How to access Spanish healthcare as a pensioner correctly?
If you are a pensioner from an EU country, Switzerland, within the European Economic Area or the UK, and plan to stay in Spain for a longer period of time or live there permanently, Spanish public health insurance (“Seguridad Social”) is certainly a very important issue for you.
Above all, you will be interested to know which country is responsible for your health insurance cover and when or how you have access to Spanish healthcare.
Here you can now find out about the steps required to get free healthcare benefits through Spanish National Health system (“Sistema Nacional de Salud” – SNS) as an expat.
Your right private health insurance for residency in Spain:
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How can I access health benefits in Spain?
Spanish public healthcare (“asistencia sanitaria”) consists of medical and pharmaceutical benefits that are suitable for maintaining or restoring the health and fitness for work of insured and co-insured persons.
How you get access to the health benefits of the Spanish statutory health insurance (“Seguridad Social”) depends on the length of your stay in Spain:
- In the case of a temporary stay in Spain (for holidays, work, study):
- Access with the European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC).
- However, with this card you can only receive free medical benefits that are medically necessary.
- Access with the European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC).
- In the case of a habitual residence in Spain:
- Access with the Spanish health insurance card (“Tarjeta sanitaria”).
- This card gives you unlimited access to all public health benefits in Spain.
- Access with the Spanish health insurance card (“Tarjeta sanitaria”).
Unter certain conditions you can also apply to join the special sate health insurance scheme (“Convenio especial para la prestación de asistencia sanitaria”). By paying a monthly fee you have access to the Spanish public health system.
Apart from the compulsory sickness insurance, you can also take out private health insurance in Spain.
There are many private doctors and clinics in Spain that also work with some private insurance companies.
Find the best private health insurance in Spain with ASSSA.
Especially designed for expats:
Which country is responsible for my health insurance?
In the EU, which country is in charge of your social security and health insurance cover (i.e. which Member State’s legislation you are subject to and where you pay your contributions) does not depend on your nationality, but on two main factors:
- the work situation (worker, pensioner, unemployed, etc.)
- the place of residence
You cannot choose which country pays the cost of benefits.
The legal basis for health insurance benefits within the EU are EU Regulations No. 883/2004 and No. 987/2009 on the coordination of social security systems.
This regulation applies to citizens of the European Union (EU), the European Economic Area (EEA), Switzerland and the United Kingdom (UK). Therefore, when I refer to the EU, I am referring to these countries.
Living in Spain as a pensioner from an EU country
If you move to Spain as a pensioner from an EU country, it is essential for your health insurance cover which country your pension comes from and you are entitled to healthcare benefits there:
- If you receive a Spanish pension, you and your family members are covered by the Spanish health system – even if you also receiving pension payments from other countries.
- If you do not receive a pension or any other income in Spain and you receive a pension from an EU country which gives you the right to healthcare benefits, your insurance cover remains in the country where the pension comes from and you continue to pay your contributions there. However, you and your family members are entitled to medical treatment in Spain at the expense of the country where you are used to work.
To claim this entitlement from the Spanish health insurance, you need the S1 form (formerly 106, E 109 and E 121 – still issued by some institutions).
The S-1 document certifies the holder’s right to receive health benefits in Spain at the expense of the state providing the insurance, under the same conditions as those insured in Spain under Spanish law.
Am I still eligible to healthcare in my home country?
In principle, you and your family members are only fully entitled to free medical care in the country where you live (here in Spain). However, in the case of some EU countries, such as Germany, Austria and Switzerland, you are entitled to medical treatment both in the country that pays your pension and in Spain (where you live now, provided that you do not receive a Spanish pension).
For UK Pensioners may mean you lose access to free NHS healthcare back in the UK receiving public healthcare in Spain.
When am I entitled to Spanish health insurance benefits?
In general, you have free access to publicly funded healthcare in Spain if you can prove legal and habitual residence in Spain. Art.3 Real Decreto-ley 7/2018
This means the basic requirements for access to state healthcare benefits are therefore:
- registration in the register of foreigners. for EU citizens or
- Tarjeta de identidad de extranjero (TIE) for other nationals
- registering your address with the local municipality (“empadronamiento”)
How do I get state Spanish healthcare?
As mentioned above, as a pensioner you first need the S1 form, which is issued to you by the relevant health insurance fund in your country of origin.
If you receive exclusively a UK State Pension, you must request an application form from the Overseas Healthcare Services.
This form must then be registered with the “Instituto Nacional de la Seguridad Social (INSS)”, the National Institute of Social Security in order to obtain the right to Spanish healthcare.
With this entitlement, you can apply for the Spanish health insurance card (“tarjeta sanitaria individual” -TSI).
With the “tarjeta sanitaria” you then have access to public healthcare benefits in Spain.
What are now the necessary steps in Spain in detail:
Step 1: Recognition of the right to public healthcare
First of all, you must have your entitlement to state healthcare in Spain recognised by the INSS.
You must then submit the S1 form to the relevant office of the Spanish National Social Security (INSS). More on this later.
To do this, you must register the S1 form.
How do I register the S1 form?
You have 2 options in this regard:
- In person: You submit this form at any customer or information centre of the Spanish Social Security (“centro de atención e información de la Seguridad Social” – CAISS) of your place of residence.
It is necessary to make an appointment (“cita previa”), which you can do online on the website of the Seguridad Social “Cita previa para pensiones y otras prestaciones (INSS)”,
- Online: You can apply for the registration of the S1 form electronically on the website of the Seguridad Social, under the heading: “Asegurados en el extranjero. Solicitar el registro del documento S-1 para cobertura de asistencia sanitaria en España”
Which documents are required?
- S1 Form
- Passport/ID card
- Certificate of register at the municipality (“volante de empadronamiento”), generally not older than 3 months
- Registration certificate („Certificado de Registro de Ciudadano de la Union Europea“) or
- Tarjeta de identidad de extranjero (TIE)
How long does it take to process and what is issued?
After 30 days at the latest, you should receive a document certifying your right to healthcare in Spain and containing your Spanish national insurance number.
With this document “Documento acreditativo del derecho a la asistencia sanitaria (Normativa international)” you then apply for the Spanish health insurance card (“tarjeta sanitaria”).
Step 2: Applying for the “Tarjeta sanitaria”?
The administration and provision of public health benefits in Spain is the responsibility of the autonomous communities (‘comunidades autónomas’). The conditions and regulations regarding applications, required documents, data queries and changes may therefore differ.
The “tarjeta sanitaria” is in some regions also called “SIP card”.
Where do I apply for the health insurance card in Spain?
There are 2 ways:
- In person at a local primary healthcare centre (“centro de salud”) closest to your home.
- electronically online, if it is possible (depending on the community) and you have a digital certification (“certificado digital”)
The regions have their own electronic systems and some also offer APPs for smartphones as a service.
What documents do I need to submit (required documents)?
If you are applying for the “tarjeta sanitaria” for the first time, you will generally need the following documents:
- Passport/ID card
- Certificate of register at the municipality (“empadronamiento”), not older than 3 months.
- Registration certificate („Certificado de Registro de Ciudadano de la Union Europea“) or
- Tarjeta de identidad de extranjero (TIE)
- Proof of the right to healthcare (“Documento acreditativo del derecho a la asistencia sanitaria”) issued by the “Instituto Nacional de la Seguridad Social (INSS)”
- and sometimes an official passport photo (32x 26 mm), if the card of the autonomous region requires a photo (e.g. on the Balearic Islands)
How do I get my Spanish health card?
Depending on the autonomous region
- the card will be sent to you by post to your home address or
- you must collect it in person from the “centro de salud” when it is ready or
- it will be issued to you on the spot (in the case of larger health centres)
You will also be assigned a family doctor (“médico de familia”) and a nurse with your health insurance card.
When you receive your TSI card, check whether there is any incorrect data on the card or errors were made when it was issued. If so, you must apply for a new one.
Take it with you whenever you visit a doctor, hospital or pharmacy.
More about the SIP or health card in Spain you can read in All important facts about the SIP card in Spain!
How do I use medical treatment in Spain?
Medical care in Spain is provided by health centres or doctors’ surgeries, hospitals and specialist centres.
Basic medical care (“atención primaria”) is provided in the health centres (“centros de salud”) and doctors’ surgeries (“consultorios”). General practitioners (“médicos de familia”), paediatricians (“pediatras”) and nurses (“enfermerías”) are located there.
If you need medical treatment, you must first make an appointment with the family doctor who has been assigned to you. Appointments can be made in person via the health centre or by telephone, online or APP (in some cases).
The general practitioner (your family doctor) will then refer you to a specialist or hospital if
he or she deems it necessary. Therefore, a referral from a primary care doctor is required for an
examination by a specialist. You cannot consult a specialist directly.
In emergencies, you can go directly (without an appointment) to the emergency ward (“urgencia”) in a health centre or hospital.
