Healthcare
in Spain
Spain's public healthcare system (Sistema Nacional de Salud, SNS) consistently ranks among the best in the world — ahead of the US, UK and many other developed nations. For expats, the key decision is whether to rely solely on the public system or complement it with private insurance.
Public vs. private — what most expats do
| Aspect | Public SNS | Private insurance |
|---|---|---|
| Cost | Free (if contributing to Seguridad Social) | €50–180/month depending on age and coverage |
| Access to GP | Assigned at your Centro de Salud (in Madrid you can choose and change GP freely). Appointment usually within 24-48h. | Choose any doctor. Same-day appointments common. |
| Access to specialists | GP referral required. Wait: often several months (national average 102 days for a first appointment, Dec 2025); varies by region and specialty. | Direct access. Wait: 1–5 days typically. |
| Hospital quality | Excellent — top hospitals comparable to private | Good — modern private hospitals with premium facilities |
| Language | Spanish primarily — English speakers rare outside major cities | English-speaking doctors widely available |
| Prescription costs | Co-payment based on income: 40–60% of the price for working people (monthly caps for incomes under €35,000), generally 10% with monthly caps for pensioners | Full cost (€10-50 typical) — some plans cover partially |
| Dental | Very limited — extractions and basic only | Most plans include dental (check coverage level) |
| Mental health | Available but long waiting lists | Faster access, more specialist choice |
The vast majority of expats in Spain use both systems: they are registered with the public SNS (which gives free emergency care and subsidised prescriptions) AND have private insurance (for fast specialist access, English-speaking doctors and dental). Monthly cost: €60-150/person. For families, many corporate packages include private health insurance.
The public health system (SNS)
The Sistema Nacional de Salud covers legal residents in Spain, but how you access it depends on your situation. Most people are covered through Social Security (as employees, self-employed workers, pensioners or dependent family members); EU pensioners and posted workers can register with an S1 form from their home country; and residents with no other public cover can, after one year of registered residence, join the Convenio Especial (€60/month under 65, €157/month from 65). Non-lucrative visa applicants must show health insurance with an insurer authorised in Spain.
| Step | What to do | Notes |
|---|---|---|
| 1. Register empadronamiento | At your Ayuntamiento (town hall) | Essential first step — needed for everything |
| 2. Get your Seguridad Social number | Your employer registers you, or go to the TGSS office | Non-EU nationals need their TIE first |
| 3. Request your health card (tarjeta sanitaria) | At your local Centro de Salud with your SS number and empadronamiento certificate | Issued same day or within a few days |
| 4. Your GP is assigned | At your Centro de Salud | In Madrid (libre elección) you can choose or change GP, paediatrician and health centre at any time |
| 5. Book appointments | By phone, in person or via the regional health app (Madrid: Salud Madrid app) | Most appointments within 24-48 hours |
GP visits · Specialist referrals · Hospital care · Emergency treatment · Maternity and childbirth · Mental health (waiting lists) · Prescriptions (heavily subsidised) · Preventive care and vaccinations · Paediatric care · Physiotherapy (limited)
Dental care (only extractions and emergency) · Optical (glasses and contact lenses) · Private rooms in hospital · Elective treatments · Non-emergency mental health · Cosmetic procedures
Private health insurance — why most expats get it
Private health insurance in Spain is significantly cheaper than in the US or UK, while offering excellent coverage and fast access. Monthly premiums for an individual typically range from €60 to €150 depending on age, insurer and coverage level.
| Profile | Typical monthly premium | Notes |
|---|---|---|
| Individual, 25-35 years | €50–80/month | Basic to mid-range coverage |
| Individual, 36-50 years | €70–120/month | Mid-range coverage with dental |
| Individual, 51-65 years | €110–180/month | Comprehensive coverage |
| Couple (35-45 years) | €130–220/month | Both covered, mid-range |
| Family (2 adults + 2 children) | €180–350/month | Full family coverage |
| International/expat plan (no co-payments) | €150–400/month | Cigna, Aetna, AXA International — higher cost, global cover |
Main private insurers — profiles
English very important + premium coverage: Sanitas or AXA. Best value for families: Adeslas. Worldwide coverage + frequent travel: Cigna Global or Allianz Care. Budget-conscious with some Spanish: Mapfre. Corporate assignment: Check what your company provides — most expat packages include one of the above.
GP, specialists & English-speaking doctors
Finding English-speaking healthcare in Madrid is straightforward — especially with private insurance. In the public system it varies significantly by area and doctor.
| Type | How to access | Cost | English availability |
|---|---|---|---|
| GP (médico de cabecera) | Public: assigned at your Centro de Salud (in Madrid you can choose and change freely). Private: direct choice from insurer app. | Free (public) / included in premium (private) | Public: limited. Private: good — choose English-speaking doctor. |
| Specialist | Public: GP referral, often a wait of several months. Private: direct booking, 1-5 days. | Free (public) / co-payment or included (private) | Private clinics in Madrid have many English-speaking specialists. |
| Paediatrician | Public: assigned with your GP. Private: direct choice. | Free (public) / included (private) | Good English availability in private sector. |
| Gynaecologist | Public: GP referral. Private: direct. | Free (public) / included (private) | Good in private sector. |
| International Medical Clinic | Private clinic specialising in English-speaking expats. No referral needed. | €80-200 per consultation | Full English service — designed for expats. |
Hospital Ruber Internacional (Mirasierra) · Hospital Quirónsalud Madrid (Pozuelo) · Hospital Universitario Sanitas La Zarzuela · Hospital Universitario Sanitas La Moraleja — these private hospitals generally offer English-speaking staff and international patient services; confirm with each one.
Dental care
The Spanish public system covers very little dental care — only emergency extractions and basic treatment for children. For anything beyond this you need private coverage or pay out of pocket.
| Treatment | Approx. cost (private, without insurance) |
|---|---|
| Basic check-up + cleaning | €60–120 |
| X-rays | €20–50 |
| Filling | €80–150 |
| Root canal | €250–500 |
| Tooth extraction | €80–200 |
| Dental implant (single) | €800–1.500 |
| Orthodontics (braces, full treatment) | €2.000–4.500 |
Most private health plans include basic dental (check-ups, cleaning, X-rays). More comprehensive dental coverage costs €15-30/month extra. Alternatively, Adeslas Dental and Sanitas Dental offer standalone dental plans from €15/month. Many expats find a good private dentist and pay out of pocket for routine care given the reasonable costs.
Mental health
Mental health services in Spain have improved significantly but waiting lists in the public system remain long — typically 3-8 weeks for a first appointment with a psychologist, and longer for a psychiatrist.
| Option | Cost | Wait time | English available |
|---|---|---|---|
| Public psychologist (via GP referral) | Free | 3-8 weeks+ | Rarely |
| Private psychologist (with insurance) | Co-payment or included | 3-10 days | Often — specify when booking |
| Private psychologist (self-pay) | €60-120 per session | 1-7 days | Many English-speaking therapists in Madrid |
| Online therapy (Talkspace, BetterHelp) | €60-100/week | Immediate | Full English |
| International SOS / IAMHC | Via insurance | Varies | Full English, expat-focused |
The cultural adjustment of moving abroad — particularly the first 6 months — can be genuinely difficult. Many expats benefit from talking to a professional, especially one who understands the expat experience. The Expat Therapy Center Madrid and Madrid Mental Health both offer English-language therapy specifically for international clients.
Emergencies — numbers & hospitals
Urgencias: A&E / emergency department at any hospital — free for all, including tourists. For genuine emergencies go directly to the nearest hospital urgencias. In Madrid: Hospital La Paz, Hospital Gregorio Marañón and Hospital Clínico San Carlos are the main public hospitals. Avoid urgencias for non-emergencies — use your GP or an urgent care clinic (clínica de urgencias) instead to avoid very long waits.
If you are an EU/EEA or Swiss citizen, bring your EHIC card. During a temporary stay it gives you medically necessary public healthcare on the same terms as people insured in Spain — useful before you have your tarjeta sanitaria. It does not replace registering once you live here: as a resident you need cover through Social Security, an S1 form or another route. UK nationals have the equivalent GHIC (Global Health Insurance Card) since Brexit.