The Public Health Care System in Spain
The Spanish healthcare system is one of the best in the world and is free for all the residents in Spain. The healthcare system is funded through security payments. All employees and self-employed workers in Spain must pay income tax and this money is used to finance the healthcare system. The contributions they make entitle them to public healthcare. With public health care you are covered for treatments by doctors and hospitals, as well as 40% of the bill for prescriptions.
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Who is Public Health Care for?
Since 2015, illegal immigrants and foreigners who are not registered at the Spanish tax office have the right to make use of the healthcare system as well. Before, by regulations, those 2 groups were excluded from the healthcare system. So the following groups have access to the Spanish public healthcare system:
- Employees
- Self-employed workers
- Illegal immigrants
- Unregistered foreigners
However, they are some additional conditions, depending on your situation:
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EU/EEA and Swiss Nationalities
The people who reached their retirement age in their home country and are from the EU/EEA and Switzerland are eligible for free healthcare in Spain. The only thing they need to do is to get a S1 Form in the country of residence. This form was used to be known as E121.
European Health Insurance Card
If you are staying on a temporary basis in Spain and are an EU citizen you can use your European Health Insurance Card, abbreviated as EHIC. This allows you to receive medical treatment at the same cost as Spanish citizens. The EHIC is displayed at the reverse of your own health card.
Pay Attention: Your EHIC only covers necessary care, as with a emergency. Planned treatments are normally not covered by your insurer. Since the compensations and conditions differ for every insurer, we recommend you check those before taking any treatment.
Non-EU citizens
If you are a Non-EU citizen you might have to prove that you possess a private health insurance. In some cases this is not necessary, when there is a agreement between your home country and Spain. Contact the embassy to find out whether such an agreement exists for you.
Students
Students from the EU that are going to study in Spain are covered by their EHIC (see ‘EU/EEA and Swiss Nationalities’). If you are a student from outside the EU and are going to study in Spain then you might have to take a private health insurance.
How to register for Public healthcare?
In order to register for public healthcare in Spain you should get a Social Security Number. This number is used to make social contributions which are automatically deducted from your wage. Next to that, the employers make some contributions as well. The social contributions from the employees and employers are used to finance the public healthcare system. The government determines the contribution rates every year.
The article below tells you step by step what you should do and which documents are required to get your social security number. Pass this number on to your employer and they will take care of the obligated social payments. The process itself is easy and there are many offices to go to. Within 30 minutes you could have your social security number and there is no need to make a appointment.
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How to get your Social Security Number in Barcelona 
Alice Nabokova 29 Jul 2014 How do I get my Social Security Number in Barcelona and the rest of Spain?
Public health card
However, a social security number alone is not enough. You should also get a ‘Tarjeta Sanitaria Individual (TSI)’, the public health card. All you need to do is to take your social security number (or actually the paper with the number on it), empadronamiento and an identity document and go to the closest health centre. The health centres are called Centro Salud. You can bring your passport, DNI, NIE or driving license as an identity document.
Pay Attention: Every single time you visit a public health service (asistencia sanitaria pública) or purchase a prescription you need to show your public health card. So it’s important to bring your card! The TSI itself is valid for 4 years!
What is not covered by Public Health Care?
Visiting a dentist is not covered by public health care and thus you should find private dental insurance or just pay everything yourself. The latter is a valid option given that the dentist fees are relatively low and of decent quality. On the other hand dental insurance is about 10 to 20 euros a month. Is that worth the risk? If you want to know more about dentists in Spain, you should have a look at this article by Expatica.
Moreover, visiting specialists, a surgery with an overnight stay is (probably) not covered by public health care or just to a limited amount. That implies that you should pay the rest and then maybe a private health insurance could be a good idea to cover you for these expenses. You will read more about private health insurance in Spain below.
Private Health Insurance in Spain
As well as public health care, you could also opt for (additional) private health insurance. With private health insurance you can cover expenses that are not covered by the public health care. Especially for older people that tend to make more use of additional care facilities, private health insurance is an option to consider. In this case we recommend thoroughly thinking about the care that you need before you close a deal.
Why Private Health Insurance?
As previously mentioned, you could opt for private health insurance to cover expenses that are not covered by public health care. Next to that there are several other advantages of private health insurance:
- Long waiting times: As the image above illustrates the average waiting time in days for certain treatments is quite long. With private health insurance you will be treated faster. In the last few years, people using private health insurance increased by 5%, likely as a result of the long waiting times.
- Higher quality care: Some people argue that the quality of private health institutions are higher than those of public ones. I cannot deny nor confirm that, but in general the public health care system is of high quality as well.
- Language: With private health insurance you can visit doctors and specialists that speak English or even your native language. This could be especially useful for people who don't speak Spanish.
Drawbacks of Private Health Insurance
So private health insurance is the best? Well, no actually. Private health insurance has some drawbacks as well. The major drawback of private health insurance is the limited choice of care providers. Private health insurers tend to have agreements with only a limited amount of hospitals, doctors, dentists and so on. Moreover, private health insurance does not cover you for all (and the whole expense of) treatments. And last but not least: private health insurance is more expensive given that public health care is for free. The best option could be to use both public health care and private health insurance.
Private Insurances providers
Spain has a lot of big private health insurance companies. To find out which one is the best for you we recommend you visit the different pages of the private insurance companies and have a look at their care packages and conditions. Furthermore, visit Brokerfish to discover the best private health insurance for you. By filling out your details, the web page will automatically provide an overview with the best insurance options. To mention a few:
How to submit a claim?
The procedure depends on your private health care provider. With unplanned treatment you could be asked to pay upfront and later on your private health insurance company will reimburse the (whole) expense. However, with planned treatment you may have to make a copy after which the rest of the care is covered by your insurance company. Or you might receive an additional bill after the treatment.
