Health care system and health insurance in Spain

Spain's health care system is among the best in the world. Social security payments fund the system, meaning most residents do not need private insurance to access health services. The 2019 Healthcare Index ranks Spain seventh out of 89 countries in terms of overall healthcare, behind only Austria and Denmark among all of Europe. While Spain's public system is excellent, some expats opt for more private coverage, which can reduce wait times and make it easier to see an English-speaking doctor.

?Who needs health insurance in Spain

If you live and work in Spain, you generally pay income tax and social security in Spain, which provides you with public health services.

If you do not qualify for health insurance, you can pay for treatment yourself or use a private health insurance plan. In some areas, you can sign up for a government scheme called convenio especial, which provides social security coverage for an initial monthly fee.

?Who does public health insurance cover in Spain

Employees: All employees and self-employed workers in Spain must pay social security contributions. It then entitles them to Spanish health coverage.

Self-employed, freelancers and business owners: freelancers in Spain are responsible for paying your social security contributions for public health care. You can apply for a Social Security number at your nearest Social Security office.

Spouse and children: Spouses and children of workers also enjoy public health services as long as they reside in Spain.

EU/EEA/Swiss Nationals: EU, EEA and Swiss nationals who have reached retirement age in their home country are entitled to free health care in Spain. To be eligible they must receive an S1 form from their country of residence. Preparing this form before migrating will help simplify the registration process. Residents of the European Union, the European Economic Area and Switzerland temporarily residing in Spain can use their European Health Insurance Card, which entitles them to receive medical treatment at the same cost as a Spanish national. .

Non-EU Nationals: Non-EU/EEA nationals may provide proof of private health insurance prior to obtaining a Spain visa. However, some non-EU countries have an agreement with Spain. It's important to check what's included, so check with the consulate or embassy in your home country before you arrive.

Students: EU nationals studying in Spain will be covered by their EHIC for the duration of their studies. However, non-EU students may need a private health insurance plan before entry. Your university can provide more details. 

?What does Spanish health insurance cover

The TSI health card covers care from doctors, hospitals and home treatment, which can be especially useful for the elderly and disabled. Presenting a TSI card means that in Spain you will not pay anything for treatment in a hospital or at a doctor. However, the cost of pharmacies must be paid by you at the time of purchase. The TSI card covers between 40% and 60% of prescription drug costs depending on your income (90% for pensioners). Although individuals are responsible for the remaining cost, prescription drugs are relatively inexpensive in Spain. Dental work in Spain is not covered by the public care system and must be paid for in full by the individual unless they have private health insurance. Dentist fees are relatively cheap and the overall quality of care is of a high standard.

How to apply for public health insurance

If you live in Spain, you must register your address in the padron at your local town hall. After doing this, you will receive an empadronamiento (certificate of registration). You need this certificate to apply for a health card.

You should also make sure you have your social security number, which is issued by your employer. Of course, if you haven't received it, you can follow up through your local social security office, Tesoreria General de la Seguridad Social (TGSS). You can also find your local Social Security Office (Oficina del Instituto Nacional de Seguridad Social) on the government website.

Once you have received your TSI card, you can register with an individual doctor or at your local health centre. You can choose doctors and pediatricians from your local health care area. However, to see other specialists, you must be referred by your GP. Your TSI health card proves that you have health insurance in Spain. Present it whenever you use public health services or buy a prescription from a pharmacy.

Private health insurance in Spain

If you need additional health care services, you can opt for private health insurance. Private health insurance companies in Spain offer a wide range of packages that specifically meet your needs. As always, it's important to thoroughly research your health insurance options and seek as much advice as possible before committing to a particular plan. Foreigners should check whether their package in Spain offers the same coverage as it does in Spain itself. EU nationals who travel frequently outside the EU may also consider private health insurance, as the EHIC only covers travel within the EU.

Benefits of getting private health insurance coverage in Spain

While the quality of public health care is high, some residents choose private coverage. This helps patients avoid the long wait times that often exist in the state system. This is an important factor to consider when considering private care options, and is especially important if you require regular treatment. A private health insurance plan enables you to choose medicine with full command of the English language. The list of English-speaking doctors is also available in tourist offices and embassies.

How to choose a health insurance provider

You can compare private health insurance providers in Spain and get a free health insurance quote. In addition, you can also use the following tools: Acierto.com (in Spanish) and Rastreator.com (in Spanish). Some of the largest private health insurance companies in Spain are:

Allianz Care

Cigna Global Cigna Global

Globality Health 

Health insurance contributions and reimbursement

Spain's health care system is funded through contributions to the country's General Social Security Fund (Tesorería General de la Seguridad Social). Everyone who works in Spain receives a social security number and must pay for it monthly. These payments are automatically deducted from their wages, and employers also contribute a percentage to the scheme for each worker. This in turn entitles employees to free Spanish healthcare. Your contributions to health insurance in Spain are based on the minimum and maximum contribution rates set by the government each year. Current payment rates are set in 2019. Public employees pay 4.7% of their annual salary to the social security system. Employers pay the equivalent of 23.6% of the employee's earnings (with a total contribution of 28.3%). Self-employed workers pay between 18.75% and 26.5% depending on their income.

Health insurance for unemployed or low-income people

Spanish authorities offer a payment plan known as a Convenio Especial (Special Agreement). The scheme is available to those who may have difficulty accessing system benefits, such as those who are unemployed or on low wages. Also, this plan is basically a low-cost insurance plan that covers people for a low monthly fee. You can choose to pay the minimum, average or maximum cost base. Your contract becomes stagnant, especially during normal employment periods where your contributions are covered by your salary.

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