Health insurance in Spain: private and public cover, prices and requirements

A Spanish residence permit requires a private health insurance policy from an insurer authorised to operate in Spain, with cover comparable to the public health system, paid up front for the whole term, usually a year. For the digital nomad visa and other permits under Law 14/2013 the rules expressly require a policy with no co-payments (sin copagos) and no waiting periods (sin carencias). For other permits such policies are also rejected in practice. Travel insurance of €30,000, which is enough for a Schengen visa, is not accepted for residence.

Policies accepted for residence are DKV Visado, Sanitas Residents and AXA, plus the separate products for foreigners Adeslas Welcome and ASISA Health Residents. Mass-market Adeslas and ASISA policies come with waiting periods and do not qualify.

An annual policy for an adult costs from around €620 in an inexpensive region. The price depends on age and postcode: in Barcelona the same policy costs 20–35% more. An unsuitable policy is one of the most common reasons for a request for further documents and a lost month.

Below we explain how a residence policy differs from a travel policy, which three conditions the official checks, what is needed for each type of residence permit, which companies are accepted for residence, what about age and chronic conditions, how much it costs, and how to check an insurer in the DGSFP state register before you pay.

How residence insurance differs from travel insurance

Travel insurance (seguro de viaje) covers emergency care during a trip: emergency consultations, hospitalisation after an ambulance call, repatriation, sometimes flight cancellation. A €30,000 limit and a term of up to 90 days are the requirements for a short-stay Schengen type C visa, and for a trip such a policy is indeed enough.

Residence insurance (seguro de salud) is a contract with an insurer authorised to operate in Spain for healthcare where you live: GP and specialist appointments, diagnostics, planned operations, hospitalisation, sometimes dentistry. The requirement for it is worded differently: the cover must be comparable to that of the Spanish public health system, and the insurer must be authorised to operate in Spain.

These are two different products, and substituting one for the other is obvious at first glance. A travel policy states the trip dates and the sum insured, but says nothing about outpatient care, co-payments or waiting periods, which are exactly what is checked when you apply for residence.

How Spanish healthcare works in general (the public system, private clinics, booking a doctor and getting a patient card) is covered separately in our article on healthcare in Spain. Here we deal only with the document you need for your application.

Three conditions that get a policy rejected

The regulations describe the requirement in general terms: health insurance, public or private, taken out with an insurer authorised to operate in Spain. The specifics come from the practice of consulates and Extranjería (the immigration office) and boil down to three points. They are why people buy a policy that formally matches the description and then receive a request for further documents.

Sin copagos: no co-payments

A copago is a fixed extra charge for each use of the service: for example, €8 for a specialist appointment or €12 for tests. Policies with copago are noticeably cheaper, and they are what people most often buy when going by price. The logic of rejection is simple: if the patient pays part of the service out of pocket, the cover is no longer comparable to the public system, where appointments are free for insured people. The certificate must state explicitly sin copagos or copago 0 €. Phrases such as “low co-payments” or “copago reducido” are not enough.

Sin carencias: no waiting periods

A carencia is a period during which some services under the policy do not yet apply: usually six to ten months for planned surgery, childbirth and certain types of diagnostics. For the insurer it is protection against a client buying a policy for an operation that has already been scheduled. For a residence permit applicant it is a gap in cover for most of the first year, and the official is entitled to consider that the policy is not effective from day one.

The solution is to request an exención de carencias, a waiver of waiting periods. DKV, Sanitas and AXA offer this option, sometimes free of charge, sometimes for a higher premium; the mass-market ranges of ADESLAS and ASISA generally do not. Both, however, have separate products for foreigners, Adeslas Welcome and ASISA Health Residents, with no waiting periods from the outset. Sanitas Residents for visas has none either, including for childbirth. It is important that the waiver is stated in the certificate, not just promised verbally by the agent.

Payment for the whole term in advance

The policy must be effective from day one and must not depend on whether the next monthly premium is paid. That is why instalments do not work: on paper, only the first month has been paid. You need an annual policy and proof that the premium has been paid in full, usually a separate document, a recibo or certificado de pago.

The practical conclusion: do not ask the insurer for a brochure or forty pages of terms, but for a certificate in Spanish stating your surname and first name as in your passport, your passport number, the start and end dates of cover, the absence of co-payments and waiting periods, and the fact that the year has been paid. These three points are checked both at the consulate when you apply for a type D visa and at Extranjería on renewal.

Which companies are accepted for a residence permit

Formally, you can buy a policy from any insurer with a Spanish licence. In practice, only a narrow group of companies is accepted for residence: those with products without co-payments and, above all, a real possibility of doing without waiting periods. It is carencias, not price, that rule out most mass-market policies.

The practical difference between them is small: DKV, Sanitas, AXA, Adeslas Welcome and ASISA Health Residents all work for any grounds, including family reunification, and the certificate is issued with the required wording. But Adeslas Welcome cannot be bought without an NIE, so it is not an option when applying from a consulate on a passport alone. What sets AXA Optima apart is that it does not need to be “brought up” to the requirements: the sin carencias condition is built into the product itself rather than arranged through a separate agreement.

The flip side: the mass-market products of ADESLAS, ASISA and most other insurers almost always come with waiting periods. Such a policy is cheaper and looks attractive in advertising, but as a rule it is not suitable for a residence permit: the official sees carencias in the contract terms and requests the documents again. With these companies the waiting periods either cannot be waived at all, or waiving them costs more than taking a suitable product from the start. Both companies do have such products, Adeslas Welcome and ASISA Health Residents: ask for those specifically, not a mass-market policy.

A separate note on AXA Optima: some of the favourable terms for this product exist only in broker rates, not in open sale on the website. So comparing “the insurer’s price versus the intermediary’s price” often turns out not to favour the insurer’s website here.

Age, chronic conditions and pregnancy

Price is not the only filter. Before paying, check three things that can stop a policy with the right wording from being issued, or from covering what you bought it for.

Age at purchase

Sanitas Residents for visas and DKV Visado are issued up to age 75, Adeslas Welcome only up to 70. Sanitas renews an existing policy with no upper age limit, so age matters at the time of purchase, not five years later. ASISA does not state an age limit on its website; it is confirmed when you get a quote. If the applicant is over 75, a new policy is priced individually, so start looking well in advance, not a week before applying.

Chronic conditions and the health questionnaire

Before the policy is issued you fill in a health questionnaire (cuestionario de salud). Conditions that existed before the insurance and were not declared are not covered. Declared ones may be excluded by a specific clause. Do not hide a diagnosis: false answers allow the insurer to cancel the contract, and the policy would disappear in the middle of your permit. For past illnesses, Sanitas states that its medical department will call the applicant.

Pregnancy and childbirth

Visa products have no waiting period for childbirth: this is the case with Sanitas Residents for visas and Adeslas Welcome. But a pregnancy that began before the policy was bought counts as a pre-existing condition at DKV, and cover is decided on the questionnaire. The Sanitas International Students policy excludes pregnancy and childbirth altogether. If a family is planning a child in the first year, choose the policy with that in mind.

The trap comes when you switch policies. In ordinary, non-visa products the waiting period for childbirth is 8 months: this is the case with Adeslas, DKV, Asisa, Mapfre and Sanitas. Many people move after a year from the visa policy to a cheaper one, or from a company policy to a personal one, and the clock then starts again: when you switch, Sanitas recognises your previous cover and lifts the other waiting periods, but not the one for childbirth (Sanitas terms). If you are planning a child within the next year, do not change the policy until after the birth.

Which policy your type of residence permit needs

The requirement is worded the same way for all grounds, but it can be met in different ways. The key question is one: will you pay contributions to the Spanish social security system, the Seguridad Social? If you are already registered, public cover is enough and no private policy is needed. For a digital nomad, an undertaking to register after approval is also enough: the UGE information sheet says so directly. In all other cases you need a policy for the whole term of the permit.

A full breakdown of the grounds, income requirements and application procedure is in our article on Spanish residence permits. The most popular route for remote employees and freelancers is covered on the page about the digital nomad residence permit.

Insurance for the digital nomad residence permit: when no policy is needed

Not every digital nomad needs a private policy. The UGE information sheet for teleworker applications says it directly: insurance documents are not required if, after approval, you will register with the Spanish Seguridad Social. The fifth rule of the Joint Instruction of 30 March 2023 says the same: anyone who must pay contributions in Spain meets the requirement with an undertaking to register before starting work. The instruction was signed by the directorates for migration and for consular affairs, so it also applies when you apply through a consulate.

• Self-employed (autónomo). After approval you register with RETA, the scheme for the self-employed, and no policy is needed with the application. A self-employed person cannot stay in their home country’s social security: the UGE FAQ says that for an autónomo, carrying over the right under an agreement is not allowed.
• An employee whose foreign company registers with the Seguridad Social. You need proof of the company’s registration (when applying from abroad, proof that it has applied) and an undertaking to complete the alta. No policy is needed with the application.
• An employee who stays in their home country’s social security under an agreement. If the agreement covers healthcare, you attach a certificate of entitlement from your home social security body. If it does not, you need a private policy for the whole term of the permit.

Between arrival and registration there is no public healthcare yet. Everyone covers this gap on their own, for example with a short-term policy.

How much healthcare through RETA costs

RETA has no separate payment for healthcare: the right to it comes with the monthly self-employed contribution (cuota de autónomo). For the first 12 months after registering, a reduced contribution applies (cuota reducida, or tarifa plana) if you were not in RETA in the previous two years. Under Article 38 ter of the Self-Employment Law 20/2007, its amount is set by the budget law. For 2023–2025 it was €80 a month, and the Seguridad Social page gives the same amount. There is no separate act setting the amount for 2026, either in the contributions order or in Royal Decree-law 3/2026, so check the figure when you register. A second reduced year is only available with net income below the SMI, so a nomad earning at the visa threshold does not qualify.

After that, the contribution follows a scale of net income (rendimientos netos): 15 brackets, each with a minimum and maximum base. The 2026 scale was set by Order PJC/297/2026 of 30 March. The rate is 31.5% of the base: 28.3% common contingencies, 1.3% professional contingencies, 0.9% cessation of activity, 0.1% vocational training and 0.9% for the intergenerational equity mechanism (MEI).

An example. Income exactly at the visa threshold, €2,849 a month, with almost no expenses. For contributions, 7% of general expenses is deducted from income (Article 308 of the General Social Security Law), which puts it in bracket 7 of the general table: €2,330 to €2,760 a month, minimum base €1,356.21. Under Order PJC/297/2026 the contribution is €427.21 a month, €5,126.52 a year. It includes public healthcare for you and your family. For comparison: private policies for two adults and a child in Barcelona cost €2,658 a year and give healthcare only, with no pension record. You can choose a base above the minimum, and after the annual tax return the Seguridad Social recalculates the contribution on your actual income.

Spouse and children in public healthcare

Family members of an insured person get healthcare as their beneficiaries (beneficiarios), with no separate contribution. Under Seguridad Social rules, a beneficiary can be a spouse or a de facto partner (pareja de hecho) if the partnership is entered in an official register. Also children and those treated as children, such as children in your care and the insured person’s brothers and sisters, under 26 or with a disability of 65% or more. The conditions: legal and habitual residence in Spain, and the beneficiary is not working with their own social security registration and does not receive a pension. The right is recognised by the INSS after the main applicant’s alta.

For the residence permit application this means the following. The UGE information sheet for family members does not require a policy from them if the main applicant will register with the Seguridad Social after approval and the relative is entitled to be their beneficiary. The exception is a de facto partner not entered in a public register: such a partner does not become a beneficiary and needs a private policy.

How much insurance costs in 2026

There is no single price for a residence policy, and this is not an evasive answer but how pricing works. The premium is calculated from two parameters: the insured person’s age and the postcode of the address where they will receive care. Age is recalculated every year, so the policy gets more expensive at every renewal, even if you have changed nothing in the terms.

Why a “from” figure tells you little

Any advertised price of “from … € a month” can be reached by picking the most favourable age and the cheapest region. We can calculate that way too, but real people with real details are the ones being insured. So below is not one figure but the whole price list: the annual premium by year of birth for three typical regions, inexpensive Asturias, mid-priced Valencia and expensive Barcelona. These are real 2026 rates, not a “from… to…” range.

Annual premium for an adult

Applicants born in 1950 or earlier are insured under a separate procedure: the application is assessed individually, and there is no automatic price-list calculation for them.

The table shows two things no calculator on an insurer’s website will show. First, the region moves the price more than you might think. Barcelona is 20–35% more expensive than Asturias, and the gap grows with age: for a thirty-year-old it is an extra €180 a year, for a seventy-year-old almost €720. Valencia sits in the middle, roughly 8–13% above Asturias. Second, the age steps are uneven. Between 31 and 41 the policy gets about 19% more expensive, but between 56 and 66 it is already 44%. The rough turning point is forty-five: after it, each five-year band adds noticeably more than the previous one.

Children’s policy

Children are priced on a separate rate, and it works in an unexpected way: the most expensive policy is for a baby, the cheapest for a child of nine or ten. The difference between these two points is almost twofold.

What pushes the premium up

Example calculation for a family

Calculate for each insured person and add them up. Two adults born in 1985 and an eight-year-old child will cost €2,093 a year in Asturias and €2,658 in Barcelona, for the same policy; only the address differs. A year later both amounts will rise on their own, as the age in the rate moves up.

Why the monthly price and the annual premium differ

Insurers sell policies with monthly premiums because that makes the offer look cheaper. But a residence permit requires a year paid in full, and the annual bill is not simply the monthly figure multiplied by twelve.

First, insurers usually give a discount for paying annually, from a few percent up to a month’s premium. Second, one-off costs are added to the premium: issuing the medical card and, with some companies, a surcharge for waiving waiting periods. Third, the “from” monthly rate is calculated for the youngest age and the cheapest postcode, whereas your quote will use your real details.

Hence the practical rule: compare offers by the final annual bill for a specific person, not by the “from … €/month” figure on the insurer’s home page. And budget for the fact that a year later this bill will rise on its own, as the age in the rate is recalculated automatically.

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Policies that are not accepted

This list is based on the typical reasons for requests for further documents. If your option falls under even one point, it is better to change the policy before applying rather than after.

• Travel insurance for €30,000. It is designed for a short-stay visa and not intended for residence.
• International nomad insurance such as SafetyWing, Genki and similar. This is cover for travellers that reimburses costs: you pay first, then submit a claim. The UGE information sheet explicitly rejects travel policies, reimbursement-only policies and policies with co-payments or waiting periods. On top of that, such products are often issued by an insurer outside the Spanish DGSFP register (SafetyWing’s, for example, is a Puerto Rico company), and a deductible means the patient pays part of the bill.
• A policy from an insurer without a licence in Spain. Even a large international company will not do if it is not in the DGSFP register.
• A policy with co-payments. The size of the co-payment does not matter; what matters is that it exists.
• A policy with waiting periods for planned care, unless they have been waived in writing.
• Monthly instalments without proof of payment for the whole year.
• Convenio especial for a first application. This is an agreement with the public health system: €60 a month under 65 and €157 from 65, and regions may raise the amount. It can only be signed after a year of continuous residence in Spain with a padrón registration, so it does not work for a first application. At renewal it becomes an option: the permit requirement allows public insurance, but there is no direct ministry guidance on this, so check the practice in your province.
• Corporate insurance from a foreign employer, even with worldwide cover.
• A policy with the wrong dates: it starts after the application date or ends before the term of the permit applied for.

How to check a policy before buying

Four checks that take half an hour and remove almost all the risks.

The insurer is in the DGSFP register

The register of insurance companies is kept by the Dirección General de Seguros y Fondos de Pensiones (DGSFP), the Directorate-General for Insurance and Pension Funds under the Ministry of Economy. The search is open without registration: rrpp.dgsfp.mineco.es, section “Entidades Aseguradoras y Reaseguradoras”. Search by name (Denominación, option “Que contenga”) or by the tax number (NIF) on the policy: the brand and the legal entity often have different names. Check three things in the company record. The status (Situación) is “Activa”, not “Cancelada”, “Liquidación” or “Revocación”. The authorised classes include ramo 2 “Enfermedad”, ideally with the “Asistencia Sanitaria” modality: here the insurer provides treatment itself through its network rather than reimbursing costs (Article 105 of the Insurance Contract Law 50/1980). And the type of entity: a Spanish company, a branch of a foreign one (sucursal) or an EEA insurer operating in Spain without a branch. If the insurer is not in the register or is not active, the policy is useless for a residence permit, however broad the cover. This is the one check you must not skip: the other points can be sorted out with the agent, but a missing licence cannot be fixed.

The wording in the certificate

Ask for a certificado de seguro and check it line by line: surname and first name in Latin letters as in your passport, passport number, start date and end date, the words sin copagos, a note that there are no carencias or that they have been waived, confirmation of annual payment, and cover throughout Spain. If anything is missing, ask for the document to be reissued; this is a normal request.

Match with the grounds and family members

The policy must cover the term of the permit applied for and everyone applying with you. Children and a spouse on a joint contract must be listed by name: a reference to “and family members” is not accepted.

Dates

The policy must be active on the application date. At the same time, there is no point activating it too early: the year runs from the start date of cover, not from the date you receive your card, and if the process drags on, the policy will expire before you need it for the renewal.

Buying a policy from abroad and what happens if the visa is refused

The policy is bought before you apply, usually while still at home. Visa products are designed for this: DKV Visado is issued on a passport, ASISA Health Residents without an NIE. The exception is Adeslas Welcome, which cannot be bought without a valid NIE. The premium is annual and paid in one sum.

The purchase itself takes twenty minutes. The difficulty lies elsewhere: getting a certificate with exactly the wording the official expects, not a standard letter confirming that a contract exists. An insurer has no obligation to tailor the document to Extranjería‘s requirements, and when asked to write sin copagos ni carencias in the certificate, an agent often replies that there is no such template. This is why a visa product is safer than a mass-market one: the required wording is already in its certificate.

Will you get your money back if the visa is refused

ASISA states this officially: the premium is refunded to the same card if the policy has not yet taken effect and there is an official letter of refusal from the consulate or ministry. Once the policy is in force, there is no refund. We did not find such a clause in the official terms of the other insurers, so ask before paying and get the answer in writing. Hence the practical advice: set the policy start date to the application date, not a month earlier.

If you would like to compare options for your grounds and age, we can discuss it in a consultation; more on choosing a policy is on the “Choosing and arranging insurance for a residence permit” page.

Frequently asked questions

Is travel insurance accepted for a Spanish residence permit?

No. A travel policy is designed for a trip of up to 90 days and covers emergency care. For residence you need insurance with outpatient care, no co-payments and no waiting periods, from an insurer licensed in Spain.

Will SafetyWing or Genki be accepted for the digital nomad residence permit?

No. These are international policies for travellers that reimburse costs, and the UGE information sheet does not accept travel policies, reimbursement-only policies or policies with co-payments or waiting periods. The insurer must be in the Spanish DGSFP register, and the cover must be equal to public healthcare. A nomad who will register with the Seguridad Social after approval does not need a private policy with the application at all.

Can I take out a policy once I am in Spain, after arrival?

If you apply through a consulate, the policy is needed at the time of applying, that is, before you enter. If you apply while already in Spain, for example for the digital nomad permit via the Spanish online platform, the policy is needed on the date you submit the application. In both cases you must buy it before applying, not after. A nomad who will register with the Seguridad Social after approval does not need a policy with the application.

For how long should I buy the policy?

For the term of the permit applied for, but at least a year. If the permit is issued for three years, the insurer will still write a one-year contract with annual renewal; this is normal, and an annual policy with automatic renewal meets the requirement.

Do I need a private policy if I pay Seguridad Social contributions?

No. Registration with the social security system meets the requirement on its own; a certificate of registration is enough. For the digital nomad permit even an undertaking to register after approval is enough: the UGE information sheet directly exempts from the policy those who will pay contributions in Spain. A policy is needed if you stay in your home country’s social security and the agreement does not cover healthcare.

Does RETA cover a nomad’s spouse and children?

Yes. A spouse, a de facto partner entered in an official register and children under 26 become beneficiaries of the main insured person, with no separate contribution. The UGE information sheet for family members does not require a policy from them if the main applicant will register with the Seguridad Social. A partner not entered in a register needs a private policy.

What if the insurer refuses to waive waiting periods?

Change the product or the company. A refusal usually means you chose a product from a mass-market range not intended for residence: ADESLAS, ASISA and most other insurers do not waive waiting periods on such policies. Options with no carencias from the outset are the visa products: DKV Visado, Sanitas Residents, AXA Optima, Adeslas Welcome and ASISA Health Residents.

Does the policy need to be translated?

The certificate must be in Spanish. If the insurer issues the document in English, you will need a sworn translation (traductor jurado) into Spanish. It is easier to ask for the Spanish version from the start.

How much does insurance cost for a family of three?

It is calculated for each insured person and added up. Two adults born in 1985 and an eight-year-old child come to €2,093 a year in Asturias and €2,658 in Barcelona. The only difference is the postcode: the policy and the family are the same.

Will an ADESLAS or ASISA policy be accepted?

Their mass-market policies, as a rule, no: they come with waiting periods. But both have separate products for foreigners with no co-payments and no waiting periods, Adeslas Welcome and ASISA Health Residents, and these qualify. Adeslas Welcome requires a valid NIE and an age of up to 70; ASISA Health Residents is issued without an NIE.

Which residence permit insurance can I get after 70?

Sanitas Residents for visas and DKV Visado are issued up to age 75, Adeslas Welcome only up to 70. Sanitas renews an existing policy with no upper age limit. After 75 a new policy is priced individually, so start looking a few months before applying.

Will I get my money back if the visa is refused?

With ASISA, yes, if the policy has not yet taken effect and there is an official refusal letter: the money is refunded to the same card. Other insurers have no such clause in their official terms, so check before paying and set the policy start date to the application date.

What happens if the policy is not accepted?

You will receive a request for further documents with a short deadline to fix it, usually about ten days. Formally this is not a refusal, but in reality it is a lost month: you have to reissue the policy, get a new certificate and submit it in time. That is exactly why the policy should be checked before paying, not after applying.

Prices and requirements were checked against insurers’ websites and the BOE in September 2026. Insurers’ rates change during the year, and the practice of consulates and Extranjería varies by region, so check the conditions for your grounds before buying a policy.

Sources

• Ley 14/2013, Article 62.3.e: insurance for the digital nomad permit, «seguro público o privado… autorizada para operar en España». BOE-A-2013-10074.
• Ministry of Inclusion: information sheet on the non-lucrative residence permit (Hoja 6).
• Real Decreto 1155/2024, Article 35: insurance for studies valid for the whole stay. BOE-A-2024-24099.
• Real Decreto 576/2013, Articles 3 and 6: convenio especial, one year of residence, €60 and €157 a month. BOE-A-2013-8190.
• Insurers: Sanitas Residents, DKV Visado, Adeslas Welcome, ASISA Health Residents.
• UGE information sheets for teleworkers: for the main applicant (section “Seguro público o privado de enfermedad”) and for family members; the UGE digital nomad FAQ. Joint Instruction of 30 March 2023, fifth and sixth rules.
• Order PJC/297/2026, Article 18: RETA contribution scale for 2026. BOE-A-2026-7296. RETA rates for 2026: Seguridad Social.
• Self-Employment Law 20/2007, Article 38 ter: reduced contribution. BOE-A-2007-13409. General Social Security Law, Article 308: the 7% deduction. BOE-A-2015-11724.
• Seguridad Social: who counts as a beneficiary of an insured person.
• DGSFP insurer register: rrpp.dgsfp.mineco.es. Insurance Contract Law 50/1980, Article 105. BOE-A-1980-22501.