Explaining Spain’s New Healthcare Legislation
Some big changes to Spain’s healthcare system took place in March, when the Spanish government introduced Real Decreto 180/2026, a piece of legislation that makes access to healthcare dependent on residency in the country rather than on social security contributions or other factors. This could be good news for third-country nationals resident in Spain, such as British expats, as it simplifies the access pathway into the Sistema Nacional de Salud, Spain’s comprehensive national healthcare system.
To comply, you will need to prove that you live in Spain, even if you do not have formal residency status, and that you do not have alternative healthcare options — so if you have an S1, you do not need to do anything else and can continue using that. Proof includes:
- utility bills
- school enrolment certificates
- social services reports
Once you have applied, you will be issued with a temporary healthcare document. If you have not heard anything to the contrary three months after your application, this means that your application has been approved — a process known as “administrative silence”. There is no minimum residency period.
The new legislation is designed to help those who currently “fall between the cracks” in terms of residency and healthcare status, particularly post-Brexit Brits.
Higher Deductibles in the Netherlands
The Netherlands Bureau for Economic Policy Analysis (CPB) told the press in early April that it has now run its calculations and estimates that higher deductibles in healthcare are going to lead to lower health insurance premiums, as well as relieving pressure on the healthcare system. Overall, deductibles are estimated to rise by around €60 per year, on top of a compulsory deductible of around €380, but could result in a €300 reduction in premiums.
Previous suggestions included halving the current mandatory deductible, but there were objections to this on the grounds that it would increase pressure on the healthcare system. This current proposal also has its detractors, so if you are an expat in the Netherlands who is likely to be affected by this, keep an eye on any amendments.
Top Five Countries Offering Healthcare to US Expats
According to recent research, nearly half of Americans are concerned about being able to afford healthcare from 2026 onwards, and, as we have reported before, many are looking abroad for their medical needs. Recently, International Living compiled a list of the top five most popular nations for US expats or medical tourists:
- France
- Portugal
- Spain
- Costa Rica
- Panama
Executive Editor of International Living Jennifer Stevens says:
“These countries don’t just offer cheap health care—they deliver peace of mind. You can walk into a clean, modern facility and see an English-speaking doctor for less than the cost of a lunch out in the States.”
These nations offer excellent-quality healthcare at a fraction of the cost of similar procedures in the USA. However, it is not just about the money: expats report that doctors seem to have more time for their concerns in, for example, Portugal, and the increase in medical apps in English is making access to healthcare increasingly straightforward. Some hospitals also have links with US medical institutions, such as the Cleveland Clinic, while English-speaking doctors can be found throughout the medical systems in these countries.
German Government May Scrap Healthcare Benefits for Spouses
Currently, if you are working in Germany, you can extend your healthcare to cover a non-working spouse or civil partner, but this may be about to change. It has been reported in Handelsblatt that the CDU/CSU-SPD government is considering limiting health coverage for spouses and partners, although children under six would still be covered, as would partners who are caring for someone else, such as an elderly parent.
It is estimated that around 3 million people could be affected and, if they do not have private coverage, would need to pay a flat rate of €225 per month for their statutory health insurance, regardless of household income. This would affect lower-income households significantly.
Federal Health Minister Nina Warken told the press that she has been waiting for a report published at the end of March from the Health Finance Commission (FinanzKommission Gesundheit), set up in late 2025 and tasked with investigating the healthcare situation and proposing measures.
Trade union representative Jonas Wolframm of ver.di has issued a press release raising questions:
“…the fact that we aren’t even allowed to discuss taxing other sources of income, such as capital gains or income from rents, is a sad reflection on the situation. The CDU/CSU is otherwise always quick to invoke the principle of “fairness in benefits”. Why is it fair that income from work is taxed more heavily than other types of income?”
High Price of Illness Abroad
MSN reported this month on the cost of medical evacuation flights from Spain, estimating via statistics published on the Staysure website that air ambulance repatriation from the Canaries can cost just under £38,000. From the Balearics, this came in at just under £23,000 and from mainland Spain, around £25,000. This is all in addition to the cost of hospital treatment in your host nation, and can result in frightening bills to bring your loved one home. Some families have been compelled to resort to crowdfunding to do so.
Obviously, this does not just apply to Spain: a British tourist is facing a £21,000 bill this month after breaking her back in Thailand. The logistics of medically evacuating someone are complex, from getting them out of hospital and into a helicopter with a specialist medical team, to finding them a bed at the other end, and the further away you are, the higher the cost is likely to be.
Insurance specialists say that too many people treat health insurance as an afterthought when it comes to travelling — but none of us knows when an accident might happen. There is a straightforward way to avoid this: either do not travel at all or, preferably, take out the right insurance to cover these alarming possibilities.