option—and sometimes the only one, such as for many transplants, where Spain’s system is among the world’s best. However, it also involves months-long delays for specialist consultations, diagnostic exams, and scheduling of non-urgent surgeries. According to official government sources**, the average wait time for a specialist is 65 days, with an average of 135 days for surgery (October 2022 data). This means it can take over six months between visiting a specialist and undergoing surgery.

This is why private insurance is highly advantageous: it provides quick and convenient access to the doctor of your choice, allows you to seek multiple opinions, enables early diagnosis, facilitates access to follow-ups, and, in the case of surgery, allows for a hospital stay in a private room within days or weeks. The costs offer excellent value relative to the premiums paid and the services covered. Note, however, that not all private insurance policies are the same, so it’s wise to be aware of what your policy covers (and doesn’t cover).

In summary, we recommend combining both types of coverage for those choosing to live in Spain:

• Register with social security using one of the designated forms. Spain mandates that all individuals requiring emergency care are treated under social security. However, if you don’t have the corresponding insurance coverage and the government assesses you have the financial means, you’ll be billed for the costs.
• Invest in private insurance to give yourself faster and more convenient access to healthcare.

Any questions? Don’t hesitate to contact us.

*Besides employment, there are additional ways to qualify for social security healthcare in Spain:

If you’re already insured under social security in your home country, you can request recognition in Spain (using the S1 form, which you must obtain from your home country). Retirees typically qualify for this. If you’re not working in Spain but can demonstrate a one-year residency, you can enroll for a very low monthly fee (medications wouldn’t be included, as this is a special agreement).

**https://www.ibsalut.es/es/servicio-de-salud/transparencia/transparencia-en-datos-sanitarios/listas-de-espera/lista-de-espera-diaria-de-consultas-externas-y-quirurgicas