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Health Insurance in Spain for Foreigners: Private or Public (2026)
· 10 November 2026
Health insurance in Spain for foreigners comes down to three options: the public system, if they work, receive an EU pension with an S1 form or qualify as residents; the public system paid monthly through the convenio especial, at €60 under 65 and €157 from 65, after a year of residence; or private health insurance. For a non-lucrative or digital nomad visa, private insurance must have no copayments and no waiting periods. Private premiums depend mostly on age: in Girona, Sanitas lists individual cover from about €65 a month at 25-29 and about €192 to €229 at 65-69.
Recently a member of our team needed hip surgery. The cartilage in his hip had worn away, so a surgeon who specialises in hips fitted a metal cap over the joint surface in its place. The operation was done at ICATME, the Catalan Institute of Traumatology and Sports Medicine at Hospital Universitari Dexeus in Barcelona, and his private insurance, Adeslas, paid for all of it.
That covered several visits to Barcelona beforehand with tests, X-rays and scans; the operation; four nights in a single room, with a bed for a relative to stay overnight; all meals and medication; and 40 physiotherapy sessions afterwards. He paid nothing extra. He and his family have been insured with Adeslas for 12 years, and the policy for the four of them, parents aged 55 and 52 and daughters aged 28 and 18, costs €352 a month, about €88 a person.
One case doesn't make a rule, and every insurer and policy has its own conditions. Below is how the public system works for foreigners, what a visa requires, what the main private insurers publish, what cover costs by age, and what to check before you sign.
Public healthcare for foreigners
Who is covered. Workers who pay Spanish Social Security and people receiving Spanish pensions or benefits are covered automatically. Foreigners with legal, habitual residence can also apply to the INSS if no other compulsory cover applies to them, usually with a certificate from their home country showing it does not cover them in Spain.
Pensioners from the EU. If another EU country pays your state pension, it usually covers your healthcare in Spain through the S1 form, which you then register in Spain.
The health card in Catalonia. The card is called TSI. You need to be registered on the padrón in a Catalan town; you apply online or at your local health centre (CAP) with your ID or NIE and a padrón certificate less than three months old.
The convenio especial. Residents who are not covered any other way can pay to join the public system: €60 a month under 65 and €157 a month from 65. In Catalonia you need one year of continuous residence in Spain before you apply. It covers the basic public services, including GP, specialists and rehabilitation. The Catalan description lists only these basic services; other regions, such as the Balearic Islands, state that prescriptions and orthopaedic devices are not included.
Visitors. The European Health Insurance Card covers care that becomes necessary during a temporary stay, in public centres only. It does not cover planned treatment or private care, and it stops being valid once you move your residence to Spain. A non-resident owner who spends a few months a year here should plan for travel or private cover.
Waiting lists in the public system
On 31 December 2025, according to the Ministry of Health, patients in Catalonia waited on average 90 days for a hip prosthesis, and 5.2% had waited more than six months. Across all operations in Catalonia, 31.97% of patients on the list had waited more than six months, and the average wait for a first appointment with a trauma specialist was 188 days. These figures are averages for the whole region; times vary by hospital and urgency.
Health insurance in Spain for foreigners on a visa
For the non-lucrative residence visa, the law asks for public or private health insurance with an insurer authorised in Spain. The Spanish consulate in the United States, for example, spells out what that means: the policy must cover the same risks as the public system, with no waiting periods, no copayments and no coverage limit. Travel insurance is not accepted.
The digital nomad visa asks for the same: Social Security cover or equivalent private insurance, without copayments or waiting periods, and not a reimbursement-only or travel policy. For a study visa the wording varies from one consulate to another, so check the page of the consulate where you apply. EU citizens who register as residents without working need public or private cover equivalent to the Spanish system; pensioners can use their public cover certificate.
You can check that an insurer is authorised in the register of the Spanish insurance supervisor, the DGSFP.
Private health insurers in Spain: what they publish
Around 12.8 million people in Spain had private health insurance in 2025, and five groups held 72% of the market. The table lists only what each insurer states on its own website or in its conditions, as of November 2026. Starting prices are often promotional and apply to young adults; your price comes from a quote.
| Insurer | Product for residents and visas | What the insurer states |
|---|---|---|
| SegurCaixa Adeslas | Adeslas Welcome | No copayments or waiting periods, up to age 70, from €660 a year; physiotherapy reimbursed at 50%, up to €500 a year |
| Sanitas | Sanitas Residents | No copayments; a version without waiting periods for visa applicants; can be taken out up to 75, with no age limit to stay insured |
| DKV | DKV Visado | No copayments or waiting periods, up to age 75, from €37 a month as a promotion (€57 standard) |
| Asisa | Asisa Health Residents | No copayments or waiting periods, includes hospital stays, prostheses and implants; price by age through an online quote |
| Aegon | Aegon Salud Completo | No copayments, can be taken out up to 67, single room with a bed for a companion, from €55.35 a month as a promotion |
| FIATC (Catalan insurer) | Medifiatc | Versions with and without copayments; waiting periods can be reduced if you come from another insurer |
| Assistència Sanitària (Barcelona) | Serveis complets | Own network mainly in the province of Barcelona; this product excludes pre-existing conditions and internal bone and heart prostheses |
| Cigna Global, Allianz Care | International plans | Premiums by age and region, cover in several countries; ask whether the policy is accepted for your visa |
Mapfre, AXA, Generali and others also sell health insurance in Spain. We do not rank insurers: networks of doctors and hospitals differ by area, so check that the specialists and hospitals you would use near your home are in the network. ICATME and Dexeus, for example, work with many insurers, but the hospital asks patients to confirm cover for each specialty by phone.
How much private health insurance costs by age
Age matters more than anything else. As one public example, here is the April 2026 tariff of Sanitas Más Salud for the province of Girona, for new policyholders in their first year, per person per month:
| Age | Óptima | Plus | Sin copago |
|---|---|---|---|
| 25 to 29 | €64.75 | €78.96 | €98.13 |
| 40 to 44 | €75.19 | €89.39 | €106.98 |
| 55 to 59 | €121.83 | €137.42 | €156.17 |
| 65 to 69 | €191.86 | €203.56 | €229.22 |
| 70 to 74 | €219.14 | €225.69 | €249.38 |
Families pay less per person. For a family like our colleague's, with parents of 55 and 52 and daughters of 28 and 18, the same Sanitas tariff for four or more people comes to €278.49 a month on Óptima, €323.86 on Plus and €383.97 without copayments. His family pays Adeslas €352. The products are not identical, so compare what is covered, not only the price. Sanitas accepts new policyholders up to 75.
Public, convenio especial or private: side by side
| Public system | Convenio especial | Private insurance | |
|---|---|---|---|
| Who can get it | Workers paying Social Security, Spanish pensioners, EU pensioners with S1, residents who qualify | Residents with no other public cover, after one year of residence | Anyone the insurer accepts, usually up to 67 to 75 for new clients |
| Monthly cost | Included in contributions or pension | €60 under 65, €157 from 65 | Set by age and product; in Girona, Sanitas from about €65 at 25 to 29 and about €192 to €229 at 65 to 69 |
| Waiting period after joining | None | None once signed | On standard policies, months for planned surgery and prostheses (8 at Adeslas Plena Plus); none on visa products |
| Waiting for treatment | Public lists: in Catalonia 188 days on average for a first trauma appointment | The same public lists | Depends on the network and the specialist |
| Doctor and hospital | Through your local health centre (CAP) | Through your local health centre (CAP) | Any doctor or hospital in the insurer's network |
| Accepted for a visa | Social Security cover is accepted for the digital nomad visa | No, it needs a year of residence first | Yes, with no copayments, waiting periods or limits |
Before you sign: waiting periods, past illnesses and age
Waiting periods. On a standard policy, planned surgery and prostheses are covered only after a waiting period. In Adeslas Plena Plus it is 8 months for hospital stays, surgery and prostheses and 3 months for advanced scans; Sanitas Residents, in its version with waiting periods, sets 10 months for hospital surgery. In Adeslas Plena Plus there is no waiting period in a life-threatening emergency. Visa products are sold without waiting periods. Our colleague had been insured for 12 years, so none of this applied to him.
Conditions you already have. Insurers ask you to fill in a health questionnaire. Illnesses you knew about and did not declare can be excluded, and some products exclude pre-existing conditions altogether. Answer the questionnaire carefully.
Copayments. Cheaper products charge a small fee for each visit or test. If you see doctors often, a policy without copayments can work out cheaper over the year.
Age limits. Most insurers accept new clients only up to a certain age, from 67 to 75 in the products above; Sanitas and Aegon state that existing clients can stay insured with no age limit. In our view, taking out a policy before that age matters more than the price difference between insurers.
Room and companion. In Adeslas Plena Plus the hospital room is always single with a bed for a companion, except in intensive care, psychiatry and neonatal units. Check this in your own conditions.
Tax: who can deduct health insurance
If your employer pays your health insurance, up to €500 a year per person (you, your spouse and children) is free of income tax, or €1,500 for a person with a disability. Self-employed people taxed under the direct method can deduct premiums up to the same amounts. Catalonia has no extra regional deduction for health insurance.
Our view
If you live on the Costa Brava most of the year, we think private health insurance is worth having, even if you also have public cover. For our colleague, the policy proved its worth in one operation, with the visits before it and the rehabilitation after. Which insurer suits you depends on your age, your visa, the hospitals near your home and how you want to pay, so ask two or three for a quote with the same cover and compare the conditions line by line.
Moving here is easier with the paperwork in order: see our guides to the NIE number, moving to Spain after the Golden Visa and moving to the Costa Brava with children. For the monthly budget, see the cost of living in Lloret de Mar.
Questions people ask
Is private health insurance worth it in Spain?
For many residents, yes. Public waiting lists in Catalonia are long, with an average of 188 days for a first trauma appointment at the end of 2025, and a private policy lets you use the insurer's own network of specialists and hospitals instead. A member of our team had hip surgery in Barcelona fully covered by his private insurance.
What health insurance do I need for a non-lucrative visa?
A policy with an insurer authorised in Spain that covers the same risks as the public system, with no copayments, no waiting periods and no coverage limit. Travel insurance is not accepted.
How much is private health insurance in Spain per month?
It depends mostly on age and on copayments. In Girona, Sanitas lists individual cover from about €65 a month at 25 to 29 and from about €192 at 65 to 69 in 2026. Our colleague's family of four pays Adeslas €352 a month.
Can a foreigner use public healthcare in Spain?
Yes, if you work and pay Social Security, receive an EU pension with an S1 form, or qualify as a resident. Residents without cover can pay for the convenio especial, €60 a month under 65 and €157 from 65, after one year of residence.
Does private insurance cover conditions I already have?
Not always. Conditions you knew about and did not declare in the health questionnaire can be excluded, and some products exclude pre-existing conditions altogether. Read the exclusions before you sign.
Planning a move to the Costa Brava?
Tell us where you would like to live, how many months a year and your budget for a home. We'll suggest towns with good access to hospitals and show you homes there, in person or by video call.
Author: @katy.bon.estate, property consultant on the Costa Brava
Sources: Seguridad Social and INSS (healthcare entitlement, S1 form); CatSalut and Barcelona International Welcome (TSI); Real Decreto 576/2013 and Generalitat de Catalunya (convenio especial); European Commission (European Health Insurance Card); Ministerio de Sanidad, SISLE-SNS waiting lists at 31 December 2025; Ministerio de Inclusión and Spanish consulates (non-lucrative, digital nomad and study visas); DGSFP register; ACES and ICEA, health insurance market 2025; insurers' websites and conditions (SegurCaixa Adeslas Plena Plus 2026 and Adeslas Welcome, Sanitas Residents and Sanitas tariffs April 2026, DKV Visado, Asisa Health Residents, Aegon Salud Completo, FIATC Medifiatc, Assistència Sanitària, Cigna Global, Allianz Care); ICATME and Hospital Universitari Dexeus; Agencia Tributaria, IRPF 2025 manual. Case: a member of the VivendaNova team, 2026. Photos: Arxiu d'Imatges del Patronat de Turisme Costa Brava Girona. Cover: S'Agaró. Photo: Alex Tremps. Arxiu d'Imatges PTCBG, 27064. Information as of November 2026. This is general information, not medical or insurance advice.