Healthcare in Spain for EU citizens

It is reassuring to know that Spain’s national health service (Sistema Nacional de Salud or SNS) is rated among the best national health services in the world. Personally, I have always found the staff to be outstanding, thorough and extremely professional. There is a protocol for following up cases and an aim to find resolutions of ailments, as opposed to just treating the symptoms. The state-of-the-art information technology applications that are available also allow patients to be kept informed, and for medical professionals to be able to track patients through accessibility to records at the touch of a button. These easy-to-navigate apps ensure making appointments is easy, including details such as effective periodic testing and screening. 

Spain’s SNS has a system where your GP or family doctor (medicina de familia) is the first port of call for any issues. For any more complicated issue you are then directed to a specialist or a consultant, usually with the hospital associated with your local medical practice (centro de salud). Waiting times are not excessive and the ability to access this higher-level of knowledge and expertise is reassuring, as well as resulting in quicker treatment and resolutions.

So, the National Health System is pretty good then. But who can use it? Here is the key information for healthcare in Spain for EU citizens.

Healthcare system in Spain

Spain has universal health care, and its constitution guarantees all Spanish nationals and residents the right to have access to basic universal and preventative healthcare. To benefit from public healthcare in Spain, residents must live, work, and pay taxes in the country. Children, pregnant women, state prisoners and students under 26 can obtain free medical treatment.

Healthcare in Spain for EU citizens or EEA citizens.

If you are a working citizen of the European Union or European Economic Area you can use your EHIC or European Health Insurance Card for free access to healthcare in Spain during your first 3 months in the country. There are reciprocal agreements in place between all member countries with their European partners. Despite Brexit, British citizens can still access the benefits of the EHIC, by obtaining the new GHIC (Global Health Insurance Card). 

You should apply for the EHIC in your country of residence so that you have it before you leave. However, if you don’t have an EHIC and you need treatment when in an EU/EEA state you could still apply for a document to say you are entitled to free treatment. For UK citizens, for example, this is called the Provisional Replacement Certificate (PRC), and each EU country will have a similar back up measure in place. So, if you do need to go to a hospital, but had been unaware or forgotten to sort out your EHIC before coming to Spain, all is not lost. However, just as it is your responsibility to show your EHIC when you request care, it is also very important to explain your situation to the medics and to ask for assistance with required consent and associated paperwork before any care is given. Otherwise, you might find yourself footing a large bill. 

You are reminded that the EHIC is not a substitute for travel insurance. Holiday makers, just as visitors of up to 3 months can use the EHIC to access medically necessary state-provided healthcare in Spain. That means healthcare which cannot reasonably wait until you go back home. The healthcare provider will deem if your treatment is necessary or not, but would include things such as emergency treatment and visits to A&E (urgencias), treatment for a long-term or a pre-existing medical condition, routine medical care for pre-existing conditions that need monitoring, and maternity care (as long as you're not going abroad to give birth). So, as you can see, there is pretty good coverage of healthcare in Spain for EU citizens.

However, the EHIC does not cover all circumstances. 

-  Some medical centres in Spain offer both public and private care options. If you opt for private care, you will be liable for 100% of the costs incurred. It is your responsibility to present the EHIC and check that the centre you have arrived at accepts this documentation. 

-  Dental care is not available free of charge in Spain on in the state system, except for emergency extractions, so you would be liable for any costs incurred if you need to visit a dentist for treatment.

-  In the case of serious illness or death, repatriation to your home country (which can cost many thousands of euros) is not covered by the EHIC. 

-  Another practical consideration is the language barrier. Although some doctors or nurses may speak your language, there is a good chance that in the state system the medical professional who you come into contact with will only speak to you in Spanish (we are in Spain after all). With a private insurance policy, such as those provided by Caser Expat insurance you are much more likely to be able to access services and assistance in your native or mother tongue, and ideally, be put into contact with a medical practitioner who also speaks your language. 

This is why you need to obtain travel insurance as well as get your EHIC when you travel away from your home country, being an EU citizen does not give you full cover for any incident or eventuality in Europe. And it will of course cover a whole plethora of things, from lost luggage to needing to get home quickly.

Obtaining the Spanish Health Card

If you are staying in Spain longer-term you should apply for the Spanish Healthcare Card.
If you are working and contributing to the system, by making monthly payments to social security, you can obtain a Tarjeta Sanitaria Individual (TSI). This Spanish health card lets you make appointments with medical professionals and receive care. 

To apply for this card, you must do the following:

1. Register yourself to an address in Spain (Empadronamiento).
   
   
2. Obtain a Social Security Number. (If you intend to be employed by a company, self-employed, or even to be a student taking on an internship you will need a Social Security Number, so therefore are eligible for the Spanish Health card).
   
   
3. Find a healthcare centre near you.
   
   
4. Prepare the required documents.
   
   
5. Submit your application

For any non-EU citizen moving to Spain, it is a requirement to get travel insurance to enter the Schengen area. That goes for non-EU students too. 

If you aren't working in Spain or are an unemployed non-EU citizen, you are not eligible for getting free access to healthcare in Spain. In this case, you will need to arrange for private health insurance and pay a premium each month.

Caser offers a range of excellent offers for Health insurance. Check out the options on the Caser website or download the free guide below: