What kind of health insurance do I need if I'm moving to Spain?
Introduction
Many French people choose to relocate to Spain for a variety of reasons: they have a property development project on the Costa Blanca, are planning a retirement in the sun or simply want a change of scenery to start a new life. But whatever your situation, a successful expatriation depends on good health cover. Knowing what is covered by the Spanish system will help you get organised and make the most of your new life.
1. How do I access the Spanish healthcare system?
The Spanish health system, known as the Sistema Nacional de Salud (SNS), is based on a universal cover model based on the principle of residence and compulsory social security contributions (INSS). Anyone residing in Spain for any length of time is eligible, provided they meet the membership criteria. To complete the administrative formalities, it is essential to obtain a NIE (identification number for foreign nationals). Without this number, you cannot register with the INSS or access the SNS.
As soon as you transfer your tax residence to Spain, French Social Security ceases to cover you, except in the case of temporary secondment (from a French company) or if you are retired. As International Santé points out, membership of the Spanish scheme then becomes compulsory. At the same time, it is possible to take out international health insurance, for expatriates who wish to retain comprehensive, cross-border cover.
2. Health cover for expatriate workers in Spain
Expatriate employees with a local contract are automatically covered by Spanish social security. The employer is responsible for registering with the INSS, which then allows access to care in the public network, subject to registration in the health centre corresponding to your place of residence.
For self-employed or freelance workers, the procedure is different: voluntary registration with the local RETA scheme (Special scheme for self-employed workers) is required. To benefit from the cover provided, you must register with the Social Security Treasury and pay monthly contributions.
In more atypical cases, such as digital nomads who are not declared for tax purposes in Spain, there is no automatic affiliation. In certain cases and depending on the region, recourse to the Convenio Especial, a voluntary contribution scheme, may be considered.
Bear in mind that access to public care does not mean total cover or free treatment for all types of care. Some medical expenses, such as optical and dental care, so-called "comfort" procedures and private treatment, are not covered by the SNS. Hence the frequent interest in complementary private health insurance, or even international health insurance, for French expatriates who wish to supplement their cover and retain cover in France.
3. Health cover for retired people living in Spain
Pensioners who receive a French pension can request form S1 from their pension fund. This document is used to transfer French health insurance entitlements to the Spanish system. Once registered with the INSS, pensioners have access to the SNS under the same conditions as a local resident.
This procedure is well known and widely used by French pensioners moving to Spain. However, despite access to the SNS, many retirees opt for private insurance in order to limit waiting times in the public sector, have access to a wider choice of specialists and be able to consult in private clinics without putting a strain on their finances.
For more details about retirees, see our guide: Expatriating to Spain after retirement.
4. Health cover for mobile students and young professionals
The European Health Insurance Card (EHIC) is a healthcare tool specific to the EU. During a temporary stay in Spain, this free card, issued by the health insurance scheme of the main country of residence, gives access to essential medical care in the public sector under the same conditions as a permanent resident. Cover is provided in the public sector only and does not include repatriation assistance.
For students or young people working in France, the EHIC is a valuable asset for short stays. On the other hand, for long-term studies, a stay of more than six months or a salaried job in France, affiliation to the local scheme generally becomes compulsory. However, taking out temporary travel insurance at the same time helps to overcome local or EHIC limitations. In some cases, the school may require you to take out private health insurance in order to validate your enrolment.
5. When should I consider taking out international health insurance in Spain?
International health insurance for expatriates in Spain is particularly recommended if you wish to maintain cover both in Spain and in your country of origin. This is the case for cross-border expatriates or those who prefer to continue receiving treatment in France for certain conditions. This expatriate mutual insurance is also aimed at working people who move between several countries, as well as intermediate statuses such as digital nomads.
This type of contract offers much more comprehensive cover than that provided by the SNS or local private insurance. Expatriate insurance covers all your needs, with appropriate reimbursement ceilings, while offering the freedom to consult the healthcare professionals of your choice, without restriction to the public sector or a limited private network. It also significantly reduces out-of-pocket expenses, which are common in Spain, and protects against high private-sector bills, even when a visit to a public establishment generates unpaid expenses.
Last but not least, these policies are modular and customisable, with a choice of deductible levels, dental and optical cover, alternative medicine and more. In this way, they become a genuine tool for comfort and security, with much-appreciated additional services such as teleconsultation, contract management in French, as well as assistance and provident options.
Conclusion
Spain offers a high-quality healthcare system, but access via the public sector can be limited by waiting times and a restricted choice of practitioners. In the private sector, costs can quickly escalate. For the French, the procedures are simplified by membership of the EU, but this does not mean that cover is automatic or free. Planning ahead and adapting your health cover therefore remains a key factor in successfully setting up home in Spain.
