Andorra – Health Service

What is the standard of healthcare in Andorra?

Healthcare ranks among the Principality of Andorra’s greatest strengths, and the country’s health outcomes reflect this clearly. According to the World Health Organization (WHO), life expectancy in Andorra is notably high: 86 years for women and 80 years for men. These figures place Andorra on a par with Europe’s most health-advanced nations, comparable to countries with well-established universal systems such as France or Switzerland.

In 2017, the medical journal The Lancet published the Healthcare Access and Quality Index (HAQ), in which Andorra achieved the top global ranking with a score of 95/100. More recently, the European Observatory on Health Systems and Policies released its 2025 report on Andorra’s health system, prepared at the request of the WHO Regional Office for Europe in cooperation with the Ministry of Health.

Household out-of-pocket payments represented just 11% of total health expenditure in 2023 — among the lowest proportions across the entire WHO European Region — and only 2.1% of households faced catastrophic health costs, establishing Andorra as a benchmark for financial protection in healthcare.

The health workforce has grown substantially: the number of doctors climbed from 295 in 2010 to 507 in 2023, nurses increased from 364 to 451, and the general practitioner cohort expanded by 27%. Medical professionals across Andorra commonly speak several languages, among them Catalan, Spanish, French, and English.

Because of the country’s small geographic footprint, healthcare facilities are concentrated rather than dispersed over a wide area. Andorra maintains a well-equipped central hospital alongside a network of medical centres in each of its seven parishes, ensuring that primary care is close to hand. This differs markedly from large countries where rural residents may face lengthy journeys to reach specialist services. That said, the Andorran system does rely on hospitals in neighbouring countries for complex or uncommon surgical procedures not available locally.

For current and authoritative assessments of healthcare quality, readers should consult the WHO European Observatory on Andorra and the Andorra Ministry of Health (salut.ad).

How is healthcare funded in Andorra, and is private health insurance necessary?

Andorra’s healthcare system is grounded in a social insurance framework. The principal institutions overseeing healthcare are the General Council, the Ministry of Health and Welfare, CASS (the Andorran Office of Social Security), and SAAS (the Andorran National Health Service). This arrangement closely mirrors the Bismarckian model used in countries such as Germany, France, and Belgium — one in which healthcare funding flows from mandatory payroll contributions rather than general government taxation.

Social security contributions form the financial backbone of Andorra’s healthcare system. Both residents and workers pay into CASS, which funds public healthcare services; contributions come from employers, employees, and the self-employed alike. Employees contribute between 6% and 9% of their salary to CASS, while employers contribute 13% per worker. These figures are subject to revision and should be confirmed directly with CASS.

Healthcare for residents operates on a co-payment basis: coverage absorbs a portion of the total expense rather than the entirety. For registered residents, CASS reimburses 75% of consultation and visit costs, 90% of hospitalisation costs, and 100% in the event of workplace accidents or childbirth. These figures apply as of 2025 — current rates should be confirmed at CASS (cass.ad).

CASS extends public health coverage to 98% of residents through a comprehensive benefits package, and the Ministry of Health continues to broaden this scope periodically, including coverage for certain procedures carried out in Spain and France. Enrolment is obligatory for salaried workers; those not covered are predominantly passive residents, who are required to maintain private insurance.

Unemployed residents may join CASS voluntarily by paying a contribution of approximately €200–€400 per month (as of 2025 — verify the current rate directly with CASS). Passive residents are not automatically enrolled in CASS and typically access care through private insurance arrangements.

For those who prefer not to bear any co-payment, complementary insurance policies are available specifically to cover the percentage of costs left after CASS reimbursement. Private insurance is also recommended to address areas not included in the public plan, such as dental treatment, optical care, and healthcare received abroad.

How do I register with a doctor or access primary care in Andorra?

To access Andorra’s health services, you must hold legal residency. Once you have established residence and are contributing to CASS, you become entitled to public healthcare. Registering with CASS is the indispensable first step and should be completed as soon as your residency permit is granted.

Once CASS registration is in place, accessing primary care follows a clear and straightforward sequence:

1. Register with CASS: Expats employed in Andorra are required to register with CASS, which administers public health insurance. Self-employed residents must register independently. You can begin the process at a CASS office or through their online platform.
2. Select a referring physician (metge referent): Each CASS member must designate a GP or paediatrician as their referring physician. This doctor provides personalised general care, monitors your health over time, and serves as the initial point of contact for diagnosis, specialist referrals, and coordination with other healthcare providers.
3. Schedule your appointment: The booking process is entirely digital and straightforward — you can arrange an appointment directly with your chosen doctor or specialist, or do so through the CASS online platform.
4. Pay at the point of care and reclaim costs: You pay 25% of the consultation fee at the clinic, or the full amount if the practice does not participate in the third-party payment scheme (in which case the clinic issues a stamped reimbursement form). Claims are submitted at a CASS office with all supporting documentation, and reimbursement is made by bank transfer.

Publicly funded and managed health centres operate across all seven parishes and form part of the country’s broader effort to strengthen primary and community-based care. These centres deliver preventive services, vaccinations, first aid, prenatal and child health care, family planning, and general health advice. Urgent care can be obtained by attending a health centre directly or through a home visit, without requiring a prior appointment.

Andorra has made considerable progress in digital healthcare, including a shared electronic health record and ongoing improvements to the Andorra Salut app, which allows patients to access medical reports, referrals, and vaccination records. For official registration guidance, visit cass.ad and salut.ad.

What services do hospitals in Andorra provide, and what should patients expect?

Hospital services in Andorra are delivered through a single hospital operated by SAAS. The principal facility, Hospital Nostra Senyora de Meritxell, is situated in Escaldes-Engordany and has a capacity of 220 beds. It comprises a day hospital and a main inpatient building, offering care across six core medical areas including surgical specialties, paediatrics, gynaecology, traumatology, and mental health, along with an intensive care unit (ICU), a dedicated emergency department, and a full range of support services.

For more specialised treatment, Andorra hosts a number of clinics and consultants providing services in fields such as cardiology, neurology, gynaecology, and orthopaedics. Where certain procedures are not available locally, residents may be referred abroad — typically to Spain or France — and CASS often contributes to the associated costs in such cases.

Andorra maintains well-developed emergency medical services, including ambulance provision and dedicated emergency response teams. Emergency treatment is available to all residents at no direct charge, and patients can receive immediate care at Hospital Nostra Senyora de Meritxell or at other healthcare centres. For critical cases requiring transfer, helicopter transport to hospitals in neighbouring countries is available.

Patient privacy is taken seriously within the hospital, with all rooms being single-occupancy and furnished with television, a private sink, wardrobe space, and comfortable fittings. In contrast to hospital cultures in parts of Asia, the Middle East, or Southern Europe — where family members are often expected to assist with personal care — Andorran hospitals operate in the Western European tradition, with nursing staff fully responsible for patient care. Family members are welcome as visitors but are not expected to carry out caregiving duties.

Elderly patients requiring residential care may be accommodated at the Centre Geriàtric Sant Vicenç d’Enclar, a 50-bed private geriatric facility. In addition, SAAS operates 12 primary healthcare centres distributed across the country’s parishes.

How does follow-up and aftercare work in Andorra?

Both public and private services contribute to ongoing chronic care management, with the general practitioner coordinating referrals and overseeing treatment plans. The referring physician (metge referent) model ensures that post-hospital follow-up is typically channelled through your registered GP, who acts as the central figure in coordinating your continuing care needs.

Physiotherapy and rehabilitation sessions prescribed by a physician are reimbursed at 75% by CASS (as of 2025 — verify current rates with CASS). For the majority of expats, this means that medically recommended rehabilitation following surgery or injury is both accessible and substantially subsidised. Outpatient specialist follow-up visits are subject to the same co-payment structure as initial consultations.

The Comprehensive Mental Health Plan (PISMA), developed in alignment with WHO mental health action plans, is advancing governance structures, professional training, and a transition from hospital-centred towards community-based mental health provision. This reflects a wider ambition to enhance community aftercare, though expats should bear in mind that, as is common in small states, the range of community nursing and home-based rehabilitation services may not match what is available in larger countries. Private arrangements may therefore be necessary for intensive or highly specialised follow-up care not provided locally.

When specialised follow-up treatment requires travel to Spain or France, CASS frequently covers a portion of the costs involved. Expats managing complex chronic conditions or requiring regular specialist follow-up are advised to confirm the full scope of their coverage with CASS directly and to consider supplementary private insurance to address any remaining gaps.

What are the rules on medical treatment for foreign visitors and new arrivals in Andorra?

Foreign nationals visiting Andorra are responsible for meeting the full cost of any medical treatment they receive. This is a crucial point for anyone who arrives before obtaining residency or completing CASS registration. Healthcare pricing in Andorra differs depending on whether the patient is a registered resident or a foreign visitor. Residents enrolled in CASS benefit from negotiated, reduced rates, whereas visitors face non-resident pricing that is considerably higher.

A particularly significant point for those arriving from EU member states: the European Health Insurance Card (EHIC) and Global Health Insurance Card (GHIC) are not accepted in Andorra. Expats from European countries should be aware that the EHIC carries no validity here, as Andorra is not a member of the European Economic Area (EEA). Even those accustomed to reciprocal health coverage across EU countries cannot depend on that protection within Andorra’s borders.

Andorra does hold bilateral social security agreements with Spain, France, and Portugal. In general, these treaties operate on a reciprocity basis, allowing individuals to receive social security healthcare in the partner country with costs charged to their country of residence. For instance, an Andorran resident seeking care in Spain is covered, with CASS meeting the associated costs. However, the terms and scope of these agreements are subject to change, and readers should verify the current provisions directly with the CASS website or the Ministry of Health before travelling or relocating.

New arrivals who have not yet completed CASS registration should arrange comprehensive private health insurance to cover the period before their CASS entitlement takes effect. Obtaining thorough travel and medical insurance prior to arrival is strongly recommended.

What are the most important health insurance options for expats in Andorra?

Expats in Andorra generally have three insurance routes to consider, which can be combined to achieve comprehensive protection:

• CASS (public social insurance): Andorra’s public healthcare system, sustained by social security contributions and administered by CASS, gives residents access to affordable, high-quality care at Hospital Nostra Senyora de Meritxell and other public facilities. It covers core services including emergency treatment, maternity care, and general medicine, with CASS reimbursing 75–90% of costs depending on the type of care. This forms the primary coverage layer for employed and self-employed residents.
• Complementary local insurance: Supplementary insurance policies exist specifically to cover the remaining co-payment share — approximately 25% — that CASS does not subsidise, eliminating out-of-pocket expenses entirely. These policies are readily available from Andorran insurers and are popular among residents seeking predictable, surprise-free healthcare costs. Current premiums and coverage details should be confirmed with the Andorran financial regulator (UIFAND).
• International health insurance: International plans give expats access to quality care beyond Andorra’s borders, covering hospitalisation, outpatient treatment, and emergency evacuation. These are especially valuable for passive residents, frequent travellers, and those who wish to access specialist care abroad without incurring additional costs. When selecting a plan, consider the premium, international coverage, specialist access, and emergency care provision — particularly if you participate in winter sports.

Medical evacuation cover is especially worth considering for expats who are far from home and unfamiliar with local healthcare systems. Having evacuation insurance in place ensures that emergency medical situations are managed effectively and without unnecessary delay. For serious cases requiring advanced tertiary care, Barcelona is the nearest major city and can be reached by air ambulance.

Practical steps to manage your healthcare in Andorra include: registering with CASS as soon as residency is confirmed; selecting a GP who has experience with expat patients; considering supplementary private cover for added flexibility; retaining copies of all receipts and prescriptions for reimbursement purposes; and making use of the CASS online portal to handle claims efficiently.

Are there any particular health risks or considerations for people moving to Andorra?

Andorra is a mountainous country situated at high altitude, and this brings specific health factors that newcomers — particularly those relocating from coastal or low-lying areas — should consider carefully. The elevated terrain creates a clean environment with minimal industrial pollution, which can be beneficial for individuals with respiratory or rheumatic conditions. However, those with cardiovascular health concerns should seek medical advice before relocating, as high altitude can impose additional strain on the heart, especially in the initial weeks after arrival.

The peak winter sports season accounts for the majority of accidents in Andorra. Visitors and residents are advised to monitor local avalanche warnings and weather alerts. Avalanches are most prevalent from mid-winter through to early summer, and landslides can occur following sustained heavy rainfall. Expats who ski or engage in mountain pursuits should ensure their insurance policy explicitly includes winter sports and mountain rescue coverage.

Given the demands of its mountainous landscape, Andorra has developed specialised rescue teams and emergency medical services trained to respond to mountain accidents and outdoor injuries, forming part of a national response structure designed to provide rapid care in critical situations.

Andorra has no meaningful endemic tropical diseases, and food and water safety standards are high throughout the country — tap water is safe to drink everywhere. No vaccinations are required for entry, though travellers and new residents should confirm that their routine immunisations — including MMR, tetanus, and diphtheria — are current before making the move.

The Comprehensive Mental Health Plan (PISMA), aligned with WHO mental health action plans, is progressing governance reforms, professional development, and a shift from hospital-based to community-centred mental health care. While provision is improving, those with existing mental health needs should assess local specialist availability before relocating, as a small country may have a more limited range of practitioners in niche areas.

Before relocating, readers are encouraged to consult the WHO Andorra country profile and their national travel health advisory service — such as NaTHNaC (TravelHealthPro) — for up-to-date vaccination and health risk information.

Frequently asked questions about healthcare in Andorra

Can expats use the public health system in Andorra?

Foreign nationals residing in Andorra who are employed or self-employed generally contribute to CASS and are entitled to benefits under the public healthcare system. Those who are not in employment may need to arrange private health insurance instead. Passive residents — individuals living in Andorra without working there — are required to hold private health insurance and are not automatically enrolled in CASS.

How do I find a doctor who speaks my language in Andorra?

Medical professionals in Andorra routinely work across multiple languages, including Catalan, Spanish, French, and English. The CASS online platform lists all affiliated doctors together with their details, enabling you to search for a referring physician suited to your language preferences. The official health portal at salut.ad and the Andorra Salut app can also help you identify practitioners in your area.

What happens in a medical emergency in Andorra?

Emergency care is provided at the national hospital, which is fully equipped and operates around the clock. The emergency services number in Andorra is 116 (SUM — Servei d’Urgències Mèdiques). Helicopter evacuation to hospitals in neighbouring countries is available for the most critical cases. Visitors who are not covered by CASS will be responsible for the full cost of emergency treatment, making comprehensive insurance essential before arriving.

How do prescriptions work in Andorra?

CASS covers up to 75% of the cost of prescription medications (as of 2025 — confirm current rates with CASS). Andorra holds one of the highest per capita pharmacy-to-population ratios in the world, with more than 50 pharmacies across the principality supplying both prescription and over-the-counter medicines as well as health supplements. Prescriptions issued by an Andorran doctor can be dispensed at any pharmacy, with the standard co-payment applying.

Are pre-existing conditions covered under the CASS system?

As a social insurance scheme, CASS does not exclude pre-existing conditions for residents who enrol through employment. Coverage activates once you are registered and making contributions. Those considering complementary or private insurance should review policy terms carefully, since private insurers may apply waiting periods or exclude pre-existing conditions — always verify the terms with your insurer before signing any agreement.

Is dental care covered in Andorra?

CASS covers 75% of the cost of two dental cleanings per year (as of 2025). Both public and private dental practices operate in Andorra, but more extensive dental procedures typically require out-of-pocket payment, and many expats choose to attend private dental clinics. A supplemental private insurance policy is advisable for anyone seeking broader dental coverage.

Does the EHIC (European Health Insurance Card) work in Andorra?

Neither the European Health Insurance Card (EHIC) nor the Global Health Insurance Card (GHIC) is valid in Andorra. Because Andorra is not a member of the EU or the EEA, these cards are not accepted, and private health insurance must be obtained instead. This rule applies to all visitors and newly arrived residents regardless of nationality.

What should I do about healthcare cover in the period between arriving in Andorra and registering with CASS?

A gap between your arrival and the activation of CASS coverage is common, particularly while residency documentation is still being processed. During this interval, you are treated as a foreign visitor and bear full responsibility for any medical costs incurred. Comprehensive private health insurance should be arranged to cover this transitional period. Once your residency and employment status are confirmed, register with CASS without delay — visit cass.ad for current registration procedures and documentation requirements.