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Health insurance in Spain

This letter consists of two parts. The first section briefly describes how the Spanish health system works and what consequences it may have if you are on a holiday (long or short term) or if you are a resident in Spain. The second part gives you more information about private health insurances. Before you read further, the best rule is: If you are on holiday, have your EHIC card with you. Take out sufficient holiday insurance to cover you for your stay. If you are planning on being in Spain for 90 days or more, you need to check that your holiday insurance will cover you or take out private medical care here in Spain for the remainder of your stay. We do not pretend to be perfect, but if you have any comment, please let us know. You won’t find any advice telling you which insurance company to use, these are just general guidelines that you should consider. It is important you should understand that in Spain there are two health systems which function alongside each other. The private and the public health care. Both systems have their own infrastructure (primary care, hospitals, home care, nursing homes, etc.). In certain situations there may be an overlap and they will work together. In the public system (INSS: Instituto Nacional de la Seguridad Social) anyone with the Spanish “Tarjeta Sanitaria (SIP)” or a European Health Insurance Card (EHIC) from a country that Spain has an agreement with are covered. In the latter case, this is for emergency medical care only. You can use private health care with travel insurance, foreign health insurance with cover abroad or with Spanish private insurance. And of course, if you just pay yourself.

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Holiday

If you have a European Health Insurance card (EHIC) you can use all the Spanish Public Health facilities. Make sure you request a card before you leave your country. This is only for acute medical care. For everything you need to know about EHIC, including how it works, coverage, cost, status after Brexit, the application process, validity, and more, delve into SchengenVisaInfo.com website. It is advisable to have travel insurance cover. Repatriation costs and after care etc. are all covered. You will be communicating in your own language, which is always easier. We have a good relationship with all the international travel insurances companies. It is important you read the terms of your policy.

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Long Stay

If you are in Spain for long periods of time it is presumed you will have a GP, even though you are still registered in your own country. You can use your EHIC card too as it covers all the public health facilities but only for acute medical care.

However, most people take private insurance (an insurance with international cover or Spanish private insurance). Read further on about what to look for when taking out private insurance. Travel insurance including medical care for short term (depending on the policy, usually up to 90 days) also provide cover.

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Residents

For those who live and work in Spain the majority pays into the state system (direct or indirect) and can use the Spanish National Health. You have full access to the SNH with your SIP card. However, a large part of the residents also (and some exclusively) have private health. Read further on about what to look for when taking out private health insurance.

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Public or private care?

Sometimes unless otherwise stated, the public and the private care complement each other and provide a complete and flexible system. The public health sector works with the private system to reduce waiting lists and for example gather information about a foreign patient. Should it become necessary for the SNHS Police or social workers to become involved in a case, an appeal goes out to the private sector for help. Conversely, there are certain procedures only available within the SNHS. In exceptional cases some treatments, which were started in the private sector, will be continued in the public system. Most people (foreigners and Spaniards) opt for additional care in the private sector because of the lack of waiting lists, choice of doctors / specialists, private hospital room, a more personal approach with more time and more efficient care etc.

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Private insurance, a difficult subject

Choosing a private insurance is not easy. This is mainly due to the wide range of insurance companies with very different policies. The following section attempts to give you some information about what to consider when looking for the best company for you. It is important to take the time to carefully read all the conditions. Talk to all the relevant agents, brokers and maybe even doctors before you make your decision. Do not go on price only.

Things to consider:

You must first ask yourself whether you need insurance, in addition to your Social Security/EHIC. If you only want to use the private care for ‘little things’ and you have some spare money, you can do that too.
If you cannot use the public care system, you need to have private insurance cover. Most private insurance cover is seen as complementary to public health care and do not give complete cover. For example, no reimbursement of medicine costs.
There are very cheap Spanish insurance companies. Often they have limited cover. Don’t be fooled by low premiums. Often if you pay a little more you get much better cover.
Due to the economic times it is better to choose a larger rather than a smaller Private Insurance company. A large company is less likely to close due to lack of funds.
There are also some other aspects of cover to consider. Excess charges such as per year or per transaction. Exclusion of medication, prostheses and other aspects that make the choice more difficult. Most insurers have a maximum age (usually 64, sometimes 74 years). If you have a medical history of serious diseases, you will find it difficult to find a (new) insurance without with no restrictions.

Roughly speaking, there are four types of private insurance:

Foreign insurance with coverage for Spain.
The so-called ‘reembolso’ or refund insurance. This gives you the opportunity to visit the doctors and hospitals of your choice. You pay the invoice yourself and get 80-100% return, depending on the insurance company..
The assurance of a ” cuadro médico ‘ or network. With this option, you must use the hospitals Doctors, Consultants and Surgeons affiliated to the same company.
Spanish insurers that offer a mix. This allows you to visit Doctors and hospitals within a network, but also elsewhere.

The advantages of a refund policy are clear: Free choice of Doctor’s and Hospital’s (also some insurance abroad). In practice, the Doctors and Hospitals are better paid by such insurance companies. That in some cases has unwittingly had an impact on care. The downside is that you always have to pay in advance and the premium is normally slightly higher.

Our experience shows that, in addition to foreign insurance with cover for Spain, the mix policy is a good, flexible and not too expensive option.

Our advice is:
Obtain several quotations from various agents (please note that agents in general only offer limited selection of insurance companies) or by brokers. You can then preselect several insurances. Have a good look at the network or cuadro médico’ in your region. It is a good idea to read the small print and compare all of them carefully. Once you have made your choice, please feel free to contact Dr. Meertens who will help you to confirm how it works and if this policy is a good option for you.

You will find below a list of almost all health insurance companies in Spain covered by Dr. Meetens. Note that various insurers have several products. We have not listed foreign insurances, that would be impossible, but these foreign insurances are definitely worth considering.

There are various types of insurance brokers in Spain. The ‘corredores’ or brokers work with their own customer base and can negotiate with any insurer. You can contact them and, depending on your personal situation, you will be taken through the possibilities of health insurance in Spain. The ordinary agents can only offer one or more insurance. You can contact the insurance company or agents by clicking on the below companies.

Refund or mixture: