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Health Insurance In Spain: A Guide For American Expats

Moving abroad is a tricky proposition from all angles, but healthcare is one of the main worries people state when they are considering making an intercontinental move. If you’re moving from the USA to Spain, you might be wondering about the quality of healthcare available, how to sign up to the healthcare system there, and whether and how to take out private health insurance, either as a supplement to your national health care or instead of it. Below, we will take a look at the options that are open to you and how to apply.

Spain spends more money than neighboring European countries on its public health, at around 10% of its GDP.

Hospitals and health services are of good quality and some offer both public and private healthcare.

It is vital to state which service you require beforehand to avoid being left with a hefty bill.There are many reasons why expats purchase private health insurance in Spain, for example:

• They are unable to access the state benefits system, i.e retired early and not paying into the state system.
• Significantly lower waiting times for non-emergency treatments.
• Generally better care in hospital, with regards to food and comfort.
• Multilingual doctors, nurses and surgeons.
• High standard of professionalism.
• Often dental cover is included.

Sanitas is a hugely popular health insurance provider amongst the expat community. Their website is very simple to use. This grid details all of the benefits and hidden costs, and you can easily compare the plans. Those who have held private health insurance with any BUPA group worldwide for over a year are able to transfer their current policy to Sanitas.

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The cost of private insurance is generally calculated based on your age, your medical health and the geographical area in which you require cover. If you have pre existing health complications or need regular treatment you can personalise your plan. Here are some examples of health insurance plans available from Sanitas, at the cheapest available prices.

• HealthPlan Basic from 13 Eur PM – Recommended if you have Spanish security cover and wish to access consultants, GPS and outpatient appointments quicker than using the state system. It also comes with basic dental cover and up to 10,000 Euro medical insurance costs whilst overseas. It does not however cover you for surgery or hospitalisation.
• Mas Salud from 25 Eur PM – One of the most popular plans which includes dental treatment, hospitalisation, general medicine and outpatient surgery.
• Healthplan Classic 43 Eur PM – Ideal plan for those expats living or planning to live in Spain. Perfect for people without other health cover as it covers all eventualities. As it is so reasonably priced there are co-payments on the policy such as eur 12 for each diagnostic test taken.
• HealthPlan complete 91 Eur PM – The plan for expats living between countries. Note if your second country is the UK BUPA covers you 100% under this plan. There are no co payments and up to Eur 500,000 in 2 Eurozones.

The above are quotes from one insurance provider; many others are available. For more details and other insurance options, visit our quotes page.

What to look for in an insurance plan

• The size of the network of hospitals, doctors and medical facilities you can choose from.
• The deductible and co-payment amount
• Whether medical evacuation is offered
• The plan’s cancellation period
• Comparison between local, private and international health insurance plans
• Is 24/7 support available?
• Available in your native language
• What pre-existing conditions are excluded

Many expats opt to take out international health insurance before moving abroad. Some expats in Spain report that they have had problems regarding health cover when they first arrive as they need to have been paying into social security for 3 months before being eligible for free healthcare courtesy of the state.

Local vs international insurance


If you are residing in Spain permanently and do not intend to be moving around Europe for longer than 3 months at a time then a basic policy from any of the leading insurers should be satisfactory. Local health insurance plans will generally cover you for:

• Hospital care
• Surgery
• Emergency dental treatment
• General consultation fees
• Cancer treatment.

You can personalise your plan to include things necessary for you, such as physiotherapy, cost of prescriptions, psychiatric support etc. Some local plans will cover you when you travel abroad, typically only up to 3 months. There may also be restrictions on how many countries you can visit. For EU residents an EHIC card will entitle you to reduced or free healthcare for the first three months of your stay in an EU country. It must be noted that the healthcare covers only necessary treatments; medical conditions that do not require immediate treatment may incur charges.

Local cover categories explained

First category – includes an extensive list of doctors, specialists, medical centers and hospitals. Just show your card to say you have the premium insurance to the approved center and the invoice will be made directly to your insurance provider. There are certain treatments and procedures that may need prior authorisation, so always check first! This information will be in the small print of your policy or available via the website or helpline.

Second category – in addition to the list of specialists the policy holder is also able to seek any healthcare specialist not on the list (often includes inside and outside Spain). Up to 90% of the invoice will be reimbursed. Again it is strongly recommended that you consult with your insurer before you begin any treatments as approval will be needed.


If you are in a situation which means you will be moving between countries frequently and spending extended periods of time abroad, a comprehensive international health insurance package is recommended. International plans generally cover for a range of eventualities, treatment of injuries and evacuation in an emergency. As well as this, they will cover the basics of hospital care, surgery, consultation fees, dental treatment and so on.

It is worth noting if you are travelling to regions that are less developed and where the level of medical care is limited it is advised to take out insurance that includes medical evacuation. This type of cover will allow you to be transferred to more advanced medical facilities.

Things to note

• Always compare policies. Type in your spec then allow the internet do the hard work. Popular health insurance comparison websites include Rastreator and Acierto. Note: if they don’t automatically translate to English right click and then press translate. Alternatively, contact Expat Focus’ partners for an individual quote.
• The minimum contract is usually 12 months and this will be renewed automatically unless you cancel a month before your contract is due to expire.
• Not fluent in Spanish? Then make sure you get your health insurance policy documents in English.
• Paying high excess can reduce premiums considerably. Also paying half of the yearly cost upfront and the rest in monthly instalments can significantly reduce the cost.
• Depending on the plan you chose it is often company policy to receive Eur 50-70 per day you are hospitalised.

Recommended websites for expats seeking private health insurance:
• Expat Focus
• Health Plan Spain
• Private Healthcare Spain
• Inovexpat
• Cigna Global

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