Spain has a reputation for having one of the best national health services in Europe. How can you make sure you can access it if you come to live here? Caroline Clinton explains what the options are.
For those people considering coming to live in Spain permanently, how to access the health care in Spain is one of their main concerns. Most people want to take advantage of the state run health service if they can. It has got a good reputation and rightly so. However, there has been confusion at different times about who is and who isn’t eligible. This article aims to clarify the situation at the time of writing.
Working in Spain
If you are contracted to work in Spain then you will be entitled to health care here and your employer will pay your contribution. You can also register as being self-employed or autonomo in which case you pay a monthly fee for social security. This is a contribution towards a state pension in Spain and entitles you to a health card. Your family will also be covered for health care including your spouse and children.
You should note that resident children and pregnant women are automatically entitled to health care in Spain whatever their status.
Retiring to Spain
If you are in receipt of a state pension or long term sickness benefit from many European countries then you are entitled to Spanish health care. You need to get an S1 form (UK) or E121 if you are Swedish. This is available from the International Pension Centre on +44 191 218 7777 if you are from the UK. Once you have this you can register the form with your local INSS office in Spain and then you will be able to register with your local GP surgery and receive your SIP (health card).
Early-retirement in Spain
If you registered as a resident in Spain before 24th April 2012, have an annual income of less than €100,000 and are not covered by health care in any other country or by any other means then you are eligible to register for health care in Spain. In order to do this you will need to speak to your local INSS office (Instituto Nacional de Seguridad Social-Oficina).
Until 1st July 2014, early retirees were also able to apply for an S1 form based on their national insurance contributions. However, this is no longer the case and if you come to live in Spain now as an early retiree you must make your own health care arrangements. There are a number of private hospitals in Spain and plenty of insurance options to enable you to pay on a monthly basis for the health care you might need whilst you are here.
If you have a pre-existing condition then this option can be closed to you. However, there is another alternative that you can sign up to. Many Spanish regional health authorities offer a special pay-in scheme (convenio especial) which you can pay for on a month-by-month basis. Of course, this isn’t only open to early-retirees but to anyone who doesn’t have any other entitlement.
The basic monthly fee is €60 for those under 65 and €157 for those aged 65 and above. However, your prescription costs are not subsidised under this scheme and you need to build this into your calculations. Nor will you be issued with an EHIC card equivalent (TSE in Spain) and you will need to take out private insurance if you travel to another country, including your home country.
In order to access the scheme you must:
- be registered on the padron
- have lived in Spain continuously for a period of at least a year before applying.
- not be in receipt of public health care in any other country
The fees are paid by direct debit from your bank account and this must be under the same name as the person benefiting from the scheme. If you would like to apply for this scheme you must contact the Regional Directorate of the Ministry of Health of the province where you are living.
Obtaining your SIP card
In many ways the medical service in Spain operates in the same way as it does in most other European countries. You have your local GP surgery – here called a centro de salud – and you will be allocated a specific doctor who will be your first port of call for any health concerns you have.
Other services take place in your health centre too such as the taking of samples for further investigation, advice from the nurse and vaccination. If you should need more specialist help you will be referred to a specialist at the local hospital.
Depending on your level of Spanish you will need to take a translator with you. Although many doctors in Spain do speak at least some English and in tourist areas you might be lucky enough to have a fluent English speaker.
If you do decide to live in Spain, making sure that you are adequately covered for your future health care needs must be paramount in your planning. We hope this advice clarifies what can be a confusing range of options.