Private Vs Public Health Insurance In Spain [English Guide]

The public healthcare system in Spain provides coverage to more than 90% of the population. However, there is still a segment of the population that opts for private insurance. While the law does not require you to be insured, it is still in your best interest to go for it. To help you decide between the two, this article will provide all the details about public and private insurance along with the benefits and costs of each.

Health Insurance Options In Spain

If you are living in Spain, you have two options to get health insurance: public or private. Since Spain is a social welfare state, most of the population is covered under public health insurance, with very few opting for private options. The ideal one for you would depend on your residence status in the country and your circumstances.

As an expat, it is natural to be confused about the way the healthcare system works, if you even qualify for public insurance and whether you are better off opting for private insurance instead. Remember that in some cases, as an expat you might only qualify for private insurance!

Compulsory Vs. Voluntary Health Insurance In Spain

Health insurance in Spain is not required by the law. You can live in the country and access all the health services at a fee whenever needed. On average, you will be charged somewhere close to 200 euros for an emergency room visit and around 100 euros for a doctor’s visit. However, for it to remain an affordable and cost-effective option, you will need to make sure that you have insurance. It is also almost unheard of to be uninsured in Spain since the state is mandated by law to provide health cover for basic universal and preventative treatments. This also includes cover for any pre-existing medical conditions you might have.

Public Health Insurance In Spain

Spain’s universal public healthcare system is among the best in Europe and a big attraction for anyone looking to settle here for the long term. The system is known to be so efficient that almost 90% of Spaniards use public health insurance.

The healthcare system is known as the Sistema Nacional de Salud (SNS) and is funded by the social security fund. Everyone who is employed in Spain makes contributions towards this fund as taxes each month from their salary. And employers contribute a certain percentage to each of their employees’ schemes too. The system is decentralized, meaning that each of the 17 autonomous regions is responsible for maintaining these services and all related infrastructure at their own end. Basic healthcare coverage is free, but you might have to pay for some services. For instance, you will have to pay for an ambulance if it is called in a non-life threatening situation, and for certain other services that are not covered under the basic scheme.

How Much Does Public Health Insurance In Spain Cost?

Public health insurance covers primary care services like all emergency services, family and pediatric medicine, and nursing and midwives services. It will also partially cover prescription costs at the pharmacy, and any surgical prosthetics, orthopedic equipment and wheelchairs you might need. There is no cover for dental care and eyeglasses.

Healthcare for the most part is free in Spain, which means that you will not be required to pay for the services that you avail as long as you present your TSI or the healthcare card. This is a result of universal healthcare that is funded by the government and taxpayers’ money. Therefore, you could think of it as paying indirectly via the contributions you make to the social security fund out of your salary. At present, general employees pay 4.7% of their annual salary as a contribution to the social security system while employers pay 23.6% of their employee’s earnings. Self-employed workers will be paying somewhere between 18.75% and 26.5% of their earnings. 

The cost of healthcare varies across autonomous regions in Spain. On average, there are only a few categories for which you will need to pay a proportion out of your own pocket. For all others there are neither any copayments nor any claims you need to file afterwards.

Which Public Health Insurance Should You Choose In Spain?

There aren’t various public insurance providers in Spain as in some other countries. You will simply be eligible to receive public healthcare as long as you make contributions to the social security fund and fulfill all other requirements. You will find cover for various services like consultations with general practitioners and specialists, hospital and emergency care (including emergency dental treatments), physical therapy and even mental health services. There is also a co-payment scheme for prescription drugs.

If you do not qualify for public healthcare, you don’t have to worry since you can still access public services. The Spanish social security offers a pay-in scheme called the Convenio Especial where you can pay a monthly premium of 60 euros (157 euros for people older than 65) to access public health services. You can even choose your own contribution base. All you need to do for this is apply using the TA-0040 form and your certificate of empadronamiento at the social security office closest to your residence. It is designed to be a low cost public insurance option. However, at present you will not find it in all areas of Spain, but in some bigger provinces and cities like Madrid, Andalusia, the Canary and Balearic Islands among others.

How Do You Get Public Health Insurance In Spain?

In order to qualify for public health insurance in Spain as an expat, you must fulfill certain conditions. These include:

• You are a legal resident of Spain and either working as an employee at a company or are self-employed
• You live in Spain and receive state benefits
• You live in Spain and recently got divorced or separated from a spouse who was registered with social security
• You are living in Spain and are pregnant
• You are temporarily living in Spain and have a European Health Insurance Card
• You are an international student in Spain and under 26 years of age

The process for getting public insurance has a few simple steps. You will need to register with your local health center and receive your Spanish healthcare card called the Tarjeta de Identidad de Extranjeros (TSI). Getting the TSI can be done in the following way:

Register Your Address In Spain

Once you arrive in Spain, one of the first things you will need to do is register your address with the local town hall to get your registration certificate which is the empadronamiento. This is one of the most essential documents that you will need during your time in Spain and is also required for obtaining the health card.

Get Your Social Security Number

You can obtain your social security number from the company that employs you. Alternatively, if you are self-employed you will need to apply at the local social security office to get your number. This is an essential step in setting up your life in Spain.

Prepare The Required Documents

In order to apply for your health card you will need your residence card, your TIE (which is your foreigner ID card), your certificate of registration and a document issued by the social security office that proves your right to receive health care.

Find The Nearest Local Health Center

The location of your local health care center will vary depending on the region of Spain that you are living in. You will need to take along all of your documents when you go to apply for the healthcare card. You can locate the nearest office from the government’s website. Once the social security office has confirmed on their end that you qualify for public health insurance, they will send you your TSI card by post. Don’t get confused if the card is referred to by a different name: in some regions like Catalonia, the card is called the CAP (Centre d’Atencio Primaria) instead of the TSI card. 

Once you have the card, you can register with either your local health center or with an individual doctor. You are allowed to choose doctors from all over your local healthcare district. However, if you need to consult a specialist, you will need a referral from your GP.

Private Health Insurance In Spain

Despite the fact that you might qualify for public healthcare coverage, some people might want to opt for private health insurance. As long as you can afford it, it gives you access to private doctors and hospitals, which means shorter waiting times. This has become a more relevant concern in more recent years since wait times for elective procedures have gone up dramatically, ranging anywhere from 60 to 100 days.

For expats, this has an additional benefit in that you can also access English-speaking healthcare staff. While you might be able to find the same in public healthcare, it is not a guarantee. If you do not speak any Spanish and this is a major concern for you, getting private insurance will help a great deal. At present, nearly 19% of people in Spain opt for some level of private health insurance.

You can also tailor private healthcare plans depending on your needs. This means that at a higher cost, you can get a lot more services included than are available in the standard public healthcare package. Dental care particularly is a big example of this. Furthermore, when you first arrive as an expat in the country, you will need to have private health insurance in any case until you sign up for coverage under the social security fund. This is especially important until you are not working since you will need to demonstrate to the Spanish government that you will not be a huge liability in terms of government money that will need to be spent on you in case of an accident.

How Much Does Private Health Insurance In Spain Cost?

The average cost that you can expect to pay for private health insurance is around 100 to 200 euros per month. This can vary a great deal depending on the provider, the plan you opt for and your personal health circumstances. A basic health plan will cost 35 euros for one person and 130 euros for a family of four. A plan with more options will cost you 290 euros for your family. For most treatments you will also be expected to make payments upfront. The remainder of the cost will be covered by insurance. In some procedures, even after the co-payments you could be mailed some medical bills. Therefore, always check with your provider about the specific procedures before you commit to anything.

Older people will have to pay higher premiums since medical problems usually increase with age. Moreover, extensive coverage plans and longer time periods for the policy will also drive the premium up.

What Is The Insurance Cover Of Private Health Insurance In Spain?

Private health insurance policies can vary a great deal in the coverage that they offer. Depending on the company and the price you pay, coverage can range from basic to comprehensive. Since premiums vary for each, you can pick and choose the package that suits your health needs. For instance you can opt for comprehensive dental cover, quicker appointments with specialist doctors and even international cover if you are a frequent traveler.

Which Private Health Insurance Should You Choose In Spain?

When you are making a choice between providers, be sure to consider the packages and different coverage offered by each company and not just go for the cheapest option. This is because a plan might cost less at the get-go, but in an emergency it will end up costing more if that treatment is not covered under the original package. You will find low-cost plans with limited coverage to more extensive plans that are also a little heavier on the pocket.

There are several providers you can choose from. Cigna Global is a major player in the industry and offers a wide variety of plans. Their Essentialcare plan is the most basic one that you can opt for, while the Elitecare and Executivecare packages offer more comprehensive cover. For an additional cost, you can also include dental and vision related treatments. They also have multilingual service centers so you don’t have to worry about communicating your needs.

Allianz Care is another popular option. The company has digital and in-person support available round the clock to cater to your issues. They also offer wellbeing tools for physical and mental health, and a service to get a second medical opinion if you are unsure about your diagnosis. They have the Care, Care Plus and Care Pro plans for varying degrees of coverage. You can even get global health services, and a dental and outpatient plan at additional cost and the ability to choose your deductible amount.

The third most common private insurance provider is Sanitas. Their most popular product called the Mas Salud has three levels depending on your affordability and health needs: the Mas Salud No Excess, Plus and Optima. The three differ only in their co-payment charges and not the coverage levels. The plans cover dental care and worldwide emergency care on top of the basic cover. They also have online and telephone support services in English.

How Hard Is It To Get Spanish Public Or Private Health Insurance From Abroad?

If you have planned to move to Spain, you will need to have health insurance when applying for the visa. It might be slightly easier to buy private health insurance since you can contact the companies beforehand and choose your desired package. Then as long as you mutually agree on a method of payment, you should have no trouble getting insured. You can also alternatively get international insurance which is another accepted form when you first arrive in Spain.

Public health insurance however, is not possible to get if you are not living in Spain yet. This is because this applies only to people who are living and working in Spain, and hence paying their social security contributions. If you have already signed a contract with a Spanish company, you can look into the initial steps but will need to complete the process once you arrive in the country. And if you do not have a job before moving, then you will not be able to apply for public insurance beforehand.

Expat Health Insurance In Spain

Private healthcare options are very popular among expats. Part of the reason behind this is that a 2013 law in Spain made some of the health services inaccessible for expats. Moreover, even before you arrive in the country, you are required to have proof of health insurance. This is so that even if you are unable to find work, you will not be presenting as a big burden to the government to bear. Therefore, in any case, you will need to take out private insurance first.

Private Vs Public Health Insurance In Spain Comparison

	Private Health Insurance	Public Health Insurance
Cost	Based on your age and pre-existing health conditions	Free (technically you pay through the social security contributions you make)
Family coverage	No family coverage	You can insure your family through yourself
Treatment costs	Can opt for a reimbursement or co-payment policy	No co-payments or claims to be filed for most services
Deductible or no-claim cashback	Can be added depending on your contract	Not applicable
Geographical cover	Can be extended to international, depending on your plan	All over Spain
Treatment cover	Standard or comprehensive depending on the plan	Standard cover
Dental care	Comprehensive cover	Only emergency dental care
Selection of doctors	Any of your choice	From your local healthcare district, but not private specialists
Appointments with specialists	Possible on a short notice	Long waiting times, and will need a referral from your GP
Selection of hospitals	Any of your choice	From within your local healthcare district
Medication	Comprehensive cover	Co-payment up to 60% depending on your income
Glasses and contacts	Comprehensive cover	Only for certain cases, but not covered for the most part

Combination Of Public And Private Health Insurance In Spain

In recent years, those who can afford have made a shift to private health insurance, either partially or completely. This means that even if you cannot afford to opt for private health insurance completely, you can get partial insurance and combine it with your existing public coverage. For instance, most dental treatments are not covered under the public healthcare system. So instead of getting a complete private health insurance plan, you can only get private dental insurance. And that comes at a decent price too. You can get packages for dental insurance as low as 10 to 20 euros per month. This is a major advantage since dental care can otherwise get very expensive.

How To Change Health Insurance From Public To Private In Spain

Let’s say you shift to a job that pays better than your last one and you can now afford private health insurance. Or maybe you think that there are some services like dental care which you would like to be insured for as well (and which are not covered under public insurance). Shifting to private insurance is not a complicated process. You simply need to reach out to several insurance companies depending on your needs and requirements. Once you have the quotations from various companies, you can then compare their packages. You will then need to reach out to your chosen provider and fill in a questionnaire related to your health conditions and needs. Once the company evaluates your case, you can finalize the details with them and then sign a contract.

Keep in mind that technically you cannot cancel public health insurance. This is because the Spanish constitution guarantees the provision of these services to all citizens. Moreover, as long as you are employed and making contributions to the social security find, you will remain entitled to receive those services at public healthcare centers.

How To Change Health Insurance From Private To Public In Spain

If instead, you wish to make a shift to public insurance, it will involve more paperwork but is certainly not a very drawn out process. You might wish to do this if for instance, you have just come in from another country where you purchased private insurance to fulfill the visa requirement. And now that you have settled in Spain and are employed, you wish to transition to public health insurance. In order to do so, you will need to get your local healthcare card, or the TSI, from your local health center. The exact steps to do this have already been outlined in the beginning of this article. Apart from this, you will also need to cancel your contract with the private insurance provider. Most providers will require at least a month or two’s notice otherwise they automatically renew your contract. 

Independent Health Insurance Brokers For Expats In Spain

You will find plenty of insurance providers that cater to expats specifically. They offer services in the English language and a number of other benefits which will make it easier for you to access Spanish healthcare. The most prominent of these include:

• APRIL International
• ASSSA Insurance
• Sanitas Expat Insurance
• Aetna International

Conclusion

The healthcare system in Spain is one of the most advanced that you can hope to find, and provides coverage to an overwhelming majority of the country’s population. However, it is not without its own shortcomings. For various reasons, over recent years some people have been shifting to private health insurance. This article was designed to give you information to help you navigate the system and find the best option for yourself given your health needs. We hope you choose wisely!