Gibraltar runs the Group Practice Medical Scheme (GPMS), an NHS-modelled public health service delivered by the Gibraltar Health Authority (GHA) and funded mainly through compulsory Social Insurance contributions from employees, employers and the self-employed, giving free care at the point of use to entitled/registered persons. Here is what that actually means for an American or Briton living in Gibraltar: what the public system gives you, what it does not, and where private cover fits.
Can you use the public system?
- Working for a local employer: Yes, once you complete residence registration
- Self-employed: Yes, once you complete residence registration
- Retired or not working: Only in limited cases
Employed and self-employed residents become compulsorily insurable and pay weekly Social Insurance contributions (employees 10% of gross pay, employers 18%, self-employed 20%, as of the 2025/26 schedule); after registering with the Income Tax Office they can apply for a GPMS card. Registration is also open to anyone ordinarily resident in Gibraltar under the GPMS Act, but in practice British nationals get by far the easiest route: a valid UK passport plus proof of ordinary residence is generally enough, and retired British passport holders can transfer their UK-linked entitlement. There is no reciprocal healthcare deal for US nationals: non-British, non-contributing residents are not covered by GPMS and are expected to hold private medical insurance instead.
The picture differs for UK citizens
British retirees holding a UK State Pension can access the Gibraltar public health scheme via a UK passport and proof of ordinary residence, without new contributions; US retirees have no reciprocal arrangement and must hold private insurance.
If you are retiring here
British retirees are the favourable case: those previously insured under the UK or Gibraltar schemes, or holding a UK State Pension, can generally access GPMS via a UK passport and proof of ordinary residence without new contributions; multiple advisory sources describe UK pensioners as effectively the main group who get free public healthcare access as retirees. US retirees (and other non-British, non-EU retirees) have no reciprocal arrangement, are not covered by GPMS, and as a condition of most non-work residency routes must hold private medical insurance meeting the roughly GBP 100,000 minimum described above.
What public cover will not give you
- Adult dental care is excluded from GPMS entirely (only children are covered); adults need private dental care
- Specialist/tertiary treatment not available on-site is referred to the UK (occasionally with visiting UK specialists) or historically to Spain, but the Spain reciprocal healthcare arrangement ended in 2022, so Spanish referrals may not be automatically covered
- Only one public hospital (St Bernard’s) serving a small population, so capacity for complex or elective care is limited locally
- Medevac/air repatriation not covered
- Non-British, non-contributing residents (including most US nationals) get essentially no free GPMS access at all
So do you need private health insurance?
Legally mandatory for several residency routes: self-sufficient and Category 2/HEPSS residency permits require proof of private medical insurance of at least about GBP 100,000/year covering treatment in Gibraltar, the Spanish hinterland and UK hospitals. For anyone not employed, self-employed, or otherwise paying Gibraltar Social Insurance, private cover is the only realistic option since GPMS is contribution- or nationality-linked. Proof of health insurance is also a condition of the main residence routes here, so most expats need a policy in place before they apply.
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General information, not insurance, immigration or medical advice. Rules change and individual situations differ; check the official position before you commit. Researched from official sources, July 2026.