Spain has two parallel systems: the state-run Seguridad Social and private health insurance. Most citizens have access to the state system, but private policies are chosen for their quick appointments, wider network of clinics, and no-wait routine check-ups. Below is how it all works and what to choose.
State Health Insurance (Seguridad Social)
- Who has the right: employed, self-employed (autónomos), family members of insured persons, as well as persons with temporary protection.
- How to get: Social Security registration, NIE number, registration (empadronamiento), choice of health center.
- What it covers: family doctor, specialists by referral, tests, hospitalizations, emergency care, vaccinations.
- Pros: free of charge within the system, full basic spectrum.
- Cons: waiting for specialists and routine diagnostics, rigid referral system, dentistry mostly not included for adults.
Private health insurance
- For whom: who wants to quickly get to specialists, have a choice of private clinics and service in English/Spanish without queues.
- Policy models:
- sin copago — no co-payments for visits;
- con copago - with small co-payments for each appointment, usually cheaper than the monthly price;
- reembolso (reimbursement) — you can go to any doctor, part of the costs will be refunded;
- What to pay attention to: availability of waiting periods, network of clinics in your city, hospitalization and surgery, emergency care, highly complex diagnostics, dentistry, psychotherapy, reimbursement for medications.
Digital Nomad and other visas/residence permits: policy requirements
- without surcharges (sin copago)
- without waiting periods (sin carencias)
- full coverage in Spain: doctors, tests, diagnostics, hospitalizations, surgeries, emergency care
- repatriation
- contract for at least 1 year, payment for the entire period
- a policy from a Spanish insurance company, properly completed for the consulate
Read more in the article Digital Nomad visa: what health insurance is needed?
Estimated prices
The price depends on age, city, policy type and options. To get an idea: younger age groups usually pay less, 50+ more expensive; sin copago usually more expensive than con copago; rembolso is the most expensive, but the most flexible. It is better to make an exact calculation based on your age and city of residence.
Private or public: what to choose?
- if you already have Social Security and the pace suits you, you can stay on the state pension
- if quick fixes and flexibility are important, add a private policy
- for visas and residence permits, be sure to check the requirements: often only private insurance with specific parameters is suitable
A more detailed comparison of private or public insurance in Spain is described here. Private or public healthcare in Spain? Important differences and tips for choosing.
What to look for in a private insurance contract
- Waiting periods: are there any waiting periods for childbirth, diagnostics, dentistry, or scheduled surgeries?
- pre-existing conditions: how pre-existing conditions are treated
- network of clinics: are there any large private hospitals in your city?
- emergency assistance outside the home and in the EU
- dentistry: basic or advanced, limits
- repatriation
- language of the service and method of making an appointment with a doctor (app, phone, web)
- clear limits and exceptions, authorization rules
Documents and registration
For the state system: NIE, empadronamiento, Social Security number, registration at the health center.
For private: passport/NIE, address in Spain, completed health questionnaire; for visas - a certificate for the consulate with the necessary wording.
Common scenarios
- combine public and private: public for the base, private for emergency specialists and diagnostics
- Family packages are more profitable than single packages
- for students and Digital Nomads: separate visa policies with the necessary conditions without additional fees and without waiting periods
Where can I get advice on private insurance in Spain?
Need to choose a policy for your case or visa requirements? Contact us Olesia Brych, official DKV insurance agent in Spain: www.seguro.expertFill out a short form and receive a free estimate and a list of clinics in your city.
Questions and Answers (FAQ)
- Is it possible to have both public and private insurance at the same time?
Yes. Many residents do this to avoid queues and get diagnosed faster. - Is registration required for state medicine?
Yes, to register at a health center, you usually need empadronamiento. - Does it cover private insurance dentistry?
Depends on the plan. Often basic services are included, while prostheses/implants are available at additional costs or in extended packages. - What is a waiting period?
These are waiting periods before certain services (diagnostics, elective surgeries, childbirth) begin. Visa policies usually require no waiting periods. - Is the tourist route suitable? insurance for Digital Nomad?
No. You need a private policy from a Spanish company with full coverage, no co-payments, no waiting periods, and coverage throughout Spain.