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National Health System for Expats in Spain

Submitted: July 2013

The National Health System (SNS) is Spain’s public healthcare service. It is a subsidised public service, though charges may apply for medications.

Spain is a regional state (Estado de las Autonomías). Healthcare is within the jurisdiction of regional governments. Consequently, there are 18 separate health administrations in Spain (one for each of the 17 regions, and one at national level).

Although the right to health is guaranteed by the Constitution, austerity cuts in Spain have not spared healthcare. On 20 April 2012 came into force Royal-Decree Law 16/2012. Harsher medication charges have been implemented (see below), and more unregistered foreigners are now being refused subsidised healthcare in public facilities (some regional governments are resisting the move).

A private medical insurance policy might supplement SNS services. See Health Insurance for Expats in Spain.

SNS entitlement

An expat in Spain should always be registered with his local health authority and seek a medical card (tarjeta sanitaria individual). SNS Entitlement (asistencia sanitaria) is generally conditional on being affiliated to social security, and social security contributions may apply. You should check your social security status before moving to Spain.

You are expected to register with your local health authority even if you are entitled to SNS services but are not paying Spanish social security contributions, e.g. if you are paying social security contributions in another EU country and you have a portable document S1 issued by your country of origin.

You are covered by the social security (condicion de asegurado) if:

You are entitled to the SNS, even if you are not covered by the social security, if:

If you come from a country outside the EEA or Switzerland, you might wish to check your social security agreement with Spain. Spain has concluded treaties with Andorra, Argentina, Australia, Brazil, Canada, Colombia, Chile, Dominican Republic, Ecuador, Japan, Mexico, Morocco, Paraguay, Peru, Philippines, Russia, Tunisia, Ukraine, Uruguay, US, and Venezuela.

Medication charges

As a Spanish resident, your local pharmacist may charge you a contribution towards the costs of your medications. This does not apply if you are on disability or means-tested benefits, or if you are no longer entitled to Spanish contribution-based jobseeker’s allowance. No charges should be paid by victims of the Toxic Oil Syndrome.

The amount you have to pay depends on your work status and your annual income for Spanish income tax purposes (IRPF). From 20 April 2012, it is calculated as follows:

Annual income

Work status

Contribution rate (%)

Contribution cap (€)

€17,999 or less

Working age



Receiving Spanish state pension



€18,000 to €99,999

Working age



Receiving Spanish state pension



€100,000 or more

Working age



Receiving Spanish state pension



Unconditionally free services

Some services are always free of charge, even if you are not entitled to SNS services. These include:

European Health Insurance Card (EHIC)

If you come from another EEA country or Switzerland, the EHIC normally grants you access to public healthcare on the same conditions as Spanish residents while you are temporarily visiting Spain, unless you specifically come to Spain to seek treatment. However, your EHIC may be invalidated by your country of origin if you are no longer residing there.

It is generally advised not to rely solely on your EHIC. European Expats should therefore seek health or travel insurance to supplement their EHIC.

Over the recent years, a large number of EU expats have been victims of some Spanish public hospitals (See Doctors and Hospitals for Expats in Spain) who reject EHICs and ask expats to pay upfront, even if it is for services that are free for Spanish citizens. The European Commission is currently in dispute with Spain regarding this matter.



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