Andorra runs a Bismarck-style contributory social security fund (CASS, Caixa Andorrana de Seguretat Social) that covers people through employment or self-employment contributions, reimbursing most of the cost of care rather than funding it purely from general taxation. Here is what that actually means for an American or Briton living in Andorra: 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, from arrival as a legal resident
- Self-employed: Yes, once you complete residence registration
- Retired or not working: No
Salaried workers are affiliated to CASS automatically by their employer, from the first day of the labour relationship, and confirmed sources state healthcare benefits are covered from the first day of registration. Self-employed workers must actively register (form CASS-0055) when they start their activity, with affiliation processed within days of administrative authorisation. Both routes require the person to already hold an immigration authorisation permitting work in Andorra; there is no separate US or UK reciprocal healthcare arrangement, this was checked and none was found.
If you are retiring here
A non-working retiree almost always enters via the ‘residencia passiva’ (residence without work) route, and passive residents have no access to CASS at all, since they carry out no economic activity in Andorra. Andorra’s own government procedure page (residencia sense treball, e-tramits GV000499) confirms applicants must justify and keep in force, for the duration of the permit, insurance covering illness, incapacity and old age; people aged 60 and over only need the illness/medical component, not incapacity or old-age cover. This is a permit condition, not optional, and there is no reciprocal UK or US public healthcare arrangement that substitutes for it. Passive residency rules tightened further under 2026 regulations (higher investment thresholds), which is worth flagging as a currently-moving target.
What public cover will not give you
- Dental beyond two cleanings a year at 75 percent reimbursement (crowns, root canals, implants generally paid privately)
- Specialist care not available in Andorra requires cross-border referral to Spain or France under bilateral agreements, with only partial reimbursement, and this does not extend to other countries including the US or UK
- Private or single hospital rooms
- English-language providers are not the norm (Catalan, Spanish and French are the working languages of the system)
- A practical coverage gap while an incoming worker’s residence/work authorisation and CASS registration are being processed
So do you need private health insurance?
For anyone entering Andorra as an employee or self-employed person, private insurance is not a legal requirement once enrolled in CASS, but it is de facto useful to bridge the pre-registration gap and to cover CASS’s gaps (dental, cross-border specialist costs, private rooms). For passive (non-working) residents, private insurance covering illness, incapacity and old age is an explicit, legally mandated condition of the residence permit itself. 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.