Expat Health Insurance & Private Medical Care in Spain


The cultural differences between northern Europe and southern Europe should not be underestimated. Spain puts a strong emphasis on family ties with the older generation who, when suffering from diseases such as Alzheimer’s, will often be cared for within the family home, by relatives. Nursing homes and care homes are in limited supply and Spanish citizens get priority for these. Where elderly people are being looked after in care homes, relatives may be called upon to supply meals and bed linen for the in-patient. Expats and other foreign nationals needing to make use of Spain’s healthcare system may find there are language barriers, which can delay admission and occasionally cause misdiagnosis. Otherwise, standards in Spanish clinics and hospitals are considered better than in the UK’s NHS.

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State or private care in Spain

It is advisable, for people travelling to Spain, to arrange for private medical cover in advance of their arrival in Spain. You can register with the local authority, within a few weeks of arrival in Spain but this may expose you to tax. If you register you will be given a medical card, which will allow you to have the same healthcare rights as a Spaniard, within the state system.

Private health care

BUPA international acquired, in 1989, the large Spanish insurer and care provider Sanitas. BUPA’s Sanitas health plan has been customized to cover expats who frequently move between Spain and their home country, and policyholders can designate the European countries they require. Insurers IMG, ALC and Expatriate healthcare, offer similar schemes to BUPA’s Sanitas plan. However, some major insurance providers with Europe-wide schemes, are considered to be as competitive and may be able to offer additional benefits.

Spanish insurance plans

A good proportion of Spain’s population has private health cover and in proportional terms, this group is roughly twice that of the UK. It has been claimed, by some health insurance brokers, that the small print in Spanish policies can become misleading, after translation. Iñaki Ereño, the Sanitas’ managing director, stated that the private medical insurance industry in Spain is now mature, with slowing growth and competition between the various insurance companies increasing.

Buy in UK for protection

Those considering settling in Spain may benefit by buying insurance, in advance of moving to Spain, from a UK company which is regulated by the UK’s financial conduct authority, as this is considered to be more secure.

Using a Broker or agent

Most expats buy cover as soon as they arrive in Spain and some will renew their cover in their home country, when the premium year ends. If expats use a Spanish broker, they should ask how many companies they represent and if they have the software to check the market for the best deals. Also check if they are just an agent for a single insurer, as anything they would offer would be limited to that insurance company’s products.

Spain has lagged behind the rest of the EU with implementing the insurance mediation directive of 2005. This directive was intended to create competition between insurance companies and distinguish the differences in the role between agents and brokers. The directive requires brokers to sell products from competing insurers to ensure they get the best deal for you from the whole market. The EU acted, after claims that single-company agent’s, the majority in Spain, were promoting themselves as brokers.

State health care

Expats in Spain have generally considered that health care quality in Spain is as good as the UK’s NHS and that it has been largely unaffected by the economic recession. Spain spends a greater proportion of its GDP on health, than Britain, and has more practising doctors. Spain’s health care expenditure is 9% of GDP (data.worldbank.org, 2014).

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Language barrier issues

Study group interviewees who lacked language fluency have confused matters and increased the risk of a misdiagnosis. In both Spain and Portugal, charities and non-governmental organisations have reported significantly growing number of Britons seeking repatriation because of failing health.

E numbers

Those people eligible for state health care include:

  • Retired EU foreigners who follow correct procedures
  • The employed and the registered self-employed

Not eligible are:

  • Non-working expatriates below retirement age, unless they register
  • Pensioners who have not completed the formalities

Spain has reduced the number of expatriates from northern Europe who had been freeloading on its state health care system, as certain E (for EU) documents give access to the system.

  • The European Health Insurance Card (EHIC and formerly E111) is mainly aimed at holidaymakers, or those on short stays within the EEA and Switzerland. It opens the door to any required treatment. The Department of Health states that expats are advised to take out comprehensive private insurance for visits to all countries, regardless of whether you are covered by the EHIC.
  • E121/S1State pensioners should get this from the Department for Work and Pensions before departing the UK to live in Europe. It de-lists them from the UK social security system. Within three months of arrival in Spain, they should report with their passport to a Foreigners’ Office or a police station. They will receive a certificate allowing them to register with the local sickness insurance office.
  • E106/S1Britons, who have been employed or registered self-employed in Spain for two years, may extend their eligibility of access to the state healthcare system through the E106, usually by two years at most.
  • E109/S1The E109 covers your family living in another member state. You must remain living in your home country, working and paying National Insurance.

Retiring early may run a risk for some

Many Expat early retirees and self-employed Britons, rely on the EHIC. The Foreign Office advises that those settling in Spain, after early retirement, should consult their local DSS office before travelling. If registered self-employed, you pay a levy and are then entitled to the same benefits as a Spaniard. Across Spain, early retired expatriates must register with the authorities if they want access to state healthcare. They will be liable to pay a health tax, set by the provincial government, the devolved body responsible for healthcare. This tax could be around €1,000 a year.

EHIC limits

Medicine is a liberal profession and some doctors will take a charitable view of what constitutes emergency medicine available under the EHIC , while others will not.

Returning home

Britons who spend less than six months a year in the UK but do so within Europe, are denied non-emergency access to the NHS. This could affect UK Expats in Spain who are planning to return home for elective surgery, such as hip replacement, cataract removal, hernia repair or non-urgent cardiac surgery. However, expat retirees, who have not completed formalities, cannot expect non-emergency care in Spain. The British embassy in Madrid summed up the situation by saying that UK nationals, living in Spain, who are not officially resident in Spain, are not automatically entitled to health care in Spain at UK expense.

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