International health insurance in Spain

Spain has a well-regarded public health service and a large private sector that most expats use. IPMIEMEA explains who can use which, how residence visas generally treat private cover, and how to compare international health insurance before you move or renew.

How healthcare works for expats in Spain

Spain's public health service is universal for those entitled to it and is run region by region. Entitlement usually comes from working and paying social security contributions, whether as an employee or self-employed, or from arrangements that some countries have with Spain for their pensioners. If you fall into one of those groups you register with a local health centre and use the public system much as a Spanish resident would.

Many expats do not fall into those groups, at least at first. Retirees who are not yet covered by a reciprocal arrangement, people on non-working residence visas, remote workers employed abroad and newly arrived families often have no public entitlement until their status settles. For them, private cover is not a luxury; it is how they see a doctor.

Even expats with public entitlement commonly keep private cover. The reasons are familiar: shorter waits for specialists and elective surgery, English-speaking doctors, a choice of private hospital, and cover when they travel. International private medical insurance (IPMI) is one way to buy that. A Spanish domestic policy is another, and the two are compared below.

Residence visas and private cover, in general terms

In general terms, Spain's residence visas for people who will not be working for a Spanish employer, such as those for retirees, investors and remote workers, require proof of private health insurance. The expectation is usually for comprehensive cover from an insurer authorised to operate in Spain, with no co-payments and no waiting periods, so that the holder will not be a burden on the public system.

This matters when you compare plans, for two reasons:

• Not every international plan qualifies. Some international insurers are authorised in Spain or issue a Spanish-compliant policy; others are not and do not. A plan with an excess or co-insurance may also fail the "no co-payments" expectation.
• The rule is applied by people. Consulates and immigration offices interpret the requirement, and practice has varied. What was accepted last year may not be accepted this year.

Confirm the current requirement with the consulate that will process your application or with your visa agent, and ask any insurer you shortlist to confirm in writing that its policy meets it. Once you are resident and entitled to public care, the visa question falls away and the choice becomes a matter of preference.

Why expats in Spain choose international cover

Spanish domestic policies are good value and widely used. Expats choose an international plan instead, or as well, for these reasons.

• Cover beyond Spain. A domestic policy covers you in Spain. An international plan covers you throughout its area, which can be Europe, worldwide excluding the USA or worldwide. For people who visit family abroad, work across borders or spend part of the year elsewhere, that is the deciding factor.
• Portability. If you leave Spain, the international plan goes with you. A domestic policy does not.
• Underwriting that moves with you. Once accepted, you are not re-underwritten when you move country. For anyone whose health has changed since they first took cover, that is valuable.
• Treatment at home. Some expats want the option of serious treatment in their home country. A European or worldwide area makes that possible.
• Service in English. International insurers run their claims and support in English as standard.

Our guide to Europe-only versus worldwide cover explains how to choose the area, and our guide to international health insurance in EMEA compares international, local and travel cover.

The decisions that change your cover

Settle these before you compare prices. Each one changes the quote and the usefulness of the plan.

For the difference between the two main building blocks, read our guide to inpatient versus outpatient cover.

Pre-existing conditions and underwriting

Every individual plan, domestic or international, is underwritten on your medical history. The common routes are full medical underwriting, where you declare your history and get a written decision on each condition, and moratorium underwriting, where recent conditions are excluded automatically for a period and may be covered later if they stay quiet.

Two points are specific to Spain. First, if you need the policy for a visa, an exclusion for a serious condition may matter to the consulate as well as to you, so ask. Second, if you already hold a plan elsewhere and are moving to Spain, ask whether a new insurer will continue your existing terms rather than underwrite you afresh. Some will consider it.

Our guide to pre-existing conditions explains the routes and the vocabulary, including what a moratorium does and does not do.

Insurers worth reading about first

Nomi quotes the insurers on our insurer pages for residents of Spain where the insurer offers cover there. Useful first reads:

• Bupa Global publishes its plan limits in pounds sterling, which suits British expats in Spain who think in pounds and expect to return. Note that one of its areas excludes Europe; a Spain resident needs an area that includes it.
• AXA Global Healthcare offers five cover levels, a choice of including or excluding the USA and a per-person excess, which makes it easy to build a European plan at the level you want.
• Cigna Global and Allianz Care are modular plans with European areas of cover. Our Cigna versus Allianz page sets them side by side.

If a visa is involved, ask each insurer whether it is authorised in Spain and whether it will issue a certificate for the consulate.

How to prepare a comparison

Have these ready and the comparison takes minutes.

1. Your residence status, and whether a visa application depends on the policy.
2. Who is to be covered, with dates of birth and nationalities.
3. Where else you spend time, and whether you want the option of treatment outside Spain.
4. Your medical history.
5. A view on outpatient cover and on excess, bearing in mind any visa expectation.

Our cost guide explains what drives the premium. The HealthiNomad Premium Index publishes a country table for context.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to a regulated broker.