Public healthcare
The public healthcare system in Spain has recently been rated one of the world’s best. Waiting times are low and there are four general practitioners to every one thousand people.
Expats living and working in Spain can expect free healthcare providing they pay their social security contributions, which is obligatory. The Spanish social security system includes services such as healthcare, pensions, and unemployment benefits. In 2015 it was recorded that there are 1.6 million foreigners registered with the Spanish social security system.The UK government’s official website states that “there has been no change to the rights and statuses of UK nationals in the EU as a result of the referendum”.
You are entitled to free public healthcare if:
– You reside and work in Spain (including being self employed).
– You are a state pensioner of Spain or any other EU country.
– You are a resident in Spain and pregnant.
– You are a resident in Spain and are recently divorced or separated from your partner.
– You are a child resident in Spain.
– You are a student in Spain under the age of 26.
– You are staying temporarily in Spain and have an EHIC (European Health Insurance Card).
How to register for Spain’s public healthcare
As the healthcare system is decentralised, each region in Spain takes individual responsibility for the health budget. Therefore it is important you are listed on the Padron, a register of everyone living in each town. You must be registered as living in Spain for over 6 months of the year.
To register with TGSS, the first step is to receive your social security number and certificate. There are several offices throughout Spain. Once you have registered, take your TGSS certificate, passport, and NIE number to your local health centre.
Register with a doctor and apply for a health card, known as a TSI (tarjeta sanitania individual). This will either be posted to you or available for personal collection from the health centre.
Finally, you need a SIP (sistema de informacion poblacion). The health centre will help arrange this. This card must be shown every time you visit a health centre, clinic, or hospital, or when picking up your prescriptions from a pharmacy.
Self employed persons and freelancers must also contribute to the Spanish social security system. This is done through the RETA (Regime for Autonomous Workers).
Cost
The annual Spanish national minimum wage (2016) is €9,173. Earning above this requires you to contribute towards social security, resulting in free healthcare. For an employee you can expect to pay around 6-8%. The average monthly fee is usually around €60 for people under the age of 65 and around €157 for those aged 65 and over. There are more restrictions for the self employed and it must be noted that even if you don’t earn anything in a given month you will still have to contribute. Contact the RETA for further information and for an estimate of how much you can expect to pay per month. There are minimums and maximums, particularly if your earnings are over €60,000, at which point the percentage will decrease significantly. You are able to pay more and be covered for additional things such as accidents or sickness at work.
Short term healthcare for EU members
The EHIC ensures temporary public health benefits, the same as that of a resident of Spain. With an EHIC card EU residents are entitled to reduced or free healthcare for the first three months of their stay in Spain. It is beneficial if you are on holiday or studying in the EU. It must be noted that the healthcare must be necessary treatment and it is not valid for people coming specifically to Spain for treatment or to give birth. Medical conditions that do not require immediate treatment may incur charges.
How do I get an EHIC?
It is possible to apply for the EHIC online.
Getting an EHIC is free of charge. However, be aware that some websites may charge for the service. It is valid in all European economic areas and Switzerland. It is usually valid for 3-5 years. If you require treatment and do not have the card on your person you must pay in full, be sure to obtain a receipt and speak to the relevant organisation in your country of residence. The EHIC is not an alternative to travel insurance and it is recommended you take out private cover for the duration of your stay.
Bilateral agreements between Spain and the countries listed below mean people visiting Spain for a short term period are entitled to free or reduced medical treatment:
– Andorra
– Brazil
– Chile
– Ecuador
– Peru
– Morocco
– Venezuela
– Paraguay
– Switzerland
– Tunisia
Non-EU expats must obtain private medical insurance as a requirement for getting residency in Spain. Retirees of non-EU countries will need to speak to the autonomous community once they have established that they are legally resident in Spain. Each community sets their own rules regarding how long a person must be a resident before being legible for the social security system.
Doctors
Although there isn’t a shortage of doctors in Spain, it may be hard to find one who speaks fluent English, particularly in rural areas. If your Spanish is limited, you should be able to find an interpreter for around 9-10 euro an hour. You can find also ask for recommendations from other expats through Facebook groups and online forums. You can find doctors under medicos on this website.
Once registered with your local GP or health centre you will receive your SIP card. This must be shown every time you use the state healthcare system, to show you are registered and eligible for free healthcare.
If you are in an area temporarily for more than 24 hours you can register as a temporary patient. This is a simple process and can be done at the surgery.
Specialist doctors
Specialists are available through the state system, but you need to be referred by your GP. If you take out private insurance you will have to check your cover. Sometimes private insurers have approved specialists you must use. Generally you will be treated quicker with private health insurance than when using the state system.
Medication
Medications in Spain are obtained at pharmacies. Hospital doctors do not issue prescriptions so you need to take your hospital medical report to the pharmacy to claim a prescription. The cost of a prescription is dependent on your circumstances. Costs are significantly lower than in neighbouring countries. The co-payment system table taken from UK government’s website, detailed above, shows the percentage of income to be paid.
Hospitals
Public and private hospitals are of a very good standard in Spain. Over half of the hospitals in the country are privately owned. Some hospitals offer both private and public healthcare. You must be clear about which service you want when you arrive. You will have to show your public health card, SIP, or evidence of private cover. The Spanish health tourism website has a list of hospitals and medical centres throughout Spain.
Chemists
Chemists are open 24 hours a day, and if there are several in an area they may work on a rota system. Pharmacists are qualified similarly to GPs in the UK and may prescribe medicines when you visit them. A lot of medicine is available over the counter. If you need a specific brand, take old packaging and the pharmacist will most likely be able to help. Many speak fluent English. The cost of medicine is a lot cheaper than elsewhere in Europe.
Controlled drugs
You must comply with drug laws from your own country, so check your own government’s website. You will also need to apply for a Spanish import license from the Spanish consulate.
It is recommended that the controlled drug remains in its original packaging, complete with your full name and address. This should be accompanied by a letter from your GP explaining the nature of your condition, the treatment and the medication and dose required. It is advisable that this should be translated into Spanish.
Dentistry
Dental treatment is not covered by the state healthcare system. Often initial consultations and examinations are free, you just need to book an appointment. It is recommended that you take out private insurance to cover dental care. You can expect to pay EUR10-15 per month. Checkups and cleaning are usually included in basic stand-alone dental plans. Discounts of up to 50% are often available on treatments such as fillings, work on wisdom teeth, root canal work, and so on.
These are the average prices for routine treatments. All prices are in Euros.
– cleaning 45
– checkup 20
– injection 20
– plastic filling (size dependent) 50-95
– 1 canal 155, 2 canals 170, 3 canals 190
– bridge 440 per unit.
Private healthcare
Although Spain’s public system is widely used and is one of the best in Europe, the more wealthy Spaniards also have private health insurance. If you are not planning on working in Spain or haven’t reached retirement age, it is suggested that you take out a private medical insurance policy.
Sanitas is the largest private health insurer in the country, but there any many available. Expats on our Facebook group recommended Sanitas, ASSSA Seguros, and AXA PPP International.
Using Sanitas as an example, a 65 year old using a mid range plan can expect to pay under €150.00 per month. For a healthy 55 year old it can be as low as €100.00 per month. This is not taking into consideration any pre-existing conditions which will of course increase the cost.
Note: This information is an overview of the Spanish healthcare system. You can find more in-depth information on the websites below.
