Spain Explained

Healthcare for retired expats in Spain: Who’s entitled?

Last updated on June 5th, 2020 at 06:45 pm.

One of the main concerns for anyone coming to live in another country must be ‘how will I obtain the healthcare I need?’. This is particularly the case where you are perhaps a little older in years and know that more, rather than less, healthcare is on the horizon. Learn more on the healthcare for retired expats in Spain in the following post.

Healthcare for retired expats in Spain

The situation has been precarious for those moving to Spain as their country of choice. State healthcare in Spain is generally considered to be good. It deserves this reputation and most people who have had direct experience of it speak highly of the care they have received.

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However, it comes at a cost. Like many countries, Spain has become concerned that the Spanish health service is being taken for granted. Amid fears of ‘health tourism’ it was announced in August 2012 that foreigners in Spain without residency or work permits would no longer receive free Spanish healthcare. This would  exclude children and pregnant women and emergency services would still be free.

At the same time residency became more difficult to obtain. Not only did you need the necessary passport and NIE documentation but to prove that you would have some form of healthcare when you arrived in Spain.

Regional governments protested and organisations such as ‘Yo Si Sanidad Universal’ have grown to advise those no longer eligible. It’s claimed that the new, more restrictive approach, is saving money and clarifies the situation for everyone. But what could you do if you weren’t eligible?

Healthcare in Spain: The state insurance scheme

To compensate a little for the crackdown it was announced that there would be a state-run insurance scheme (convenio especial) that would be available to everyone, at a price.

This national scheme would require a monthly subscription in order to guarantee access to the healthcare in Spain. It would not, however, cover the cost of medicine or health transport services.

The scheme is managed by each autonomous region and accepts people with pre-existing conditions. The basic monthly fee is 60€ for those under 65 and 157€ for those aged 65 and over. Of course, most people aged over 65 will be in receipt of a state pension and so entitled to state healthcare anyway.

El País reports that only 300 people have taken out the insurance so far. This was particularly surprising as something similar had already been operating in the Valencian region with a good degree of success.

Perhaps its lack of success could partly be attributed to the fact that many expats discovered that they were already eligible for state healthcare in Spain, without knowing it.

Resident before 2012

Although the requirements for healthcare were tightening up for some, they were relaxing for others.

Those early retirees resident in Spain before 2012 discovered that they   could access Spanish national healthcare for free provided:

  • they didn’t have an income of more than €100,000 annually
  • they could produce a letter to indicate they weren’t eligible for healthcare elsewhere

There must have been mixed feelings for those who were already paying into private health insurance or the Valencian health insurance scheme.

Resident after 2012

So, what healthcare can you access if you are considering moving to Spain and will not be eligible through employment?


If you are receiving a state pension or are on long term sickness benefit, then you are entitled to healthcare and should obtain an S1 form (previously E121) from the international Pension Centre on 0044 191 218 7777. Once it has been issued you should register the S1 form with your local INSS office.

Early retirees

There are two alternatives:

  • Option 1 – you can take out private health insurance.
  • Option 2 – the convenio especial – state-run insurance scheme

For those people with a pre-existing condition, the convenio especial may be the only option in the future.  The residual S1 (formerly residual E 106) previously provided temporary healthcare for early retirees. From July 2014, its issue has been withdrawn by the UK government.

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And finally

It is a little ironic that the very measures that were taken to restrict healthcare access in Spain actually opened the door for many expats who had thought themselves ineligible. An outcome that those devising this policy had probably not foreseen.


If you were registered as a resident in Spain prior to 24th April  2012 and have an annual income less than €100,000 then you should speak to your local INSS office to register for healthcare in Spain as a resident.

More information on the Healthcare for retired expats in Spain


El Pais in English: – Healthcare in Spain

NHS choices – Update – residual S1 forms for early retirees:

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Chris Clarke

4 October, 2018 12:06 pm

I am 65 and have submitted my
I am 65 and have submitted my S1 for healthcare, my wife is 59 years old is she covered on my S1

Suzanne O'Connell

10 October, 2018 11:45 am

Hi Chris

Hi Chris

Yes, she will be covered as a dependent

bernard frankland

4 February, 2019 4:42 pm



Suzanne O'Connell

6 February, 2019 2:00 pm

Hi Bernard

Hi Bernard

Yes you can transfer the S1 form but you must apply for the Spanish residency card first.


10 February, 2019 10:33 am

Hi, I have a complex
Hi, I have a complex situation and details:- My wife is a Spanish National, over 65 who lived & worked in the UK for 30+ years, receives a UK State Pension and has made contributions to the Spanish HealthCare (NHS equivalent) for only 6 months. I am English, retired, aged 70 & receive a UK State Pension & a Contributary Private Pension. Can my wife receive FREE Spanish Healthcare??

Suzanne O'Connell

18 February, 2019 1:35 pm

Hi Patrick

Hi Patrick

Yes, she can receive free Spanish health care as long as she obtains her residency card and gets everything registered properly at the social security office. 

Michael b

26 May, 2019 10:13 am

My wife and I are early
My wife and I are early retirees ( under state pension age) living in Spain. I have a local authority pension on which I pay tax in the UK ( no choice given) I was medically discharged from my job and was on disability allowance in the UK. When I contacted DWP they stopped my disability allowance saying it was my choice to live abroad. ( we initially moved to France). Am I correct in thinking the only way I can get health cover is under the convention especial after living in Spain for 12 months.
I have attempted to register with a local doctor but they will not entertain us without a social security number and we can’t get one of them.

Suzanne O'Connell

1 June, 2019 4:11 pm

Hi Michael

Hi Michael

Since you are not on a state pension yet, it looks as though you will have to take private insurance to apply for the residency cards. Then after a year, you will be able to get on the public system paying a monthly fee. 


10 June, 2019 8:08 am

Hi me and the wife are moving
Hi me and the wife are moving to Spain in September I’ve retired early my wife will have a work contract so she will automatically get Spanish health care will I also get Spanish health care with my wife working ?

Suzanne O'Connell

20 June, 2019 8:57 am

Hi Alan

Hi Alan

Yes, your wife will automatically get Spanish health care but you will need a Spanish residency card to obtain yours. 

gary walker

11 July, 2019 1:19 pm

hello, my wife and myself
hello, my wife and myself have recently bought a property in Pedralba Valencia and have been living here for approx 3 weeks, I am 61 years old and have retired early although i may go back to work in the future, my wife does not work, i dont have any pensions and my wife has a very small monthly pension. i have a rental property in the UK which along with my wifes pension gives us approx £400 per month. what healthcare options are available to us, do we need to take out private healthcare or does the S1 cover us, or can we join the Spanish healthcare system for a monthly fee.

Suzanne O'Connell

17 July, 2019 6:10 am

Hi Gary

Hi Gary

The first thing you need to do is to obtain Spanish residency. Then, whether you can join the Spanish health care system, would require a deeper study of your situation. 

Graham Rice

6 July, 2020 1:24 pm

I have residencia in Spain, I am over 65 and I have registered my S1 with the relevant office who have sent me a letter stating that I have a right to state healthcare. What now? Is there anything else to do? I have heard references to a plastic credit card type of card, do I need to register with a doctor? Do they operate an appointment system? Can you help me?

Oscar Paoli

7 July, 2020 8:22 am

Hi Graham,
Our recommendation is to speak with our relocation adviser collaborator David Ruiz. He will go through everything with you, timing, financial means, healthcare, etc. If you wish to contact him directly please send him an email at
With kind regards,
Ábaco Advisers


2 August, 2020 1:45 pm

Hello, my wife and I are both retired and have UK State pensions. We would like to buy a property in Spain before the end of 2020 and live there.
I have two questions,
1. If we register for Spanish residency and are granted health care in Spain do we lose our entitlement to use the NHS?
2. If we ‘exchange’ our UK driving licences for Spanish licences do we lose the UK ones?

Oscar Paoli

5 August, 2020 10:58 am

Hi Alan,

Sorry we are not able to give you a straight answer, regarding the NHS we assume you will lose the coverage but recommend speaking to them directly, and regarding point two we believe yoy do lose your UK driving licensen but would recommend you double check with the British DVLA.

With kind regards,

Ábaco Advisers


31 August, 2020 8:08 pm

Hi. I am planning to move to Spain very soon along with my parents. My parents are both 62 so not yet in receipt of a state pension. However my father is on an exportable benefit that makes him eligible for S1. In Spain will my mother be able to also have access to state health care cover under my fathers S1 as a dependent? Thank You

Oscar Paoli

2 September, 2020 6:54 am

Hi Jamie,

Yes she will be able to as a dependant until such time as she receives her State Pension then she must apply for her own S1 if stil applicable under Brexit.

With beste regards,

Ábaco Advisers


2 March, 2021 2:53 pm

My husband and I have been residing in Spain since June 2015. I am British he is German. Up until now my husband received healthcare via his EHIC which has now expired. Due to Brexit even if he qualifies for a new version of the EHIC card that does not qualify him for medical treatment in Spain. We are both pensioners. I am 72 and he is 82. Because he does not receive a British state pension we have been told he cannot obtain an S1. He has contacted the pensions/health authorities in German only to be told he has been wiped off their computer system and all his contributions have been “put in the big pot” since the German reunification and no one can or will give him any information. We rely only on State Pensions and do not have any savings. Surely as a European citizen he is somehow entitled to state healthcare here in Spain. Can you provide some guidance on how we can obtain healthcare for him. I am fully registered within the Spanish system due to having an S1.

Oscar Paoli

19 March, 2021 7:33 am

Hi Eileen,
My colleague Caroline Clinton has sent you an email giving you a response to your query.
With kind regards,
Ábaco Advisers

Linda S

27 April, 2021 8:24 am

So for clarification, as a legally registered resident, pre 2012 and already in the Spanish Health system, I don’t need to register an S1 as a dependant of my recently retired husband until I am retired myself and therefore entitled to that in my own right, or do I need to obtain an S1 at all?

Oscar Paoli

10 May, 2021 9:22 pm

Thank your for contacting us. Unfortunately we do not deal with the application process ouserlves, but we would recommend you to speak with our relocation adviser collaborator David Ruiz. He will go through everything with you, timing, documentation and costs. If you wish to contact him directly please send him an email at

With kind regards,

Ábaco Advisers

Leon Laino

25 August, 2021 2:49 pm

I am a dual American/Italian citizen, although I have never lived or worked in Italy. I am over 65 years of age and have been a Spanish resident for 14 years. How can I access the Spanish healthcare system. Thank you.

Oscar Paoli

26 August, 2021 8:16 am

Dear Mr. Laino,

To get access to the Spanish healthcare system you need to register with the Spanish Social Security to get a social security number. To register you will need a valir passport or ID, residence certificate and proof of address in Spain. Once registered you will get a Número de Seguridad Social which will give you access to medical assistance in Spain.

With kind regards,

Ábaco Advisers

Klaus Liebetanz

9 September, 2021 11:05 pm

Hi, I am a German EU citizen (age 62) and my wife is a US citizen (age 70). For the last 5 years we have resided in Mexico and before that for 35 years in the US. We both receive a US Social Security pension. We are planning to relocate to Spain in 2023. Unsere which circumstances would we be able to join the Spanish public health system and how would we do it?
Thank you very much for your help
Klaus Liebetanz

Oscar Paoli

13 September, 2021 2:26 pm

Hi Klaus,

To be able to access the Spanish health system you need to either become resident in Spain or already be a pensioner in Spain, worker or to be self-employed here for example. If you are a pensioner only in the US, we are not completely sure if there is a reciprocal agreement in the health system between both countries, at least not what we are aware of. If you are a German citizen it might be easier to obtain entrance to join the Spanish Health System via Germany.

With kind regards,

Ábaco Advisers


18 February, 2022 9:07 am

I am a Spanish national (57 years of age) and I have lived and worked in the UK for 30+ years. I am going to leave my employment in the UK and go to live in Spain later on this year. I have these questions about it: a) Do I need to request the “S1” form before I depart the UK?; b) Do I need to request something called a “Legislation Letter”?; c) Should I wait and not do anything until I receive a “state pension” ? – Sorry, but I am confused about these documents. Many thanks for any clarification. Kind regards.

Oscar Paoli

18 February, 2022 1:47 pm

Hi there,

You have to apply for the S1 at the Department of Work and Pension, and we don’t think they will give it to you until you are officially a pensioner. At least that’s how they’ve done it with British clients so far.

We’ve never heard of a “legistation letter”, unfortunately does not ring a bell, might be called something different.

I hope this information has been helpful.

With kind regards,

Ábaco Advisers

Frances Langford

20 October, 2022 6:44 pm

We are both 67 and are planning to live the rest of our lives in Spain. We have bought a property and expect to be fully resident in a month or two.
We have dual British/French Nationality and terefore EU status BUT our S1 is issued in the UK.
At present the S1 that covered us in France is cancelled and a new one for Spain might – or might not – be with us in about one month.
So are we covered for public healthcare with an S1 or do we need a cover-all private policy?
We have read so much but remain confused!

Oscar Paoli

25 October, 2022 8:30 am

Hi Frances,

Unfortunately we are not experts in this matter regarding public healthcare. Nevertheless, we would recommend you to speak with our relocation adviser collaborator David Ruiz. He will go through everything with you. If you wish to contact him directly please send him an email at

With kind regards,

Ábaco Advisers

Cynthia Miller

19 April, 2023 2:32 am

My husband and I are retired but he is living in Memory Care. If we lived in Spain, would there be Memory Care facilities available for him (or affordable visiting care?)

Oscar Paoli

24 April, 2023 2:52 pm

There are plenty of centers in Spain, most of them are private so there would be a cost involved to be able to live in them.
With kind regards,
Ábaco Advisers

Thomas collins

21 April, 2023 11:49 am

I am moving to Spain later this year I am 66years old and have a state pension
Will I be able t receive state health in Spain

Oscar Paoli

24 April, 2023 2:50 pm

Hi Thomas,
It will depend on the pension and other conditions to be able to guarantee you will receive or not state healt in Spain.
Sorry for not being able to give you an exact answer.
With kind regards,
Ábaco Adviser

Trivino Y Garcia Abelardo

24 January, 2024 11:33 am

I am born in Spain (Barcelona) and I have done my Military service in Spain.
My parents moved to Belgium end of the ’50’s and I have the Belgian nationality when my father applied for the Belgian nationalty.
However, I wrote to the Spanish authorities and they said that it would be very easy to get back the Spanish citizenship.
My question is:
I am living in Thailand already more that 20 years, but I look forward to travel back to Spain soon>
Due to my age and health, I require regular hospital visits (monthly).
These monthly tests can not be done by a regular doctor (Blood analysis, etc).
Also, I will need Kidney Dialysis in a year or 2.
What are my options in Spain?

Oscar Paoli

30 January, 2024 4:23 pm

Thank you for contacting us, unfortunately we are not experts in these matters and would recommend contacting a specialist.
Sorry for the possible inconvenience.
With kind regards,
Ábaco Advisers

David Rowntree

3 March, 2024 12:57 pm

Would dialysis treatment be free for a pensioner planning to move to spain from UK.

Thank you.

Oscar Paoli

4 March, 2024 3:11 pm

We would recommend you to speak with our relocation adviser collaborator David Ruiz. He will go through everything with you. If you wish to contact him directly please send him an email at

With kind regards,

Ábaco Advisers