Health & Insurance
Private health insurance in Spain — what expats need to know in 2026
Spain has world-class healthcare — but the public system has waiting times, and not every specialist speaks English. Here is what private health insurance costs, who the top providers are, and why many DNV holders choose it even after they access the public system.
Spain's public healthcare system — the Sistema Nacional de Salud — is widely regarded as one of the best in Europe. Once you are a registered resident and contributing to Social Security, you have access to GP services, specialist care, hospital treatment, and most prescription medicines at minimal cost. For DNV holders who are employed and registered with Social Security, this access begins from day one.
So why do so many expats in Spain also take out private health insurance? The answer is practical: waiting times, language, and access. A private policy gives you same-week specialist appointments, a choice of English-speaking doctors, and access to private hospitals where the experience is noticeably different from a busy public emergency unit. This guide explains everything you need to know.
Public vs private healthcare in Spain — what DNV holders actually get
Public healthcare for employed DNV holders
If you are an employed DNV holder, your employer registers you with Spanish Social Security from the moment you start work. This registration — and the associated employer and employee contributions — gives you and your dependants full access to the Spanish public healthcare system. You register with a local centro de salud (health centre), receive a tarjeta sanitaria (health card), and can access GP, specialist, and hospital services.
Public healthcare for self-employed DNV holders (autónomos)
Self-employed autónomos who register with Social Security under the RETA also gain access to public healthcare as part of their monthly contributions. The RETA contribution covers healthcare, sick pay after day 4 of illness, and pension accrual. Coverage begins once Social Security registration is complete.
The practical limitations of the public system
The public system is excellent but not without constraints that affect day-to-day life as an expat:
- Waiting times — GP appointments in busy urban areas can be 1–2 weeks; specialist referrals can take weeks to months
- Language — outside major international cities, finding English-speaking doctors in the public system is not guaranteed
- Specialist access — the public system requires a GP referral to see a specialist; private insurance allows direct access
- Diagnostic speed — private clinics typically offer much faster scan and test turnaround times than public hospitals
Many DNV holders use both
A common approach is to use public healthcare for routine, non-urgent matters — annual check-ups, minor illness, chronic condition management — while relying on private insurance for specialists, diagnostics, and anything where speed or English-language service matters. This dual approach is cost-effective and practical.
How DNV insurance requirements differ from the NLV
This is a point of frequent confusion, so it is worth addressing directly.
The Non-Lucrative Visa (NLV) requires applicants to hold comprehensive private health insurance as a mandatory application requirement. NLV holders cannot work in Spain and therefore do not contribute to Social Security. Spain requires them to be privately insured to ensure they do not become a burden on the public health system. Without valid health insurance, an NLV application will be rejected.
The Digital Nomad Visa (DNV) works differently. DNV holders work in Spain — either employed or self-employed — and contribute to Social Security. This contribution funds their public healthcare access. Private health insurance is not a mandatory DNV requirement. However, many DNV holders choose to take a private policy, particularly in the early weeks before their Social Security registration is fully processed, or for the ongoing practical advantages described above.
Top private health insurance providers for expats in Spain
Spain has several strong domestic providers and a number of international insurers with expat-focused products. Here is an overview of the main options:
| Provider | Type | English support | Approx. monthly cost |
|---|---|---|---|
| Sanitas | Domestic (Bupa group) | Very good | €80–€180 |
| Adeslas | Domestic | Moderate | €50–€150 |
| Asisa | Domestic | Moderate | €55–€160 |
| Mapfre Salud | Domestic | Moderate | €60–€170 |
| Cigna Global | International | Excellent (English first) | €150–€350 |
| Allianz Care | International | Excellent (English first) | €140–€320 |
Sanitas
Sanitas is owned by the global Bupa group and is the most internationally orientated of the domestic Spanish insurers. It has the strongest English-speaking network of the domestic providers — particularly in Madrid, Barcelona, and the major coastal expat areas — and its hospital and clinic network across Spain is extensive. The Sanitas Más Salud plans include GP, specialist, and hospital coverage with no copayments on most plans. Sanitas is frequently the first recommendation for English-speaking expats who want a domestic plan with genuine English-language support.
Adeslas
Adeslas (now rebranded as SegurCaixa Adeslas following its acquisition by CaixaBank's insurance arm) is Spain's largest private health insurer by number of policyholders. Its network of approved clinics and hospitals is the widest of any domestic insurer, making it particularly practical if you live outside a major city. Premiums are competitive and the basic plans offer solid coverage for routine healthcare needs. English-language support is available but less comprehensive than Sanitas or the international providers.
Asisa
Asisa is a Spanish mutual insurer (owned by its policyholders) with a strong reputation for customer service and a wide clinic network. Its plans tend to be priced competitively and its no-referral specialist access is a significant practical advantage. Asisa is particularly strong in secondary cities and regional areas where Sanitas may have a thinner network.
Mapfre Salud
Mapfre is one of Spain's largest insurance groups and its health division offers a range of individual and family plans. Mapfre's strength is its combined offering — many expats who have Mapfre car or home insurance find it convenient to add health cover with the same provider. The plans are mid-range in price and quality.
Cigna Global and Allianz Care
For expats who prioritise English-language service above all else, or who travel frequently between countries, the international providers are worth the higher premium. Cigna Global and Allianz Care both offer policies designed specifically for internationally mobile professionals — with worldwide or Europe-wide coverage, English-language helplines, and policies that follow you if you relocate. The premiums are significantly higher than domestic Spanish plans, but for remote workers with genuinely international lives, the flexibility justifies the cost.
For tailored expat health insurance in Spain: 247 Expat Insurance
247 Expat Insurance is part of the same group as My Spanish DNV and Platinum Legal Spain. As a recommended partner, 247 Expat Insurance specialises in health and life insurance solutions for expats living in Spain — including DNV holders transitioning from abroad and those already resident. Their advisers speak English and understand the specific coverage gaps that new arrivals typically face. We recommend speaking with them to compare plans suited to your age, location, and health profile.
What to look for in a private health insurance policy
When comparing plans, look carefully at these key factors:
- Copayments — some cheaper plans charge you €3–10 per consultation or prescription. The best plans for expats are copayment-free, meaning you pay nothing at point of use after your monthly premium.
- Pre-existing conditions — most Spanish domestic insurers impose a waiting period or exclusion for conditions that existed before the policy start date. International plans tend to be more flexible, though at a higher premium. Declare everything honestly — non-disclosure leads to claims rejection.
- Annual benefit limit — look for at least €500,000 per person per year, ideally unlimited. Lower limits are risky for serious illness.
- Specialist access — can you see a specialist directly, or do you need a GP referral? Direct access is a significant quality-of-life advantage.
- Hospital network — check that quality private hospitals in your area of Spain are included. A Sanitas plan that does not cover the best private hospital in your city is less useful than it appears.
- English-speaking doctors — if you are not yet confident in Spanish, check the provider's English-speaking doctor list for your area before committing.
Dental and vision cover
Dental and vision care are not covered by the Spanish public healthcare system for adults (with very limited exceptions). If you want dental coverage — routine check-ups, fillings, hygienist appointments — you will need either a plan that includes dental cover or a separate dental insurance policy.
Sanitas and Adeslas both offer plans with basic dental cover included. Asisa has strong dental options as a rider. Dental treatment in Spain is generally very affordable even when paying privately — a routine check-up and clean typically costs €50–80, and a filling €80–150, so for some people with healthy teeth, self-funding dental care makes more economic sense than paying for dental insurance.
Vision cover (glasses, contact lenses, eye tests) is rarely included in standard plans but can often be added. Optica chains such as Vision Direct and Alain Afflelou offer competitive pricing and own-brand eye tests at low cost, making private vision insurance less valuable than dental cover for most people.
Common questions