Health & Insurance
Healthcare in Spain for expats — public and private explained
Spain's healthcare system ranks among the world's best. Understanding how it works — who gets access to the public system, what private insurance covers, and how DNV holders fit in — is essential planning before you move.
Healthcare is one of the most important practical considerations for any expat moving to Spain, and one of the most frequently misunderstood. The questions we hear most often are: "Do DNV holders get access to Spanish public healthcare?" and "Is private health insurance actually any good in Spain?" This guide answers both, and covers everything else you need to understand before you arrive.
The short version: Spain's healthcare is excellent at both public and private levels. DNV holders are required to hold private health insurance as a visa condition, and most rely on private insurance during their initial period in Spain. Access to the public system comes later through Social Security contributions or the Convenio Especial. By the time most DNV holders transition to the public system, they often continue with private insurance as a supplement because of its practical advantages.
Spain's public healthcare system — the SNS
The Sistema Nacional de Salud (SNS) — Spain's National Health System — is a publicly funded, universal healthcare system that covers residents who are entitled to it. The SNS is funded through general taxation and Social Security contributions, and provides comprehensive coverage including GP services, specialist referrals, hospital treatment, emergency care, surgery, maternity care, and prescription medications under a co-payment scheme.
The SNS is decentralised — each of Spain's 17 autonomous communities manages its own regional health service. The Servicio Madrileño de Salud (SERMAS) covers Madrid; the Institut Català de la Salut (ICS) covers Catalonia; the Servei Valencià de Salut (SVS) covers Valencia; and so on. Standards are broadly consistent, though there are some regional variations in service availability and waiting times.
Spain has one of the highest life expectancies in the world — around 83–84 years on average — which reflects both the quality of healthcare and the lifestyle factors associated with the Mediterranean diet and culture.
Who is entitled to the public system?
Access to the SNS public healthcare system is available to the following groups:
Employed workers
Workers employed in Spain (or by employers who register them with Spanish Social Security) contribute to the Seguridad Social and gain access to the public health system as part of this contribution. For DNV holders who are employed by foreign companies, their employer typically registers them with Spanish Social Security from the start of their residency. Once registered and contributing, public system access is immediate.
Self-employed (autónomos)
Self-employed individuals registered as autónomos in Spain pay a monthly Social Security contribution (the cuota de autónomos — currently a minimum of around €230–290/month for new registrants under the real-income-based system introduced in 2023, rising with income). This contribution includes access to the public healthcare system.
Pensioners
Retirees receiving a pension from Spain or from a country with which Spain has a Social Security agreement gain access to the public system through their pension status. UK pensioners, for example, may be entitled to use the S1 form issued by the UK to access Spanish public healthcare coverage funded by the UK.
Convenio Especial
Individuals who are legally resident in Spain but do not fit the above categories — including some NLV holders and those not yet established in the Social Security system — can access the public system via the Convenio Especial (Special Agreement). This is a voluntary contribution of approximately €60 per month (under 65) or around €157 per month (over 65) that grants full SNS access. We cover this in more detail below.
What DNV holders need to know about healthcare
The Spain Digital Nomad Visa requires applicants to hold qualifying private health insurance as a condition of the visa. This must be comprehensive coverage valid in Spain — covering in-patient and out-patient treatment, emergency care, and repatriation where required. It must be from a recognised insurer and must not have significant exclusions that leave you without coverage for routine healthcare needs.
This private insurance requirement covers you during your initial period in Spain before you have established Social Security entitlement. In practice:
- Employed DNV holders whose employer registers them with Spanish Social Security from day one can transition to public system access relatively quickly — though many maintain their private insurance alongside it for practical reasons
- Self-employed DNV holders who register as autónomos gain public access through their Social Security contributions
- DNV holders not yet registered with Social Security rely on their private insurance and may wish to consider the Convenio Especial as they become longer-term residents
Keep your private insurance even after gaining public access
Many long-term expats in Spain who are entitled to the public system choose to maintain private insurance alongside it. The reasons are practical: private appointments are available within days rather than weeks, English-speaking specialists are more consistently available, and you can see specialists directly without waiting for a GP referral. The monthly cost is modest relative to the convenience it provides.
The Convenio Especial in detail
The Convenio Especial is Spain's mechanism for giving public healthcare access to legally resident individuals who are not otherwise entitled to it through employment or pension status. It functions as a voluntary subscription to the public system.
To be eligible for the Convenio Especial, you must:
- Be legally resident in Spain (with valid residency documentation — a DNV, TIE, or other valid permit)
- Have been registered in Spain (empadronado) for at least one year
- Not be entitled to SNS access through another route
The monthly contribution is approximately €60.58 per month for those under 65 (this figure is periodically reviewed). For those over 65, it rises to approximately €157.04 per month. These are relatively modest amounts for comprehensive public healthcare coverage and compare very favourably with private insurance premiums, particularly for older expats.
Once you are in the Convenio Especial, you access healthcare the same way any SNS patient does — registering with a centro de salud (primary care centre), receiving a GP (médico de cabecera), obtaining referrals to specialists, and using public hospitals.
Private health insurance — the practical choice for most expats
Spain's private health insurance market is well-developed, competitive, and excellent value compared to equivalent coverage in the UK, US, or other markets. Private insurance in Spain gives you:
- Appointments with specialists — often within days, without GP referral
- Access to private hospitals and clinics with modern facilities and shorter queues
- English-speaking doctors in most major cities
- 24-hour telephone medical advice lines
- Choice of hospital and specialist
| Age group | Typical monthly premium |
|---|---|
| Under 35 | €55–90 |
| 35–45 | €70–120 |
| 45–55 | €100–160 |
| 55–65 | €140–210 |
| Over 65 | €180–280+ |
Major private health insurance providers in Spain
Sanitas (part of the Bupa group) is probably the most widely used private insurer among expats in Spain. They have an extensive network of clinics and hospitals, English-speaking customer service, and a well-regarded app for booking appointments. Their policies are widely accepted as meeting DNV insurance requirements.
Adeslas is Spain's largest domestic private health insurer by number of policyholders and has an extensive network across the country. Solid coverage at competitive prices.
Asisa is a Spanish mutual insurer with strong coverage particularly in Madrid and other major cities. Competitive pricing and a comprehensive network.
Cigna is the international provider most commonly used by expats who want an internationally portable policy. More expensive than Spanish domestic policies but offers broader international coverage.
Quirónsalud — Spain's largest private hospital group — offers its own insurance products that give access to their network of 50+ hospitals and clinics across Spain, which includes some of the country's best private healthcare facilities.
Vithas and HM Hospitales are other significant private hospital groups operating across Spain, both accessible via multiple insurance providers.
Emergency numbers in Spain
Two key numbers for healthcare emergencies:
- 112 — the pan-European emergency number for police, fire, and medical emergencies. English-speaking operators are available. This should be your first call in any life-threatening situation.
- 061 — the medical emergency number specific to Spain. Also known as the SAMU (Servicio de Atención Médica Urgente). Use this for medical emergencies specifically.
Dental and vision cover
Dental and vision care are generally not covered by Spain's public healthcare system for adults (there is some paediatric dental coverage). This is a significant difference from some other European countries and catches some new arrivals off guard.
Under the public SNS, adults do not receive routine dental check-ups, fillings, crowns, or most dental procedures through the public system. Emergency extractions are sometimes covered, but that is typically the extent of adult public dental provision.
Private dental care in Spain is excellent and genuinely affordable compared to the UK. A routine check-up and clean typically costs €30–60 at a private dental clinic. Fillings run €50–120. Dental practices are common in all major cities and towns and operate to high standards.
Most private health insurance policies in Spain offer dental and vision as add-on modules rather than including them in the core policy. These add-ons typically cost an additional €15–40 per month and cover routine dental check-ups, fillings, and basic treatments, with more complex work subject to separate pricing. Vision cover typically includes eye tests and a contribution towards glasses or contact lenses.
Prescriptions and medication
Spain's public healthcare system operates a co-payment scheme for prescription medications. Working-age adults pay a percentage of the prescription cost:
- Those earning under €18,000/year: 40% of medication cost
- Those earning €18,000–100,000/year: 50% of medication cost
- Those earning over €100,000/year: 60% of medication cost
- Pensioners with pensions under €11,200/year: free
- Pensioners with higher pensions: 10% up to a monthly maximum
- Children, those with chronic conditions and certain other groups: reduced or zero co-payment
In practice, most commonly-used medications in Spain are inexpensive even at the private-prescription rate available at pharmacies without insurance. Pharmacies (farmacias) — identifiable by their green cross sign — are ubiquitous across Spain and pharmacists play an important role in the healthcare system, often advising on minor ailments and providing over-the-counter medication for conditions that would require a prescription in the UK.
The European Health Insurance Card (EHIC / GHIC)
UK nationals moving to Spain often ask about the Global Health Insurance Card (GHIC) — the post-Brexit replacement for the old EHIC. The GHIC provides access to medically necessary state healthcare in EU countries at the same cost as a local would pay — but it is designed for temporary visitors and tourists, not for people who have become Spanish residents.
Once you are a legal resident of Spain on a DNV or other permit, the GHIC is not the appropriate healthcare coverage mechanism. You should rely on your private health insurance (required by your visa) and work towards accessing the public system through the routes described above. The GHIC may be useful during an initial very short pre-arrival visit but should not be relied upon as your primary healthcare coverage once you are resident.
Common questions