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Spain > Health

Spain

Expat Retirees In Spain May Have To Pay More For Their Medicine

Published Friday April 07, 2017 (15:00:09)

(c) Marie Sophie Tekian on Unsplash

Spain is one of the most popular retirement destinations in the world for several reasons. The Spanish lifestyle is a major attraction for retirees. Living in Spain enables you to savor life by taking the time to enjoy life’s simple pleasures. It is common to see people strolling on the streets or enjoying time with family and friends at the country’s many charming cafés. Retired expats will also find the Spanish warm weather a welcome change. Even though temperatures rise during the summers, the sea breeze is enough to cool you off, while winters are mild in Spain.

Spain also offers a very affordable lifestyle and is one of the least expensive nations in Western Europe. Spain, apart from having a considerable expat community, also has a warm and friendly local population. It is easy to strike up conversations with them at restaurants and bars, and once you are invited into their homes, they treat you like family.

There are more than 5.5 million foreign nationals living in Spain currently, making up nearly 12 percent of its population. Much of the country’s expat population consists of British nationals, while the number of Americans heading to Spain is also increasing. Numerous expat retirees have made Spain their home, preferring to spend their golden years in the country’s near-perfect weather, low living costs and relaxed lifestyle.

Spain was particularly hit by the banking crisis of 2008 and was among the countries with the shakiest economies in the Eurozone, along with Portugal, Ireland, Italy, Greece and Spain. On account of the crisis, jobs were unavailable, property costs dropped and a number of native and expat residents relocated to other countries. Many left because they couldn’t find jobs or keep their businesses running due to the rocky economic situation.

Of course, those considering retirement in Spain would not be looking for jobs. But retirees wondering if their pension and combination of savings will be adequate for their retirement in Spain should consider a couple of recent occurrences; real estate costs remain low by nearly 30 percent from their high point in 2007, and the dollar has become stronger against the euro than it has been for a considerable number of years. Both these phenomena make Spain a more affordable destination with $20,000 enough for a frugal lifestyle in Spain and $25,000 for a more comfortable retirement.

The two major financial concerns of most retirees are housing and medical care.


Housing


(c) Patrick Baum on Unsplash


The Spanish property boom led to dramatically high costs when it came to both buying and renting property. This has changed over the years and Spain currently offers good value for money. But the costs vary significantly due to the large size of the country. Properties closer to the coast cost more as the beaches in Spain are popular among natives and foreigners alike. The most expensive real estate is the short-term summer rentals by the coast. In the lively resort town of Marbella, a one-bedroom apartment can be rented for about $500 to $572 a month. Long-term leases are more affordable. The costs of real estate can vary from $206 to about $250 per square foot.


Healthcare

Spanish residents qualify for the state-run public healthcare program, although many expats choose private insurance to skip the long waiting times for non-emergency treatments.

However, retirees who are receiving higher pensions may have to pay more for their medicines. Dolors Montserrat, the Minister of Health, Social Services and Equality, wishes to ‘adjust’ the pharmaceutical co-payment for those retirees that come under the income range of 18,000 to 100,000 euros. Studies have shown that almost 20 percent of pensioners stop purchasing medicines that are prescribed to them, as they can’t afford them. But some experts maintain that the statistics can be attributed to the trend that a number of pensioners are being prescribed too many medicines and that no adverse effect would occur if they gave them up.

As of now, all retirees pay 10 percent of the total cost of their medicines. This is until they reach 18 euros, which is the monthly limit. Those pensioners who receive a minimum or contributory pension are exempted from copayment. They pay up to 8 euros per month if they receive an amount lower than 18,000 euros; 18 euros per month if they get 18,000 to 100,000 euros, and 60 euros per month if their incomes amount to higher than 100,000 euros.

It is this last category that the ‘adjustment’ will target, that is, those who receive between 18,000 and 100,000 euros. The Ministry of Health aims to create a couple of more intermediate sections, 18,000 to 30,000, from 30,000 to 60,000, and from 60,000 to 100,000 euros. It is speculated that the co-payment will most likely change for the range between 30,000 and 60,000 euros of income. The maximum that a pensioner can receive from the state is 30,000 euros. If it exceeds this, it implies that they have other sources of finance such as real estate, rents, stocks or deposits. If these changes are carried out, it could present a problem for retirees in Spain and therefore it is advisable to hire an accountant or lawyer to help navigate these legal issues.

Spain’s healthcare system is known to be of a high standard and consists of public and private facilities. All residents who have a Spanish social security number and the proper documentation qualify for free or subsidized healthcare. Spain is divided into 17 regions and each region is responsible for the implementation and execution of health services within their jurisdiction. For this reason, expats may discover that medical care provisions vary slightly, depending on the location.


(c) Michael Wilkin on Unsplash


Those working or living in Spain are likely to have access to the country’s free public healthcare, which is funded partly by social security payments, which are deducted from wages. Spain’s healthcare system is frequently ranked among the world’s best. It guarantees universal coverage without any upfront expenditure from patients besides contributing a part of prescription charges. The country spends nearly 10 percent of its GDP on healthcare. Spain’s healthcare system is ranked 6th in the European Union for its doctor-patient ratio, which is around four doctors per 1000 people.

The healthcare care system in Spain is made up of public and private healthcare, with some hospitals and healthcare centers providing both state and private healthcare. It is not necessary to have private health insurance in order to receive medical care, but it does offer the benefit of quicker treatment for non-emergency services.

Spain’s state healthcare is free to all those living and working in the country. But, those living in some of the Spanish islands may have to travel to find a public healthcare provider. Pensioners are eligible for free state healthcare. Those who are not contributing to social security can avail of private health insurance or pay the full amount of medical costs.

EA, EEA and Swiss nationals who have attained retirement age in their home country are eligible for free healthcare in Spain. In order to qualify they require a Form S1, which was earlier known as E121, from their country of residence. It is advisable to obtain this form prior to arrival in Spain as it simplifies the registration process. The S1 form must be filled in and presented to the local INSS - Instituto Nacional de Seguridad Social (National Institute of Social Security) along with your registration certificate, local resident certificate and passport. You will receive an accreditation that you can take your local health center. Once you obtain your S1 form and have registered it in Spain, you can also return to your home country and receive free treatment, just as those who are ordinarily residents there.

EU nationals living in Spain for shorter durations can avail themselves of medical treatment by using their European Health Insurance Card (EHIC). This enables them to receive healthcare at the same cost as Spanish nationals. Non-EU/EEA citizens may have to show proof of their private health insurance before being granted a visa. Spain has bi-lateral health agreements in place with some non-EU countries and it is advisable to check your entitlements with the consulate or embassy in your country of origin before arrival in Spain.

Those who have a European Health Insurance Card (EHIC) are entitled to free healthcare during their time in Spain, for the initial three months of their residence. This helps to cover any required immediate treatments. Non-immediate treatment, however, may incur charges. The EHIC only covers public healthcare and not private, so it is important to ensure that the facility you attend is aware of this, especially at places where both public and private healthcare is offered. If you require an ambulance, you need to make sure that it takes you to a facility that offers treatment that the EHIC will cover.

Primary healthcare in Spain is carried out through a health center (centro de salud or centro de asistencia primaria or CAP) or a general doctor (médico de cabecera). You need to register before you can see doctor. A health center is likely to have around six doctors and you may see a different one each time you visit. There are some centers where you can choose to see the same doctor, especially if you are under ongoing treatment.

Doctors may offer public and private healthcare, and patients can choose which type of healthcare they would like to receive. There may also be different surgery times for public and private patients. A leaflet called Carta de Derechos y Deberes (Charter of Rights and Obligations), which lists out the rights of a patient, is handed out. At most health centers, you can make an appointment to see a doctor. Doctors with their own practice may follow a first-come-first-served basis. You can change your doctor by re-registering.

Your family doctor will refer you to a medical specialist if there is a need. Private health insurance will enable you to see a specialist much faster than going through the state-funded system.


(c) DarkoStojanovic on Pixabay


In case of emergencies, you can directly visit a hospital or emergency room (Urgencias). For any other kind of hospital treatment, you need a referral from your doctor. You need to present your social security card or proof of private treatment during hospital visits. Hospital doctors do not issue prescriptions, and therefore upon discharge you will need to take the hospital medical report to a pharmacy to obtain your medication. Although it is not guaranteed, it is possible to find a doctor or nurse who speaks English in most hospitals. If this is not possible, most health centers provide an interpreter at a cost of approximately 12 euros per hour. But there are also some regions where doctors do not treat patients who cannot speak Spanish, unless they have an interpreter with them, as it can increase the diagnosis time. Most private hospitals have English-speaking doctors.

You can present your prescription to any pharmacy. Pharmacies in Spain have a large green cross sign on the outside, and are open from Monday to Friday from 9.30am to 2pm and 5pm to 9.30pm, and Saturdays from 9.30am to 2pm. There are also 24-hour pharmacies and most pharmacies have a notice outside providing details of the nearest one.

As mentioned earlier in the article, the norm has been that state pensioners pay 10 percent of the cost of prescription medicines unless their wages are over 100,000, in which case they are required to pay 60 percent. If the Ministry of Health carries out the adjustments, pensioners who receive an income between 30,000 and 60,000 euros will have to pay more for medications. Registered pharmacists are also allowed to offer health consultations and guidance on health issues.

Spain’s public healthcare system does not cover dental treatment unless it is an emergency. Therefore you will need to pay for dental treatment if you do not have private health insurance.

Ambulance services in Spain are both public and private, and both are known to provide timely and efficient medical care. The number for emergency services is 112. Operators are usually able to communicate in English.


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