Health Insurance in Spain Guide >> How to pick a perfect policy

We’ve used two companies in the eight years we’ve lived here – and we’ve spoken to many other Expats before writing this guide. We’ll show you how to choose the right policy and the cost of private health insurance in Spain.

If you would like to skip straight to getting a cost of Health Insurance for you and your family, click here to get quotes from our two recommended health insurance companies in Spain.

Who needs Private Health Insurance in Spain?

There are five main reasons Expats choose private health insurance when moving to Spain.

1. Your Spanish Visa or Residence permit requires you to have additional private coverage.
2. You want more control over your choice of healthcare professional and care.
3. Your Spanish language skills need to be stronger for complex health conversations.
4. Less waiting time for appointments and elective procedures.
5. You don’t pay into the Spanish social security system, so you don’t qualify for public health services.

Types of Medical Insurance for Expats in Spain

There are two main options for private medical insurance. Most Expats in Spain will use the first option for their medical coverage.

1) Spanish Private Health Insurance

These policies are only valid in Spain and cannot be transferred to another country if you move. This is the best option for Expats in two groups.

1. Expats who plan to live in Spain for the long term.
2. Those who plan to return to their home country after living in Spain.

We plan to stay in Spain, so this is the option we use for our family. This article will focus on this type of cover as it is the choice of most Expats in Spain.

2) Expat Health Insurance (with regional or global cover)

If you plan on living in more than one country overseas, this type of policy may be a better solution. See our guide to learn more about Expat Health Insurance solutions to see if they’ll suit you better.

Spanish Private Health Insurance cost

Health insurance in Spain is cheaper than similar coverage in the USA. Prices are also generally lower than in many other Western European countries.

The price you pay will depend on several factors:

1. The type of cover you select.
2. Specialties included (hospital, dental treatment, maternity, etc.)
3. If you have a co-payment and the amount of the co-payment.
4. Your age at the start of your policy.
5. Any pre-existing conditions or health issues.

Also, be aware that quotes can vary massively between companies. For this reason, we suggest getting several quotes.

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Example costs for 2023 cover from our recommended insurers

The four factors above will impact the cost of your policy, so please use these figures as a guide.

• A private health insurance policy with comprehensive cover and no co-payment for a family of four could cost around €2,500 – €3,500 a year. This cover would meet the requirements for the Spain non-lucrative visa and Spanish Golden Visa.
• Individual annual cover can be as little as €300 with higher co-payments and fewer additional extras included. This health insurance cover would not meet visa or residency requirements.
• A student policy for an international student with comprehensive cover and no co-payments could cost from €600 a year. This would meet the requirements for a Spain Student Visa.

Our experience: When we moved our family’s cover to our current insurers, our premiums dropped by 25%. At the same time, we increased our range of available Spanish healthcare services.

The advantages of private medical insurance in Spain

While the public system in Spain provides excellent coverage, having the right private cover has six main benefits.

1. You have more control. You can choose who you visit and when you visit.
2. Your visits, information, and support can be in a language other than Spanish.
3. You can access tests, preventative medicine, and elective procedures that may be impossible in the public system.
4. Online portals for booking appointments, receiving test results, and maintaining health records are available (often in English and Spanish.)
5. You’ll need private health insurance for many Spanish Visas and residency permits.
6. The public system does not cover dental care, and uninsured dentistry and orthodontics can be expensive.

We have friends who only use the public health system and are comfortable with the care they receive. However, most Expats use at least some private medical services, and many only use the private medical system.

What is the best insurance company in Spain?

We recommend three major Spanish insurers to our clients. All have excellent reputations for high-quality care and offer monthly or annual premiums.

Our recommendations:

1. ASSSA is a well-respected company with a strong focus on Expat support. They offer a range of policies and add-ons that suit many people. Their support, service, and value are excellent. Many Expats in Spain swear by them as an insurer, and we recommend them without hesitation. You also have a premium for life with ASSSA, which means that costs don’t increase with age. ASSSA will waive waiting periods for all Where Can I Live clients.
2. Adeslas is backed by SegureCaixa. They have the largest medical network in Spain and write more than 30% of Spanish healthcare policies. They offer Where Can I Live clients an exclusive 30% discount on premiums.
3. Sanitas is part of the BUPA international network. They have an extensive network of healthcare professionals across Spain, and their support and online portal are excellent. Sanitas has also been proactive in offering services like video consultations for convenience.

One easy form: Enter your information here to get a quote from our three recommended insurers.

Our experience: We chose our first insurance company without knowing what to look for. The service was poor, and getting support in English was a real challenge – made worse by our beginner Spanish.

After a stressful visit to an ophthalmologist, we went back to the drawing board and did comprehensive research. We swapped over to a new provider and now pay less for more coverage and better service.

How to choose your Spanish medical insurance

There are a few steps we recommend before you pick your cover.

• Understand your specific requirements and ensure that the insurer can cover you. For example, only a few insurers, like ASSSA, write policies for people over 75.
• Ask for personal recommendations from local Expats, in person, or through Facebook groups.
• Check the company ratings on Google and other review sites. Look out for issues like premium hikes, denial of services, and cancellation of policy renewals – all major red flags.
• Get multiple quotes before you commit to a policy.

Note: Be open, complete, and honest in your application. For example, if your insurer finds out about a non-declared pre-existing condition, it can cancel your coverage.

Health Insurance in Spain for over 75s

Many insurers will not write new medical insurance policies for those over 75. However, two of our three recommended companies do and are the most popular choices for Expats over 75 who need cover.

If you are over 75, we suggest starting with quotes from ASSSA and ADESLAS – use this form to get yours here (with some unique Where Can I Live client bonuses and discounts.)

Health Insurance in Spain with Pre-Existing Conditions

Pre-existing conditions are any medical issues you know about before you sign up for a new policy. Your policy may be invalid if you know about a condition and don’t declare it. So, how can you get medical coverage if you do have a known issue?

Many medical insurance companies in Spain will offer cover. However, there are two main issues. The first is that they may exclude the issue you raise, and second, they may increase the cost of the policy.

Note: an excluded pre-existing condition may make the policy unsuitable for a visa or residency application.

Public Insurance in Spain

Spain has universal healthcare and a solid public healthcare system. But, only some are eligible for free public medical care.

Spanish public health insurance covers these people:

• Employees / Freelancers / Self-employed workers – All must pay a social security contribution for access.
• Spouse/children/dependents of social security members.
• Retirement age European Union/European Economic Area/Swiss nationals.
• EHIC Cardholders – European Health Insurance Card details.
• Spanish citizens that are not in one of these groups.

Public Health Services include:

• General Practitioners
• Emergency Care
• Primary Care, including pediatrics
• Nursing Services
• Physiotherapy
• Specialist Health Coverage
• Hospital and surgical procedures
• Medical Testing
• Prescription drug subsidies (You’ll pay a part of the cost, though drug prices in Spain are much lower than in the USA.)

Note: Dental care is NOT covered by public insurance. In Spain, you’ll need private health insurance, including dental or dental insurance.

Find out more about Healthcare in Spain in our detailed article.

Is a European Health Card (EHIC) valid in Spain?

Yes, Spain accepts the European Health Insurance Card. This program gives EU citizens short-term access to national Spanish public healthcare services.

If you are a UK citizen moving to Spain after Brexit, this may still be an option. The withdrawal agreement means that UK citizens can use an EHIC or GHIC card to obtain low-cost public healthcare in Spain.

You can only use these cards in the public health system (for example, at a local health center.) Private hospitals, clinics, or practices will not accept them.

Insurance for Spanish Immigration

The Spanish government requires qualifying medical insurance for many visa and residency permit applications. In general, there are five main requirements for the policy to qualify:

1. Be a valid private health insurance policy from an insurance company authorized by the Spanish government.
2. Offer full health insurance coverage in all of Spain.
3. Have no co-payments.
4. Free from waiting periods.
5. Cover at least the entire term of the visa.

Find out more in our guide to health insurance for Spanish residency or visas.

Do you need to buy Health cover?

If you don’t qualify for public medical insurance or have an immigration requirement, then the answer is yes.

For the rest of us, it is a personal choice. We registered with our local public health system and use it for some primary care, preventative care, and emergency services. However, we keep our private health coverage in Spain. Our family’s health is the most important thing, and choice matters to us when it comes to treatment. Having great value medical cover makes sense to us.

Please feel free to ask any questions you have in the comments below. We’ve experienced the system, so we’re happy to share our knowledge of private health insurance plans in Spain.

Health Insurance in Spain FAQ