Andorra – Health Insurance

Is health insurance mandatory for expats in Andorra?

Every person residing in Andorra is required by law to hold health insurance. The Andorran government mandates that all residents are covered, either through the national social security system or through qualifying private medical insurance. Which route applies to you depends on your residency category and whether or not you are employed within the principality.

Enrollment in the Social Security Fund (CASS) is compulsory for anyone carrying out a professional activity in Andorra, as well as for the overwhelming majority of residents more broadly. If you work for an Andorran employer or are registered as a self-employed worker, you are obliged to make CASS contributions and will receive entitlement to public healthcare coverage as a result.

Passive residents are individuals who live in Andorra without working there. Unlike those who hold residency by virtue of their employment — and who therefore qualify for Andorran social security — passive residents have no automatic entitlement to CASS. Accordingly, one of the formal requirements for obtaining passive resident status is demonstrating that you hold medical, disability and retirement insurance that provides cover within Andorra.

Private health insurance is a requirement for all applicants until they become eligible to join the Andorran public healthcare system. This means that even expats who will eventually qualify for CASS may need private cover during the interim period while their residency permit and employment registration are being finalised. Failing to hold adequate insurance can result in a financial penalty or refusal of entry into the country.

How does the public health system in Andorra work?

Andorra’s public healthcare system is financed through social security contributions and administered by the Caixa Andorrana de Seguretat Social (CASS), the public institution responsible for social security in the principality. CASS was founded in April 1968. Rather than operating like the UK’s NHS — where general taxation funds most services delivered free at the point of use — Andorra runs on a co-payment model: patients settle their medical bills directly and subsequently receive a significant portion of those costs back from CASS.

In its overall structure, the Andorran system bears a strong resemblance to the French model of social health insurance. As in France, residents can freely choose from a broad network of both public and private healthcare providers, with the state insurance fund then reimbursing the majority of expenditure incurred.

CASS extends public health coverage to approximately 98% of residents through a comprehensive benefits package that is regularly updated. The Ministry of Health periodically broadens the scope of what is covered, including certain procedures carried out across the border in Spain and France.

Out-of-pocket spending by households represented just 11% of total health expenditure in 2023, placing Andorra among the most financially protective systems in the entire WHO European Region. Only 2.1% of households experienced catastrophic health-related costs during that period, underscoring the system’s effectiveness in shielding residents from excessive financial burden.

The social security framework is divided into two distinct branches. The general branch handles reimbursements, temporary disability, maternity and paternity provisions, risk during pregnancy, disability benefits, death capital, and orphan pensions. A separate retirement branch manages pension entitlements and survivor benefits. All healthcare funding flows through the general branch.

Andorra operates one hospital and eleven primary healthcare centres to serve its population. Given that fewer than 80,000 people live in the principality, this infrastructure is more than adequate. More than fifty pharmacies are distributed across its seven parishes, making access to medication convenient regardless of where you are based.

How do expats register for public health coverage in Andorra?

Anyone undertaking a professional activity in Andorra is required to affiliate with CASS. This obligation covers employees (registered through their employer), self-employed workers listed in the Economic Activities Register, and company directors or active partners who carry out effective management functions. The process of registering is relatively simple, and the steps below walk you through it.

1. Obtain your residency permit. Before you can access CASS, you must secure a valid residency permit through the Andorran immigration authorities. Whether your permit is classified as active (for employees or self-employed workers) or passive will dictate how you access health coverage. Consult the Government of Andorra website for up-to-date residency requirements.
2. Register your employment or business activity. If you are working for an employer, they are responsible for registering you with CASS from your very first day of work. If you are self-employed, you must complete your own registration with CASS before commencing your activity — and you will first need to be listed in the Economic Activities Register for affiliation to proceed.
3. Register with the CASS office. With your residency permit in hand, you must formally register with CASS. This can be done by attending the CASS office in Andorra la Vella in person, or by using the CASS Online platform, which brings all digital services together in one place. The official CASS website provides current registration forms and detailed guidance.
4. Provide the required documentation. You will need to submit documents confirming your residency and employment status. These typically include your residency permit, employment contract, and evidence of social security contribution payments. Non-Andorran nationals should also bring their passport and any relevant work authorisation paperwork.
5. Choose a referring doctor (metge referent). Every CASS member must select a doctor or paediatrician to serve as their personal referring physician. This individual provides continuous, personalised primary care, tracks your health over time, and manages any referrals you may need to see a specialist.
6. Receive your CASS card. Once registration is complete and your referring doctor has been designated, you will be issued a CASS card. Present this card whenever you attend a medical appointment or visit a pharmacy in Andorra.

The time needed to process a residency permit varies and typically takes between four and six weeks, during which the immigration authorities review your application for completeness and compliance. Always confirm the latest documentation requirements directly with CASS or the Andorran Ministry of Health, as requirements may be updated from time to time.

What costs are involved in the public health system in Andorra?

The combined CASS contribution for employees totals 22% of gross salary, split between the worker and the employer. Employees themselves contribute 6.5% of their gross monthly earnings, while the employer is responsible for the remaining 15.5%. These rates are correct as of 2025; always check the current figures directly with CASS, as they are reviewed annually.

For 2025, the average salary in Andorra stands at €2,560.99, which translates to a minimum monthly CASS contribution of approximately €563 for self-employed workers. Newly self-employed individuals benefit from a reduced rate during their first two years of business activity, paying just 50% of the standard contribution. This concession helps ease the financial pressures of getting established.

Beyond regular contributions, the CASS model requires patients to pay for care upfront before claiming reimbursement. Under this co-payment arrangement, CASS settles its share of the cost by bank transfer or a similar method after the patient submits their invoice. You will therefore need to have sufficient funds available to cover treatment at the time it is received.

The reimbursement rates vary according to the type of care (as of 2025, based on available sources — verify current rates at cass.ad):

• Outpatient visits to health centres or specialist consultations are reimbursed at a minimum of 75% of the cost.
• Hospitalisation expenses are covered at 90%.
• Costs arising from workplace accidents, occupational diseases, and childbirth are reimbursed in full at 100%.
• Individuals who can demonstrate genuine financial hardship — such as those without resources or in a situation of social exclusion — also receive 100% coverage of treatment costs.

Late or missed CASS contributions automatically attract surcharges and may trigger administrative penalties. Keeping contributions current is essential not only to maintain uninterrupted healthcare access, but also because timely payment is linked to the renewal of active residency permits.

What does public health cover in Andorra include and exclude?

CASS provides coverage across a wide range of medical services, encompassing primary care, specialist consultations, hospital treatment, and emergency services. Prescription medications, diagnostic investigations, and medical equipment — including items such as crutches and wheelchairs — are also included.

The extent of the coverage goes further than many newcomers expect. CASS meets 75% of the cost of two dental hygiene appointments per year, and physiotherapy or rehabilitation sessions recommended by a doctor are also reimbursed at 75%. Prescription drugs attract coverage of up to 75%. On the social benefits side, the system provides paid sick leave, maternity and paternity leave, and disability, survivor and orphan pensions.

A single CASS contribution covers not just the policyholder but also qualifying dependants. These include dependent minor children, full-time students up to the age of 25, and spouses who have no income of their own — offering reassurance that the entire household is protected.

Bilateral agreements with France, Spain and Portugal ensure that residents can access treatment in those countries when Andorra’s own medical facilities are unable to provide it. Where CASS-approved care is obtained across the border, the fund will typically contribute to the associated costs.

That said, there are defined exclusions. Cosmetic surgery and certain experimental treatments fall outside the scope of CASS coverage, leaving patients to meet these costs themselves or through private medical insurance. A particularly important limitation concerns providers: if you receive treatment from a practitioner or facility not affiliated with Andorran social security, CASS may reimburse only up to 20% of the total bill. Using CASS-affiliated providers wherever possible is therefore strongly recommended.

One of the most notable features of Andorra’s healthcare system is its speed. Access to specialists and diagnostic services is markedly faster than in many larger countries, with negligible or non-existent waiting times. The small scale of the system, combined with robust funding, means the lengthy delays familiar to users of bigger national health services are largely absent here. Digital innovation continues to improve the experience, with a shared electronic health record and ongoing improvements to the Andorra Salut app allowing patients to view medical reports, referrals and vaccination records online.

What are the advantages of international private health insurance for expats in Andorra?

While private health insurance is primarily a necessity for passive residents who cannot join CASS, there are tangible benefits to holding it even if you already have CASS coverage. Most notably, a supplementary private policy can absorb the portion of costs that CASS does not reimburse, effectively reducing your personal out-of-pocket exposure to close to zero for most treatments.

Private insurance in Andorra typically offers access to private clinics, shorter waiting times for specialist appointments, and a greater degree of comfort during inpatient stays. It can also extend your coverage to services that CASS does not fully fund, such as dental treatment beyond the two covered cleanings, optical care, and certain specialist therapies. International plans additionally provide coverage when you are abroad.

For expats who travel regularly or who have close family in other countries, this international dimension is particularly valuable. Although CASS does include limited cross-border coverage under agreements with Spain, France and Portugal, it offers no protection in the rest of the world. A private international plan fills this gap comprehensively.

International health insurance policies typically cover hospitalisation, outpatient treatment, and emergency medical evacuation. Repatriation benefits — which fund transfer to your home country for treatment when medically necessary — are a common feature of expat-focused policies but are not part of the CASS framework at all.

Healthcare providers in Andorra frequently speak several languages, including English, Spanish, French and Catalan. Nevertheless, expats who require guaranteed access to care in a particular language, or who prefer to use a provider network in a neighbouring country, may find that a private international policy offers flexibility that CASS cannot match.

How do international private health insurance plans work in Andorra?

Private health insurance in Andorra is available through local banks, domestic insurance companies, and representatives of certain Spanish insurers. International expat insurers also serve the Andorran market, offering policies that provide either worldwide treatment coverage or coverage across a specified region. This gives residents a genuine choice between locally designed plans and broader international options.

Private policies broadly fall into two types. Top-up plans are designed to complement CASS by covering the co-payment gap — typically 10–25% — that CASS does not reimburse, with local insurers offering a spectrum of packages from basic supplements to near-comprehensive coverage. Full international health insurance plans, by contrast, are better suited to passive residents who have no access to CASS at all, delivering comprehensive inpatient and outpatient benefits from the outset without reliance on any state system.

When evaluating plans, focus on the following key points: whether inpatient-only cover is sufficient for your needs or whether outpatient cover is also included; how the policy handles pre-existing conditions, particularly during any initial exclusion period; the geographic scope of coverage, as some policies restrict benefits to Andorra and its immediate neighbours; and whether the insurer has direct billing arrangements with Andorran clinics or requires you to pay upfront and reclaim costs later.

Premiums depend on factors such as age, health history and the level of cover selected. As a rough guide, a top-up or supplementary policy costs in the region of €30–110 per person per month. These are indicative figures and may not reflect current pricing; request a personalised quotation from your chosen insurer for accurate costs.

Passive residence applicants should note that the insurance requirement is a substantive one — the policy must explicitly provide health coverage within the Principality of Andorra and meet the standards set by the immigration authorities. A standard travel insurance policy will not satisfy this requirement. Always verify that a prospective policy meets these criteria before submitting your residency application.

What should expats watch out for with health insurance in Andorra?

The gap between arrival and CASS eligibility. Private health insurance is compulsory for all new arrivals until they become eligible for the Andorran public healthcare system. There will almost certainly be a period after you arrive — while your residency permit is being processed or your employer completes your CASS registration — during which public cover is not yet in place. Arrange a private policy to bridge this gap before you travel to Andorra.

The European Health Insurance Card (EHIC) carries no weight in Andorra. Expats arriving from EU member states should note that the EHIC is not recognised in Andorra. The principality is neither an EU nor an EEA member, meaning the card provides no entitlement to healthcare there. All visitors and new residents must ensure they have adequate comprehensive private health insurance for the full duration of their stay.

Passive residents are excluded from CASS. Those living in Andorra without working there are not entitled to CASS membership and must hold a valid private health insurance policy at all times. If your circumstances change — for example, you retire or cease employment — review your CASS eligibility immediately and arrange private cover without delay if you no longer qualify.

Using non-affiliated providers sharply reduces reimbursement. Receiving treatment from a provider not affiliated with Andorran social security can limit your CASS reimbursement to as little as 20% of the total cost. Before attending any appointment, confirm that the doctor or clinic is convention-affiliated with CASS so that you receive the standard reimbursement rate rather than this severely reduced amount.

Pre-existing conditions may be excluded from private plans. A significant proportion of private health insurance policies — whether issued locally or internationally — impose exclusions on pre-existing medical conditions, often for an initial waiting period. Read policy documents carefully and, if you have a current or historical health condition, seek specialist guidance or look for plans that offer moratorium underwriting or full medical underwriting with declared conditions.

Travel insurance and health insurance are not interchangeable. Travel insurance is a short-trip product with relatively low maximum benefit limits for medical treatment. It is not designed for people establishing their lives in a new country. Expats moving to Andorra should secure a genuine, renewable international health insurance policy that provides ongoing cover appropriate to long-term residence, not a product intended for holidays.

Keep CASS contributions current at all times. Maintaining your monthly social security payments ensures uninterrupted access to the Andorran healthcare system. Equally importantly, timely payment of contributions is a condition of renewing your active residency permit. Falling behind on payments can therefore jeopardise both your healthcare access and your right to remain in the principality.

Frequently asked questions

Can I use my home country’s health insurance in Andorra?

In the vast majority of cases, you cannot. Because Andorra sits outside the EU and EEA, European Health Insurance Cards have no validity there. Domestic health policies from most other countries similarly do not extend to Andorra. You should arrange either CASS membership — if you qualify through employment — or a private health insurance policy that specifically covers you in Andorra before you arrive.

Do I need private health insurance if I have a work visa for Andorra?

Expats living and working in Andorra as employees or self-employed workers are generally enrolled in CASS and receive public healthcare entitlements through that system. Those who are not in employment will typically need to obtain private health insurance instead. In either case, supplementary private cover is sensible for absorbing CASS co-payments and filling any gaps in coverage during the period your CASS registration is being completed.

What is the CASS and how is it different from a national health service?

CASS — the Caixa Andorrana de Seguretat Social — is Andorra’s official public health institution, which manages the principality’s healthcare system on a co-payment basis combining public and private elements. Unlike a national health service such as the NHS, which delivers most care to patients free of charge at the point of use, CASS reimburses a substantial proportion of healthcare costs after the event, leaving the patient to cover the remainder — typically between 10% and 25%, depending on the nature of the service.

Are dependants covered under my CASS registration?

Yes. A single CASS contribution extends coverage to qualifying dependants, including minor children, full-time student children up to the age of 25, and spouses without an independent income. When registering, inform CASS that you wish to include dependants and supply the appropriate supporting documentation for each family member.

Does CASS cover me if I need treatment in Spain or France?

CASS does provide cover beyond Andorra’s borders. Through social security agreements with France, Spain and Portugal, residents can receive healthcare in those countries and have the costs met in part by CASS. Before travelling, you can obtain a coverage certificate by visiting the CASS office or logging in to the online portal. Be aware that this cross-border protection does not extend to countries outside these three, so separate travel or international health insurance remains advisable for travel elsewhere.

How much does supplementary private health insurance cost in Andorra?

Costs vary according to age and medical history, but a top-up policy designed to cover your CASS co-payment shortfall typically runs to around €50–100 per person per month. Comprehensive international health insurance plans for passive residents tend to be priced higher. Premium levels change over time, so always request a personalised current quote from your chosen insurer.

What happens to my healthcare cover if I leave Andorra temporarily?

Provided you remain up to date with your monthly social security contributions, you retain coverage under the Andorran system while you are away. For trips to Spain, France or Portugal specifically, you can download a CASS coverage certificate through the online portal before you depart. For travel to any other destination, CASS offers no protection and you should carry separate travel or international health insurance.

Is dental and optical care covered under CASS?

CASS covers 75% of the cost of two routine dental cleaning appointments per year. More extensive dental work and most optical expenses — such as prescription glasses or contact lenses — are generally not reimbursed or are only partially covered by CASS. Private insurance is recommended to meet costs that fall outside the public system, including dental and optical care. Check your policy documentation or speak to your insurer to confirm the precise scope of any supplementary dental or vision benefits included in your plan.