The Spanish healthcare system for foreign residents

Healthcare is one of the first concerns of any foreigner moving to Spain. Will I have a doctor? How much does it cost? Do I need private insurance? The answers depend on your legal and employment situation. This article orders them so you know exactly which route applies, what it covers and what it does not.

The National Health System (SNS): how it works

Spain has a universal public health system — the Sistema Nacional de Salud (SNS) — managed by the autonomous communities. In the Valencian Community, the service is called Conselleria de Sanitat Universal i Salut Pública. Care quality is high: well-equipped public hospitals, accessible primary care and subsidised pharmaceutical coverage.

Access is through the Tarjeta Sanitaria Individual (TSI) or SIP (in the Valencian Community), your 'health card'. With it you can access: GP and specialist consultations (by referral), A&E, hospitalisation, surgery, subsidised prescriptions (with income-based co-pay), vaccination programmes, mental health and maternity care.

Three access routes for foreigners

Route 1 — Working in Spain (the most direct)

If you work legally in Spain — employed or self-employed — you are registered with Social Security, and you and your direct family (spouse and children) have full SNS access. No additional private insurance is needed for basic healthcare.

How to get the card: with your Social Security affiliation number, visit the health centre in your area and request the SIP/TSI. Choose your GP (médico de familia) — they are your gateway into the system.

Route 2 — Convenio especial (for residents without employment)

If you legally reside in Spain but do not work (retirees on a non-lucrative visa, rentiers, reunified family members who do not work), you can access the SNS through the convenio especial (special healthcare agreement).

Requirements: at least 1 year registered on the municipal roll, no SNS access via another route, no public health insurance from another country covering Spain.

Cost:

• Under 65: ~€60/month.
• 65 or over: ~€157/month.

The agreement gives access to the same benefits as an insured worker: primary care, specialist, A&E, hospitalisation and pharmacy with co-pay.

Application: at the INSS (National Social Security Institute) office or online via the Social Security e-office.

Route 3 — Private health insurance

If you have just arrived and do not yet meet the 1-year registration requirement for the convenio, or prefer broader or faster coverage, you need private health insurance.

Private insurance is mandatory for certain visas: non-lucrative, digital nomad and student visas.

What it must cover: full coverage with no co-pay (the authorities reject policies with high co-payments), hospital, outpatient, A&E, no significant exclusions or waiting periods, issued by an insurer authorised to operate in Spain.

Indicative cost:

• 25-40: €50-90/month.
• 40-55: €80-150/month.
• 55-65: €120-200/month.
• 65+: €180-350/month (fewer options, prices rise significantly).

Popular insurers among foreign residents on the Costa Blanca: Sanitas, Adeslas, Asisa, DKV, Caser.

Public vs private: the practical comparison

Public healthcare

• Cost: free (if working or 1+ year registered with convenio). Prescription co-pay 40-60 % by income (pensioners: 10 % with cap).
• Quality: high in primary care and A&E. Alicante's public hospitals (Hospital General, Hospital de San Juan) are well regarded.
• Waiting times: the main drawback. Specialist consultations: 2-6 months. Diagnostic tests: 1-3 months. Non-urgent surgery: 3-12 months.
• Language: in Spanish. Few professionals speak fluent English, though areas with large foreign populations (Torrevieja, Jávea) show more adaptation.

Private healthcare

• Cost: the monthly premium + occasional co-pays.
• Quality: variable. In Alicante, Clínica Vistahermosa, Hospital Internacional Medimar and IMED Levante are reference centres.
• Waiting times: significantly shorter. Specialist in 1-2 weeks, tests in days, surgery in 2-4 weeks.
• Language: many Costa Blanca private clinics have staff speaking English, German, Russian or French — a primary reason foreigners choose private.

The most common combination

Many foreign residents use both systems: public for A&E, hospitalisation and surgery (where public care is excellent and free), private for specialist consultations, fast diagnostics and care in their language.

European Health Insurance Card (EHIC)

If you are an EU/EEA citizen moving to Spain, during the transition period you can use the EHIC from your home country for necessary healthcare at public centres. It is not a substitute for registering with the Spanish SNS — it is temporary cover.

For EU retirees receiving a pension from another member state, the S1 form transfers your healthcare entitlement from your home country to Spain. With the S1 registered with Spanish Social Security, you access the SNS without a convenio and at no extra cost.

Emergencies: always treated

A fundamental point: in Spain, emergency care is guaranteed for everyone, regardless of nationality, immigration status or insurance. If you have a medical emergency, go to the nearest hospital A&E. You will always be treated. Billing (if you have no cover) is resolved afterwards — emergency care is never refused.

Spain's emergency number is 112 (covers police, fire and ambulance).

Pharmacies and medication

Spanish pharmacies are among Europe's most accessible. Every Costa Blanca town has at least one, identifiable by the green cross. Usual hours: 9:30-14:00 and 17:00-20:30 (Monday to Saturday). A duty pharmacy system covers nights, Sundays and holidays — the nearest duty pharmacy is displayed on a notice at each pharmacy's door.

With a SIP card, prescribed medicines have a subsidised co-pay (40-60 % for workers, 10 % for pensioners with a monthly cap). Without a card, you pay the full retail price.

Frequently asked questions

Can I choose my GP?

Yes. When registering at your health centre, you can choose a family doctor from those available in your area. If unsatisfied, you can request a change.

What if I do not speak Spanish in a consultation?

Public healthcare is in Spanish. Options: bring a companion to translate, use a translation app, or request an interpreter (some large hospitals offer this, but it is uncommon). In Costa Blanca areas with large foreign populations (Alfaz del Pi, Torrevieja, Jávea), health centre staff often have some English.

How much does an A&E visit cost without insurance?

If you attend A&E without cover, you will be treated and receive a bill afterwards. An A&E visit at a public hospital can cost €200 to €2 000 depending on complexity. Hospitalisation can exceed €5 000. This is the main reason health insurance — public or private — is not optional.

Do residents' children have automatic access?

Yes. Under-18s registered on the municipal roll have SNS access regardless of their parents' employment or insurance status. It is a universal right for minors. They only need to be empadronados.

Can I use my home-country private insurance?

It depends on the policy. Many international insurers (Cigna Global, Bupa International, Allianz Care) cover care in Spain, but the Spanish authorities do not accept them as a substitute for the mandatory insurance required for visa applications. You need a policy issued or validated by an insurer authorised in Spain. Once you have the visa and residence, you can supplement with your international insurance if desired.

If you are planning your move to the Costa Blanca and want healthcare sorted, explore our available properties or contact us for a personalised consultation.