Health insurance in Spain: what you need for a residence permit and what it costs

A Spanish residence permit requires not travel insurance but a private health insurance policy from a Spanish insurer: with no co-payments (sin copagos), no waiting periods (sin carencias) and paid up front for the whole term, usually a year. A €30,000 travel policy, which is enough for a Schengen visa, is not accepted for residence. Not every insurer will do: the workable options are DKV, Sanitas and AXA, while the mass-market products of ADESLAS and ASISA almost always come with waiting periods. The price depends on the insured person’s age and the postcode of their address, so there is no single figure: an adult’s annual premium starts at around €620 in an inexpensive region, while in Barcelona the same policy costs 20–35% more. The full price list by year of birth is below. 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, 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 a Spanish insurer 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. 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: any of the three works for any grounds, including family reunification, and the certificate is issued with the required wording. 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.

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.

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: are you registered with the Spanish social security system, the Seguridad Social, at the time of applying? If yes, public cover is enough and no private policy is needed. If not, 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.

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.

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.
• 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, an agreement with the public health system. It is taken out by residents who have already lived in Spain for a certain period and are registered locally, so it does not work for a first application.
• 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, the Directorate-General for Insurance and Pension Funds under the Ministry of Economy. You can search the register by company name. If the insurer is not there, 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.

On your own or through an intermediary

On your own it works like this: you choose a company, fill in the questionnaire on the website or at an office, pay for the year and request a certificate. The difficulty is not the purchase, which takes twenty minutes, but two other points. First, finding out whether waiting periods can be waived on the chosen product and how much that costs. Second, 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. The agent sells a policy, not a document for an application, and when asked to write sin copagos ni carencias in the certificate, often replies that there is no such template. Then the person either spends weeks in correspondence or submits what they were given and receives a request for further documents.

We work through an insurance broker rather than as an agent for one company. In practice this gives two things: access to the entire DKV, Sanitas and AXA ranges at once, and to broker terms not available in open sale, for example AXA Optima without waiting periods. Offers are compared by the final annual premium for the specific applicant, not by an advertised “from” price.

We choose a policy for the specific residence permit grounds, check the company in the register, arrange the waiver of waiting periods and obtain a certificate in the form accepted by the consulate and Extranjería. More details are on the service page “Choosing and arranging insurance for a residence permit”. The selection is free: you pay only for the policy itself, at the insurer’s rate.

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.

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.

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. The problem is that when you first apply from abroad, you are not yet registered.

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 without carencias are available from DKV, Sanitas and AXA; AXA Optima has none from the outset.

Does the policy need to be translated into Russian?

On the contrary: 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?

As a rule, no. These companies’ mass-market products come with waiting periods, while a residence permit requires a policy without carencias. For residence, DKV, Sanitas and AXA ranges are used; AXA Optima has no waiting periods from the outset.

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 are current as of August 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.