Spain Expat Health Insurance Guide
If you’re heading to Spain – either as a tourist or an expat – it’s critical that you understand how you can access the healthcare facilities on offer. We’ve put together a complete guide to health insurance in Spain to help you ensure that you can get the treatment you need while away…
The reality is that many tourists and expats visiting Spain from another EU country are under the impression that an EHIC (European Health Insurance Card) grants them free and unlimited access to healthcare in Spain.
Sadly, this is generally not the case. Numerous stories exist of disappointed visitors not receiving the standards of care they expected. If you are heading to Spain shortly and are looking to understand how the healthcare system works and whether you need health insurance read on for our detailed explanation of the system as of 2016…
Is Healthcare Free in Spain?
As in most countries there are two broad forms of healthcare on offer in Spain; public, state-funded facilities and privately-run facilities. Interestingly, while the queues in private clinics may be shorter, many expats report similar standards of care whether opting for private or state facilities.
Some expats moving to Spain will be entitled to “free” healthcare if they meet one of the following requirements:
- Health Insurance for Employed Expats
Those expats who move to Spain in order to work will generally be registered for a social security number and will then pay into the Spanish system. Thanks to these payments working expats will then gain access to the state-run Spanish healthcare system.
Healthcare in Spain for Self-Employed Expats
Self-employed expats living and working in Spain can also gain access to the public healthcare system. In order to do so you will need to register yourself for local taxation. Under this system you will then receive a social security number and will be entitled to free care at public hospitals.
“Free” Health Insurance for Travellers
Visitors to Spain from within the EU can make use of an EHIC card in order to gain access to the healthcare system. It should be noted, however, that such a card really only gains you emergency medical treatment (rather than long-term care) and is only suitable for temporary visitors.
Due to the severe limitations of this option, therefore, many travellers exploring Spain opt to take out supplemental health insurance policies offering broader care.
Visitors from outside Europe do not gain access to the same European Health Insurance Card system and so should regard private medical insurance mandatory in Spain.
Private Expat Health Insurance Spain
Spain Expats who do meet any of the above requirements will not have free or discounted access to the State-run medical facilities.
Instead you will need to make use of two possible alternatives.
The first of these is a “buy in” through the “convenio especial” system. Here you pay into the National Health Service and in exchange gain access to its facilities.
That said, this solution is far from perfect as it has a distinct number of limitations. A good example of this is that such individuals will find their prescriptions are not being subsidized so will need to be paid in full.
The second option is to opt for a fully-featured private health insurance policy for Spain. Such policies are generally recommended as the best option due to the level of coverage provided.
Not only will such a policy grant you access to all the services that you require but they also cover medical repatriation and cost-effective dental care.
Prescriptions in Spain
Generally speaking Spain operates a co-payments system for prescriptions. This means that you are unlikely to receive “free” medications while in Spain, though it is likely to be heavily subsidized.
It is interesting to note that unlike the UK where most working adults pay the same fixed fee for prescriptions, in Spain the policy is rather different. Here the level of subsidy you enjoy depends on your taxable income; the more you earn the more you will pay in general. Furthermore while some people’s annual contributions for prescriptions are capped at a maximum, others are not.
Therefore if you expect to need prescription medication while visiting or living in Spain it pays to investigate how the system will work in your case to make budgeting for such eventualities much easier.
Lastly, be aware that as with many other Spanish businesses many pharmacies maintain “Spanish” hours. In other words many drug stores close for much of the afternoon (2-5pm typically) but then re-open after “siesta time” and work late into the evening.
As a result it is wise when requesting a prescription to consider when you’ll be able to collect it. Try to avoid afternoons if possible in all but the most cosmopolitan areas or you may be disappointed to find the pharmacy closed.
Moving to Spain
For many, the thought of moving to Spain conjures up images of retirees lined-up along the seafront and a mini-England feel. Whilst many do enjoy their golden years in Spain, and there are large British expat communities, Spain is a diverse and cultural country.
Mainland Spain boasts incredible cities such as Barcelona, Madrid, and Valencia. Also, let’s not forget the cornucopia of Spanish islands, including the Canaries off the western coast of Morocco, and Ibiza, Majorca, and Minorca in the Balearic Sea.
Wherever you are moving to in Spain, you can guarantee that the people will be welcoming, the sun warm, and the food delicious. However, there is a lot to learn before you go and live the good life…
Spain is generally considered to have a Mediterranean climate, but due to its geography the regions do differ. The south coast of Spain, home to the likes of Valencia, Benidorm, and Barcelona, has the sort of weather we stereotypically envisage when we think of Spain. Winters are mild and rainy, but the summers are hot and dry. Barcelona, which is close to the French border, is a degree or two cooler than the “sun, sea and sand” holiday destinations further down the coast towards Portugal.
The vast central plateau of Spain, home to the capital city Madrid, has a great difference between summer and winter temperatures, and significantly more rainy days than the southern coastal locations. This continental-style climate means that temperatures top out at around 25°C in the summer and drop to approximately 5°C in the winter.
The third climactic region in Spain is north of the Cantabrian Mountains, on the north coast. Holiday makers flock to Bilbao, Gijon, and Santander easily by ferry. Also known as the Basque Country, the north of Spain has a maritime climate with summer temperatures averaging 20°C, and winter temperatures rarely dropping below 10°C.
Barcelona Monthly Temperatures and Rainy Days
Benidorm Average Monthly Temperatures and Rainy Days
Madrid Average Monthly Temperatures and Rainy Days
Santander Average Monthly Temperatures and Rainy Days
Even if you haven’t studied Spanish, chances are you know more common phrases than you think. The official language of Spain is Spanish, sometimes called Castilian, which is spoken by 99% of Spaniards as a first or second language. Those who do not have Spanish as a mother tongue tend to talk in Basque, Catalan, or Galican.
Basque is a co-official language spoken mainly in the Basque Country, located in the north east of Spain, and home to the city of Bilbao. Most Catalan speakers reside in the Balearic Islands, an archipelago off the south coast of Spain. It is a recognised language, but not official. Lastly is Galician, which is another co-official language of Spain. Galicia is located above Portugal, so it is unsurprising that Galician has Portuguese influences. Despite having a strong expat population, outside of expat communities and tourist areas, everybody speaks Spanish. It is best, at first, to learn some key phrases as a mark of respect. Most expats find that the Spanish language comes to them naturally over time.
|British Phrase||Spanish Phrase|
|How are you?||Como estas?|
|I am fine, thankyou||Estoy bien gracia|
Many expats drive in Spain despite road signs being in Spanish and local drivers abiding by their own rule book. In general, once you get used to the different laws and regulations, driving in the country is relatively care-free and cars can be bought and rented easily. Those living in cities will not need a car as there is high congestion and public transport is a quicker option. Whether or not you need to renew your license and obtain a Spanish one depends on the country you have emigrated from.
For those living in Barcelona or Seville, investing in a bicycle to navigate the city is a fantastic option. Both cities have fantastic cycling infrastructures, from dedicated cycling lanes to safe storage solutions. Generally speaking, cycling is popular around the whole of Spain, but some regions have considerably steeper hills than others!
The most popular way to get around Spain is by train. Two major networks run throughout Spain, the RENFE and AVE. The RENFE is the national network and, in larger cities, lines are often integrated with regional and urban networks.
The AVE is Spain’s high-speed train network. The central hub of the AVE is in Madrid and services fan out to Seville, Barcelona, Cordoba, Zaragoza, and France. However, high-speed trains can sometimes be expensive and hopping on a domestic flight can be cheaper.
The majority of major cities have a subway system and the metro in Madrid is said to be one of the best in the world. Barcelona, Zaragoza, and Seville also benefit from having extensive tram systems.
Throughout Spain’s cities, larger urban areas, and residential zones, are extensive public bus routers. Most bus travellers buy their tickets from Movelia, a central website which caters for 20 transport companies who cover routes nationwide.
Lastly, taxis throughout Spain tends to be reasonably priced, safe, and comfortable. It is best to speak to the taxi driver in Spanish as foreigners may be considered tourists and overcharged. If your taxi driver does not have his metered turned on, make sure you have negotiated a price before your set off on your journey.
Spain’s National Health System is regarded as one of the best in the world, with both public and private facilities providing a high standard of care.
State healthcare is free of charge to anybody living and working in Spain; you must have a social security number. Expats must register on the municipal register to receive a social security number and card, which can then be presented at the local doctor’s surgery to receive a medical card.
Those who are employed, a child, pregnant, receiving benefits, studying, a pensioner, or have an EHIC card can receive free healthcare. Chances are, wether on holiday or living in Spain, you will be able to receive public hospitalisation.
The public hospitals in Spain are well equipped and staff are very professional and often bi-lingual. If not, most tend to have interpreters. The only downside of general hospitals is the waiting time to see specialists and have procedures carried out.
Many expats prefer to opt for private services as queues tend to be shorter than the public system and there is a wider access to different treatments and specialists. Single consultations within the private sector are very affordable, but prices can escalate if complications or an emergency arise. This is why it is imperative to take out health insurance if you want to utilise the private sector.
For minor illnesses and injuries, many utilise the numerous 24-hour pharmacies dotted throughout Spain. Due to strict price restrictions, medicines are affordable in Spain, and virtually anything can be purchased over the counter. All farmacia will have a neon green cross outside.
The emergency number in Spain is 112. Most operators are able to speak English and will dispatch the relevant emergency service, including private ambulances. Whether public or private, Spain is championed for its short wait times for emergency help.
Before January 2002, Spain’s currency was the peseta. During this year, Spain was one of the 19 European Union members to agree to a universal currency. Euro coins and notes were introduced in January 2002 and, as of 1st March, the peseta lost its legal tender status in Spain and the euro became the official currency of the country.
Each euro is divided into 100 cents and there are 50, 20, 10, 5, 2, and 1 cent coins. There are also 1 and 2 euro coins and notes are available in denominations of 5, 10, 20, 50, 100, 200, and 500.
There are countless banks throughout Spain and most offer online banking with fast and easy transfers. The most popular amongst expats are HSBC and Barclays. However, there are a selection of banks with multi-lingual staff and documentations can be easily changed into your preferred language if banking with one of these.
One thing expats should be aware of is Spain’s variety of high charges that can be placed on debit card transaction fees, correspondence fees, and transfer fees. Most banks also charge a small sum of money for opening an account.
When living in Spain expats have the option of opening a non-resident or resident bank account. Resident bank accounts can only be opened with a Spanish tax identification number. Non-resident bank accounts do give users the option to hold in a foreign currency, but they usually have higher fees and a lack of services.
Any child living in Spain between the ages of six and 16 must attend school. For expat children there are five options; free Spanish public schools, bilingual schools, private schools, independent schools, or home schooling. Whatever option is decided upon, after the age of 16 children can either go on to attend upper secondary (the Spanish equivalent to college) and university after that.
For families with children of primary school age or younger a local public school could be a great option. Children are taught solely in Spanish, surrounded by Spanish children, which will help them pick up the language quickly and integrate into society. It must also be remembered that your child will be studying the Spanish curriculum.
Although public schools have their benefits, attending a new school is daunting for a child, and a school where everybody is speaking a language alien to you can be frightening. However, some public schools across the country offer British-Spanish programmes. Bilingual schools allow children to speak in English, but Spanish is a big part of their day. These schools allow children to feel in control and gives them a chance to settle in.
There are two types of private schools in Spain; semi-private and traditional private. Semi-private schools were once private schools, but have been taken over by the government. Fees in these schools tend to be very low or non-existent. Class sizes in semi-private schools are typically smaller than those found in public schools. Classes are taught in Spanish and follow the Spanish curriculum.
On the other hand, private schools have smaller class sizes still, higher-quality facilities, and an array of extra-curricular activities to supplement children’s learning. Unless the school is bilingual, the curriculum will be the same as that in semi-private schools, and lessons will be taught in Spanish.
If you want your child to study for the International Baccalaureate or follow the curriculum of their home country the only option is for them to attend an international school. Children can be taught in their mother tongue and follow teaching methods that they are familiar with.
Fees for international schools are notoriously high and children may have to commute to school. However, in the cities there are countless international schools, most of which are British.
Food & Drink
The cuisine of Spain varies from region to region; affected by the geography and history. However, one thing that is universally celebrated throughout the whole of Spain is the national dish, paella. Many argue that paella originates from Valencia, where it is made with the traditional rice, and laden with rabbit, chicken, and vegetables. However, Spain is famed for its seafood paella, which can contain the likes of calamari, mussels, clams, prawns, scampi, and a variety of different fish depending upon what you order.
Other classic Spanish dishes include the traditional tapas dish of patatas bravas (essentially the best chees
y fries you will ever consume) and gazpacho, a cold raw-veg soup enjoyed in the summer. Croquetaare a variant of the traditional potato-based croquettes that are recognised world-wide. Inside the fried mashed potato is molten cheese and salty ham, an ideal warming comfort food. Beef-stuffed empanadas, tortilla espanola, and albondinga meatballs are also some firm Spanish favourites.
One of the most prevalent puddings of the past few years is the humble churro, which started life in Spain. The deep-fried doughnut sticks are enjoyed at any point of the day, dunked in a steaming cup of melted chocolate.
Dairy makes the base for a number of popular Spanish deserts, and flan and Crema Catalana are no exceptions. Crème Catalana is colloquially known as the poor man’s crème brulee as, while the basic recipes are the same, the sugar on top is torched to a crisp, rather than being rich caramel. Flan, on the other hand, are drenched in caramel when turned out. A variety of flavours can be enjoyed throughout Spain, from vanilla, chocolate, and coconut, to cheese or chestnut.
How can we discuss the finest Spanish food and drink without mentioning sangria? Jugs are prepared with a bottle of red wine, two oranges, one lemon, sugar, and a cinnamon stick, before being left to sit for two hours. Talking of wine, some of the best come straight out of Spain. Favourites include Rioja, Sherry, and Cava.
Those preferring a soft drink have a plethora of fruit juices to choose from, with mango being a very popular choice. Granizado are found everywhere and are Spain’s version of a typical slushie. For something warm, you cannot beat a Spanish hot chocolate, which is thick and decadent.
Expat life in Spain is usually trouble-free. Terrorism has no greater threat over the country than other European destinations and petty crimes tend to be the most sinister committed. Pickpocketing is relatively common in tourist areas and cities, so it is best not to have your valuables on show. Some thieves use distraction techniques, working in pairs or small groups, often targeting purses, wallets, and passports. Robbery of passports in airports has seen a rise over the years, so keep them out of sight.
Theft from hire cars has also seen an increase so holiday makers and expats should always remove valuable from cars.
Although extremely rare, attacks and sexual assaults have happened to foreigners in Spain. More often than not, drinks are spiked in nightclubs. Expats and holidaymakers enjoying Spain’s nightlife should make sure to buy and guard their own drinks.
There is an issue in Spain with individuals posing as plain clothed police officers. They target foreigners by foot, or on the road, and will often ask individuals to hand over their bags, purses, and wallets. No official police officers in Spain will ever ask you to hand over your belongings and, if you are ever concerned, simply ask to see their ID.
In recent years, there has been a phenomenon sweeping Spain called ‘balconing’. It involves individuals jumping from balconies into swimming pools, or from balcony to balcony. In 2010 alone, there were six deaths due to balconing. Usually, these acts are a result of expats and holidaymakers under the influence in locations such as Magaluf, Valencia, Malaga, and Ibiza. Younger expats and travellers should refrain from getting involved with the craze.
Places to Visit
Whatever your heart desires, Spain has it. Whether you want to experience idyllic coastal retreats, contemporary cities, or Spain’s varied past, expats and visitors are spoilt for choice. With influences from Portugal and France, as well as having its own unique spin on life, Spain is more diverse than the stereotype many place on it.
It may not be the capital of Spain, but Barcelona is one of the most-visited cities in Europe. The sandy beaches set against the unique architecture are a sight like no other. Some of Barcelona’s architectural treasures date back over 2000 years, with artists such as Picasso and Salvador Dali having been inspired by the city.
Ancient Seville’s history can be seen in the Roman ruins, medieval engravings, and colonial architecture that bequeaths the city. Seville’s Triana neighbourhood is famed for its flamenco dancing. Visitors can enjoy an evening watching the dances in many of the local bars and restaurants.
Located on the Bay is Biscay, on Spain’s northern coast, is the seaside city of San Sebastian. Like Madrid, it is famed for its food, with countless restaurants boasting Michelin stars. Although San Sebastian is very much a modern city, the beaches and Cantabrian Mountains in the distance provide those who live there with an escape from the hustle and bustle.
In a world where religion can cause so much segregation, Toldeo comes as a breath of fresh air. The city sits atop a gorge overlooking the Rio Tajo. Christian, Muslim, and Jewish people coexisted peacefully here in the Middle Ages. Known as the ‘City of Three Cultures’ due to this, the streets are lined with mosques, synagogues, and churches.
The arts and fine-dining feature heavily in the lives of those who call Spain’s capital home. It is championed as one of the most exciting culinary hotspots in Europe and many nights are spent dancing until dawn after a delicious meal.
Madrid may not have the prestige of Paris or relics like Rome but its relaxed way of life and enchanting architecture make it a beautiful city in a very different way.