Spain’s public healthcare system, the Seguridad Social, has a reputation as one of the best in Europe. Once you qualify, you do not pay for doctor visits or hospital treatment. Prescriptions are heavily subsidised, so the cost of medication is lower than in many other countries. To qualify for the public health system, you must be a legal resident. This means you need to work in Spain, register as self-employed, or receive a state pension that allows you to use the system. EU citizens often use the S1 form to transfer their state healthcare rights from their home country to Spain. Non-EU citizens, such as Americans or Canadians, often cannot access the public system directly (unless they are working in Spain) and must either join through a special scheme called the Convenio Especial or rely entirely on private health insurance. Foreign residents, who have lived legally in Spain for at least one year, can access Spain’s public healthcare system by paying a monthly fee directly to the regional health service: €60 per month if under 65 years old or €157 per month if over 65 years old. Dependents such as spouses or children usually qualify once the main applicant does.
Public healthcare is excellent in emergencies, but it often struggles with long waiting times for non-urgent treatments or specialist appointments. This is where private insurance becomes attractive for many. Private hospitals and clinics in Spain are modern, efficient, and usually have multilingual staff in regions with large expat communities like Costa Blanca, Murcia, Costa del Sol, Costa de la Luz, and parts of Almería. With private cover, you will often be able to see a specialist within days. You also have more choice of doctors and often a smoother overall experience.
The cost of private health insurance in Spain is much lower than in countries like the United States, Canada, UK, and even Australia. A healthy adult may pay between fifty and one hundred and twenty euros per month, depending on your age and the level of cover you require. Once you reach retirement age, premiums increase significantly, and pre-existing conditions may be excluded. Many visas (including the non-lucrative visa and the digital nomad visa), require you to show proof of comprehensive private health insurance with no co-payments.
Many expats living in Spain will use both systems. Public healthcare for emergencies, and private insurance for faster access, better comfort, more options, and peace of mind. When you decide between public or private healthcare in Spain, the best choice is rarely one or the other. The right choice depends on your stage of life, your financial situation, and your expectations of convenience.
