Healthcare in Spain consists of the public health system (SNS) and private clinics accessed through insurance. Public healthcare is free at the point of use, but not for every resident: the right to it comes from working in Spain and being registered with Social Security, a Spanish pension or a benefit. People who moved on a non-lucrative permit, students and pensioners from Russia need private insurance, and after a year of living in Spain they can join public healthcare for €60 a month (€157 from age 65). Prescription medicines cost 10–60% of the price depending on income, and calling the emergency number 112 is free.
Below: who gets the right to free healthcare and how, how to get a health card (tarjeta sanitaria) and a Social Security number (NUSS), what medicines cost after the May 2026 reform, how long you wait for a specialist and what to do in an emergency. Which policy you need to apply for a residence permit is a separate topic: see our guide to health insurance for a Spanish residence permit.
Who is entitled to free healthcare
Under article 3 of Law 16/2003 a foreign national gets publicly funded healthcare if they live in Spain legally and habitually and the law does not require them to have health cover by other means. The right is recognised by the National Social Security Institute (INSS). Workers, Spanish-system pensioners and benefit recipients get it automatically, without applying.
| Your status | Right to public healthcare | What to do |
|---|---|---|
| Employee | yes, automatically after Social Security registration | padrón and a card at your health centre |
| Autónomo | yes, automatically after registration | the same |
| Digital nomad | yes, if registered with Spanish Social Security | if you stay in your home country’s system with a certificate, you need private insurance: the Spain–Russia agreement does not cover healthcare |
| Employee under the Beckham Law | the tax regime does not affect healthcare: Social Security registration means the right | as for employees |
| Non-lucrative permit | as a rule, no: insurance is a condition of this permit, i.e. cover “by other means” | private policy; after a year — convenio especial |
| Student | as a rule, no; with official employment — yes | policy; if working — Social Security registration |
| Pensioner with a Russian pension | no automatic right: a Russian pension is not a Spanish-system pension | private policy; after a year — convenio especial |
| Family of a worker | spouse, partner and children under 26 can be added as beneficiarios | application to INSS |
For non-lucrative permit holders and students there is no explicit ban in national regulations, but the wording of the law excludes them: they must prove insurance for their permit. Aragon’s health service says so in an official instruction — such applicants are not referred to INSS, as they must have insurance.
How to get a health card (tarjeta sanitaria)
The health card — tarjeta sanitaria individual, TSI — is issued not by INSS but by your region’s health service. It registers you with a health centre (centro de salud) and a family doctor.
- Register on the padrón (empadronamiento) at the address where you live: without it the region will not issue a card.
- Get the right to healthcare. If you work and are registered with Social Security, no application is needed. Everyone else applies at the INSS online office (sede.seg-social.gob.es) — «Asistencia sanitaria. Solicitud de reconocimiento del derecho» — with a digital certificate or Cl@ve, or without them via tramites.seg-social.es. Then download the certificate of entitlement (documento acreditativo, DAD) there.
- Go to your health centre with your NIE or TIE card, padrón certificate and INSS certificate — or apply online if your region allows it.
- You will be assigned a family doctor (médico de familia) or paediatrician. You can ask to change them.
| Region | Documents | Where and how | Timing and details |
|---|---|---|---|
| Madrid | TIE, padrón no older than 90 days, INSS certificate | at the health centre (8:30–20:30) or online with a digital certificate | the card is sent to the health centre in about 3–4 weeks; for foreigners it is valid as long as the TIE |
| Catalonia | padrón; workers do not need an INSS certificate | CatSalut online form or at the CAP | after an online application a temporary patient number (CIP) is emailed; the card is delivered home |
| Valencia (SIP card) | NIE, padrón no older than 6 months, INSS certificate | at the health centre or online with a certificate or Cl@ve | instant online reply, card collected at the health centre; virtual card in the GVA+Salut app |
| Andalusia | NIE, padrón, INSS certificate | application at a primary care centre | doctor assigned on application; the card has no expiry date |
Social Security number (NUSS): why you need it and how to get it
The NUSS is your number in Spanish Social Security, also called the affiliation number (NAF). Your region uses it to create your health card, and you cannot register as an employee or autónomo without it. The Social Security number and the health card number are different numbers.
- Employees — the employer applies for the number.
- On your own — in the Import@ss portal, «Solicitar el Número de la Seguridad Social», at any time. It also works without Cl@ve or a certificate: upload both sides of your NIE and a selfie holding the document, and give a phone number, email and address.
- For a child — the same, with form TA.1 filled in for the child.
For the Beckham Law the number matters indirectly: you must opt in within six months of your Social Security registration date (article 116 of the IRPF Regulation), and there is no registration without a number.
No entitlement: convenio especial for €60 a month
A convenio especial is a paid agreement with the region giving access to public healthcare for people who have no right to it by any other route (RD 576/2013).
- Conditions: at least a year of continuous residence in Spain before applying (Madrid also counts residence in the EU, EEA, Switzerland or the UK), padrón registration in the region, no other access to public healthcare.
- Price: €60 a month under 65, €157 from 65. The amounts have not changed since 2013; Madrid, Andalusia and Catalonia list them as current. A region may charge more if it adds services.
- What is included: doctors, tests, hospitals, emergency care and urgent transport — the SNS basic package.
- What is not: prescription medicines (you pay full price), orthopaedic products, medical nutrition, non-urgent transport. No health card is issued — you get a separate document.
- Procedure: a decision within 30 days, silence means approval; the agreement runs from signing. Missing two consecutive payments ends it, and a new one can only be signed a year later.
For a non-lucrative permit, a convenio especial does not replace insurance at renewal: the regulation requires a «seguro de enfermedad», and people usually keep a policy for the whole period.
Private healthcare and insurance
Private healthcare in Spain mostly works through insurance: each insurer has its own network of clinics and doctors. A policy covers what the public system lacks — fast access to specialists without a referral, a private room, often English-speaking doctors. Two terms worth understanding before you buy:
- Carencia — a waiting period after buying a policy when some services (for example childbirth or surgery) are not yet covered.
- Copago — a co-payment for each visit or service on top of the premium.
For the digital nomad permit UGE expressly rejects policies with co-payments or waiting periods, as well as travel insurance and reimbursement-only policies. For other permits consulate requirements vary — which policies are accepted and what they cost is covered in our guide to health insurance for a residence permit, and our insurance selection service helps compare plans.
What medicines cost: co-payments from May 2026
Patients pay part of the price of prescription medicines at the pharmacy — this is also called copago. A new scale has applied since 14 May 2026 (article 102 of the Medicines Act as amended by RDL 11/2026 and RDL 12/2026). Income means your annual IRPF tax base. Medicines given in hospital are free.
| Who | Annual income | Share of price | Monthly cap |
|---|---|---|---|
| Workers and their families | up to €9,000 | 40% | €8.23 |
| €9,000–18,000 | 40% | €18.52 | |
| €18,000–35,000 | 45% | €61.75 | |
| €35,000–60,000 | 45% | none | |
| €60,000–100,000 / from €100,000 | 50% / 60% | none | |
| Spanish-system pensioners | up to €18,000 | 10% | €8.23 |
| €18,000–60,000 | 10% | €13.37 | |
| €60,000–100,000 | 10% | €18.52 | |
| from €100,000 | 60% | €61.75 |
Medicines for chronic conditions in the reduced-contribution groups cost 10% of the price, capped at €4.98 per pack. Anything paid above the monthly cap is refunded by the region at least every six months. What you can buy without a prescription and substitutes for familiar drugs are covered in our guide to medicines in Spain.
How long you wait for a doctor and surgery
Appointments with a family doctor are usually booked through the region’s app or website. A public specialist requires a referral, and waiting lists are the main drawback. According to official Ministry of Health data as of 31 December 2025:
- a specialist appointment takes 102 days on average; shortest waits are for general surgery (61 days), gynaecology (64) and cardiology (68), longest for traumatology (132) and dermatology (127);
- planned surgery takes 121 days on average; cataract surgery 68 days, knee replacement 105;
- these are national averages; regional figures differ markedly.
That is why many residents entitled to public healthcare still keep a private policy — to see specialists without waiting.
Guaranteed waiting times: what your region’s law promises
Average waits are not a guarantee. Nationally, the law guarantees only 180 days for five operations: heart surgery, cataracts and hip and knee replacements (RD 1039/2011). Everything else is up to the region, and the differences are large:
| Region | Operations | Specialist appointment | If the deadline is missed |
|---|---|---|---|
| Andalusia | 180 days; 120 for common operations | 60 days; diagnostic tests 30 | a private clinic free of charge (SAS) |
| Valencian Community | 60 days | no guarantee | you can ask for a private clinic paid by the region, within its budget (Decreto 97/1996) |
| Catalonia | cancer 45, heart 90, cataracts and joint replacements 180 days | a 30–90-day target, not a guarantee | a private centre from the CatSalut list (Decret 354/2002) |
| Madrid | cancer 30, heart 90, cataracts and joint replacements 180 days | no guarantee | another centre is offered; if you refuse, a separate list of up to 360 days (Orden 804/2016) |
The guarantee is lost if you turn down the other hospital offered without good reason. So if you are choosing a region to live in with a chronic condition or with elderly parents, Andalusia is noticeably stronger than the rest.
Emergency and urgent care
- 112 — the single emergency number, free from any phone (article 74 of Law 11/2022). Public urgent care runs around the clock (urgencias at hospitals and health centres).
- If you are entitled to public healthcare, urgent care is free.
- If you are not, your insurance or you pay for treatment. Where there is a liable third party — an insurer, including motor insurance after a road accident — the hospital bills them.
- Foreign nationals without legal residence have, since 13 March 2026, filed a declaration and immediately received a temporary healthcare document (RD 180/2026); children and pregnant women receive full care. A tourist needs a social services report for this.
Triage in A&E: why you wait
In the emergency department the first step is triage: a nurse assesses urgency, and the queue follows it rather than arrival time. The health ministry’s target times (standards for hospital emergency units):
| Level | Condition | Seen within |
|---|---|---|
| 1, red | life-threatening | immediately |
| 2, orange | very urgent | 15 minutes |
| 3, yellow | urgent | 30 minutes |
| 4, green | less urgent | 60 minutes |
| 5, blue | not urgent | 120 minutes |
The triage systems hospitals use (Manchester or the Spanish SET) set their own targets, but the idea is the same: with an uncomplicated fever you may wait several hours.
A private policy and a public hospital: who pays
If you are entitled to public healthcare, emergency care is free and your private policy is irrelevant. If you are not, for example on a non-lucrative permit with a private policy, the public hospital will bill you as a private patient at the regional tariff: in Madrid, emergency care without admission costs €185 and a mobile ICU €882 plus €840 an hour (Orden 1975/2023). Insurers pay for hospitals outside their network only in emergencies and if notified in time: within 72 hours at DKV, and within 7 days and only when life is at risk at Asisa.
Hence the rule: keep your insurer’s assistance number in your phone and call it first; it will send an ambulance to a clinic in its network. If you had to call 112, notify the insurer within the deadline in your policy.
What public healthcare does not cover
- Dentistry — only partly. Everyone gets treatment of acute conditions and extractions; children up to 14 get fillings in permanent teeth. Braces, implants, dentures, root canal treatment for adults and cosmetic work are not included.
- Prescription medicines — with a co-payment (see above).
- Glasses and lenses, cosmetic procedures and most psychotherapy without a referral — at your own expense.
Pregnancy care and childbirth are a separate topic: what the public system and private insurance cover and which citizenship a child born in Spain gets is explained in our guide to citizenship for a child born in Spain.
Travelling in Europe: the European card
If your right to public healthcare in Spain is recognised, you can get a European Health Insurance Card (Tarjeta Sanitaria Europea) free of charge at the INSS online office. It covers necessary care during trips in the EU, the UK and Norway. Third-country nationals, including Russians, are not covered by it in Denmark, Switzerland, Liechtenstein, Iceland and Norway; it is also not valid in Andorra or for travel specifically for treatment.
How good is healthcare in Spain
The verifiable indicators are life expectancy and the number of doctors. Spain has the highest life expectancy in the European Union: 84.01 years in 2024 (INE; Italy 83.7, France 83.0, EU average 81.5). There are about 464 practising doctors per 100,000 inhabitants (Eurostat, 2024, an estimate with incomplete coverage): more than France, fewer than Italy and Germany. The weak point is specialist waiting lists; the strong points are primary care close to home and urgent care.
Your right to healthcare depends on your status in the country, so it is worth factoring healthcare into your choice of route: routes are compared in our overview of Spanish residence permits.
FAQ
Is healthcare in Spain free or paid?
For people entitled to public healthcare, doctor visits, tests, hospital and urgent care are free, and prescription medicines carry a 10–60% co-payment. The right comes from working with Social Security registration, a Spanish pension or a benefit. Everyone else needs private insurance or a paid convenio especial.
Do non-lucrative permit holders get free healthcare?
As a rule, no: insurance is a condition of this permit, and the law grants public healthcare to people who are not required to have cover by other means. After a year of residence and padrón registration you can join public healthcare through a convenio especial for €60 a month under 65 and €157 from 65.
How do I get a tarjeta sanitaria in Spain?
Register on the padrón, get the right to healthcare (automatically if you work, otherwise by applying to INSS) and apply at your health centre or online with your NIE or TIE, padrón certificate and INSS certificate. In Madrid the card takes about 3–4 weeks.
How much does a convenio especial cost?
€60 a month under 65 and €157 from 65. You need a year of residence in Spain and padrón registration in the region. It does not cover prescription medicines, and no health card is issued with it.
How do I get a Social Security number (NUSS)?
Employees get it through their employer. On your own, use the Import@ss portal: it works without Cl@ve or a certificate if you upload both sides of your NIE and a selfie with the document.
How long is the wait for a specialist in Spain?
102 days on average, and 121 days for planned surgery (Ministry of Health data as of 31 December 2025). Traumatology and dermatology have the longest waits, gynaecology and cardiology shorter ones.
Is emergency care free in Spain?
Calling 112 is free. The care itself is free for people entitled to public healthcare; otherwise it is paid by your insurance or by you.
Is healthcare in Spain good?
Spain has the highest life expectancy in the EU — 84.01 years in 2024. Its strengths are accessible primary care and urgent care, its weakness is specialist waiting lists, which is why many people keep a private policy.
Who pays if you have private insurance and are taken to a public hospital?
If you are entitled to public healthcare, care is free. If you are not, the hospital bills you as a private patient at the regional tariff, and the insurer reimburses it only in an emergency and if notified in time: 72 hours at DKV, 7 days at Asisa. That is why you call the insurer’s assistance number first.
Sources
- Law 16/2003 on the cohesion and quality of the SNS: articles 3, 3 bis, 3 ter, 8 bis, 8 ter, 57
- Royal Decree 576/2013 on the convenio especial
- Medicines Act (RDLeg 1/2015), article 102 as amended by RDL 11/2026 and RDL 12/2026
- Royal Decree 180/2026 on healthcare access for foreign nationals without legal residence
- Royal Decree 1030/2006, SNS services: urgent care, dentistry
- Social Security: recognition of the right to healthcare
- Import@ss: getting a Social Security number
- Madrid: tarjeta sanitaria, CatSalut: first TSI, Valencia: SIP card, Andalusia: tarjeta sanitaria
- Spanish Ministry of Health: waiting lists as of 31.12.2025
- INE: life expectancy, 2024, Eurostat: life expectancy by EU country
Tell us your situation — we reply within the hour
- Who is entitled to free healthcare
- How to get a health card (tarjeta sanitaria)
- Social Security number (NUSS): why you need it and how to get it
- No entitlement: convenio especial for €60 a month
- Private healthcare and insurance
- What medicines cost: co-payments from May 2026
- How long you wait for a doctor and surgery
- Emergency and urgent care
- What public healthcare does not cover
- Travelling in Europe: the European card
- How good is healthcare in Spain
- FAQ
- Is healthcare in Spain free or paid?
- Do non-lucrative permit holders get free healthcare?
- How do I get a tarjeta sanitaria in Spain?
- How much does a convenio especial cost?
- How do I get a Social Security number (NUSS)?
- How long is the wait for a specialist in Spain?
- Is emergency care free in Spain?
- Is healthcare in Spain good?
- Who pays if you have private insurance and are taken to a public hospital?
- Sources
