Options for Foreigners in Healthcare
All Spaniards, as well as foreign citizens who have established their residence in the national territory, are entitled to the right to health protection and healthcare. This is in accordance with the provisions of Article 1.2 of Law 14/1986, of April 25, General Health Law, thereby establishing the universality of the right to healthcare in Spain.
What happens to those that do not have their residence in Spain? Here you have some options in public and private healthcare.
Overview of Public Healthcare in Spain for Foreigners
The Spanish healthcare scheme ensures that all individuals, regardless of their situation, have access to emergency medical services and some basic services. However, costs can be high. Legal residents have broader and continuous healthcare coverage.
Summary
- EU Visitors for Less Than 90 Days: Emergency care with the European Health Insurance Card (for EU/EEA citizens) or with travel insurance.
- Visitors WITHOUT a Visa for Less Than 90 Days: Emergency care with travel insurance.
- Visitors WITH a Visa for Less Than 90 Days: Mandatory health insurance covering emergencies.
- People in an IRREGULAR Situation for More Than 90 Days: Emergency care, services for pregnant women and minors, with limitations for other services.
- Digital Nomad and Non-Lucrative Visa: Mandatory health insurance.
- Legal Residents: Full coverage through the National Health System with the Individual Health Card.
Click on the map
And choose the Autonomous Community you are based on.
Treatment, coverage & costs: public sector
- Before you consult a doctor or go to a hospital, make sure that they are part of the public healthcare system.
- Catalogue of public healtcare centers, hospitals and more.
Visitors from EU/EEA/Swiss citizens (<90 Days)
- Access to Public Healthcare: Tourists from European Union (EU) or European Economic Area (EEA) countries can access public healthcare with the European Health Insurance Card (EHIC). This card covers emergencies and necessary treatments during their temporary stay.
- Emergency Care: In case of emergencies, all visitors can receive medical care in public hospitals. However, without the EHIC or insurance, costs can be high.
The European Health Insurance Card (EHIC) is generally valid for temporary stays only.
Key points:
- The card itself is valid for a period (e.g., 2 to 4 years), but its use is limited to “temporary” visits, such as tourism, short-term work, or study.
- There is no strict 90-day limit for the EHIC if the stay is considered temporary.
- However, the Provisional Replacement Certificate (PRC), which you might use if you don’t have the card, is often only valid for 90 days.
- If your stay ceases to be temporary (e.g., you move permanently, or stay for an extended period), you are usually required to register with the healthcare system of the country you are in.
In summary: You might be able to use it for more than 90 days if the stay is officially considered temporary (like an extended study placement), but for long trips, you should always confirm with your home country’s social security institution and consider travel insurance.
Visitors Non-EU (<90 Days) no Requiring a Visa: ETIAS
- Travel Insurance: Visitors from non-EU/EEA countries are advised to have travel insurance that covers healthcare, as non-urgent services are not covered by the public system.
- Emergency Care: In case of emergencies, all visitors can receive medical care in public hospitals. However, costs can be high.
Visitors Non-EU (< 90 Days) Requiring a Visa
- Mandatory Health Insurance: To obtain a Schengen visa, it is mandatory to present health insurance that covers a minimum of 30,000 euros and is valid throughout the Schengen area. This insurance covers emergency healthcare and other necessary treatments during the stay.
- Emergency Care: Like the previous case, visitors with a visa can receive emergency care in public hospitals. But costs may not be covered without appropriate insurance.
People Illegally Staying for More Than 90 Days
- General Public Healthcare: Some foreigners in illegal situation are entitled to have assistance, which has to be granted case by case. They have to go directly to the Health Service of the Autonomous Community where they reside, who evaluates each case. They must prove evidence of 90 days in Spain through “empadronamiento”, aka, register at the City hall.
- Access to Emergency Services: People in an irregular situation are entitled to receive urgent medical care, assistance in cases of pregnancy and childbirth, and healthcare for minors under 18.
- NGOs: There are non-governmental organizations that offer free or low-cost medical care for people in an irregular situation.
Digital Nomad Visa & Non-Lucrative Visa
- Healthcare Rights: Generally do not have automatic access to Spain’s public healthcare system.
- Requirements Private Health Insurance: Required to obtain the visa and must cover the entire duration of the stay in Spain.
- Public Healthcare: They can access public healthcare by registering and paying into the Spanish social security system. Although this is not commonly done due to the nature of their visa.
Legal Residents (Temporary & Permanent)
- National Health System (SNS): Legal residents in Spain are entitled to healthcare through the National Health System (SNS). This includes primary, specialized, hospital, and pharmaceutical care.
- Individual Health Card (TSI): To access these services, legal residents must obtain the Individual Health Card (TSI). It can be requested at health departments in the respective autonomous community. They must already have their NIE (Spanish ID for foreigners).
- Access to healthcare in other European Union (EU) or European Economic Area (EEA) countries: Legal residents can access public healthcare with the Global Health Insurance Card (GHIC). This card covers emergencies and necessary treatments during their temporary stay.
Who Pays for Public Healthcare in Spain?
| Category | Emergency Care | Non-Emergency Care (Primary Care, Specialists, etc.) |
|---|---|---|
| Legal Residents (with TSI health card) | NO (Fully covered) | NO (Fully covered) |
| EU/EEA Citizens (with valid EHIC card) | NO (Costs billed to home country) | YES (Not covered. Must pay privately or use home system) |
| Non-EU Tourists / Visitors (Visa-waiver) | YES (Treated first, then billed) | YES (Access denied to public system. Must use private clinics) |
| Short-Stay Visa Holders (e.g., Schengen) | YES (Treated first, then billed. Insurance is mandatory) | YES (Access denied to public system. Must use private clinics/insurance) |
| Undocumented Immigrants (>90 days) | NO (Covered by law) | YES (Not guaranteed. Access varies by region; if granted, may be billed) |
| Long-Term Visa Holders (e.g., Digital Nomad) | YES (Treated first, then billed. Private insurance is mandatory) | YES (Expressly excluded from public system. Must use private insurance) |
Key Explanations:
- Emergency Care: Defined as urgent treatment to prevent death or permanent disability. By law, public hospitals must stabilize any patient, regardless of their ability to pay.
- Non-Emergency Care: Includes routine doctor visits, specialist referrals, and planned surgeries. This is strictly reserved for legal residents.
- EHIC (European Health Insurance Card): Covers medically necessary care during a temporary stay, ensuring the same cost as a Spanish national. It is not for planned medical tourism.
- Billing: For those who are not covered, the public hospital will provide emergency care but will subsequently issue an invoice for the services rendered.
Key Vocabulary
Médico de Cabecera (GP), Receta (Prescription), Cita Previa (Appointment).
Royal Decree-Law 7/2018, of July 27
The Royal Decree-Law 7/2018, of July 27, on universal access to the National Health System (Real Decreto-ley 7/2018, de 27 de julio, sobre el acceso universal al Sistema Nacional de Salud).
This decree was a landmark piece of legislation that essentially restored the principle of universal healthcare in Spain. Its purpose was to reverse a previous austerity-driven measure from 2012 (Royal Decree-Law 16/2012) that had tied healthcare access to an individual’s legal and employment status.
Key points of the 2018 decree
- Restoration of Universal Access: The decree’s main objective was to guarantee that all people in Spain, regardless of their administrative or migratory status, have the right to health protection and healthcare services under the same conditions as Spanish nationals. The government at the time explicitly stated that “health does not understand borders, identity cards, work or residence permits.”
- Reversing Austerity Measures: The 2012 decree had created a situation where undocumented immigrants were largely excluded from public healthcare, except for emergency care, services for pregnant women, and minors. This led to a public health crisis, as people in irregular situations would avoid seeking care for treatable conditions, leading to more serious, costly, and difficult-to-manage illnesses later on.
- From “Insured” to “Resident”: The 2018 decree changed the fundamental basis for healthcare entitlement. Instead of being an “insured person” (linked to social security contributions), the right to healthcare was now tied to a person’s status as a “resident” in Spain. This broadened the scope of coverage to include those who were not in the formal labor market or a legal residency situation.
- Implementation: The decree required the various autonomous communities (regions) of Spain to implement the new law. This involved setting up procedures to ensure that individuals without a residency permit could register at their local town hall (padrón) and then with a health center to receive a health card or other document granting them access to care.
In summary, the 2018 decree was a major policy shift that cemented Spain’s commitment to a truly universal healthcare system. It was celebrated by human rights organizations and medical professionals who had long argued that linking healthcare to legal status was a dangerous and inhumane policy that undermined public health.
People in an Irregular Situation
- Emergency Care: As with visitors, public hospitals must provide life-saving emergency care. However, since the 2018 decree, individuals in an irregular situation have the right to broader public health coverage.
- Non-Emergency Care: Individuals in an irregular situation who have registered with their local town hall (padrón) and health center are entitled to non-emergency care. The goal of the 2018 law was to provide universal access, so in theory, they would not pay for most services, but like legal residents, they would likely be subject to the same co-payment system for prescribed medications.