SANITARY HEALTH IN SPAIN FOR EXPATS, PENSIONERS AND WORKERS 2022

GENERAL OVERVIEW

Choosing Spain as an expat destination is very common, and widely used in the past, and today.

One of the main questions that arise when choosing Spain as a place of residence, whether for expats, workers, or otherwise, is our health system.

In addition to the conditions of good weather, excellent quality of life, and security, living in Spain is considered for expatriates as a place in which health care is of high quality, which guarantees that those expatriates who decide to choose Spain as place of residence, they can receive treatment and guaranteed health treatment.

The Spanish health system is divided, as in all countries, between public assistance and private assistance.

Considering Spanish public health system, we have to say that it is decentralized, and is managed by each of the autonomous communities, or regions, such as Catalonia, the Basque Country, Madrid, Valencia, etc.

The principles that govern healthcare in Spain are based on universality and free service. In other words, anyone who is in Spain must receive free healthcare, especially those who are in a residence situation.

In cases in which a citizen is not in a position to obtain state public health coverage, they must obtain private insurance that covers them during their stay in Spain.

Speaking of Spaniards, the majority of Spanish nationals continue to use the public national system as the base system for health coverage.

It has not been until recent years that the private system has been gaining ground, but, as we say, there is a large number of Spaniards who receive only and exclusively public health coverage, and who do not have private insurance.

When comparing public health with the rest of the countries of the European Union, we can find that Spain is not very far from those that provide high quality public health, such as the countries of Northern Europe, Germany, etc.

This is why many expatriates choose Spain to live, given the high level of quality provided by the Spanish public system.

The Social Security contributions that Spanish employers allocate and pay constitute 23.6% of annual income, while workers pay 4.7% of their salaries. As a result, self-employed workers pay between 26.5% and 29.3% of their income in Social Security contributions.

Speaking of the Spanish private system, we have to say that in recent years there has been a flow of private insurance companies that have established themselves in Spain, and that have developed infrastructures, hospitals, clinics, etc., providing Spain with a health service private high quality, and with the highest standards of service.

 The private security system in Spain is much cheaper and more affordable for nationals of the United Kingdom, or the United States, Canada, etc., who find a very high-quality private care service in Spain, and at much lower prices. reasonable is that the countries of origin such as the United States, the United Kingdom, Canada, etc.

With regard to Latin American countries, Spain has signed bilateral agreements with many Latin American countries, Peru, Ecuador, Paraguay, Brazil, Chile, Andorra, and others such as Tunisia, which facilitate access to hospitalization and public health care, as well as such as the medical treatment of nationals of these countries in Spain in case of medical assistance, accidents, etc.

 UNIVERSAL HEALTH CARE FOR SPANISH RESIDENTS

Spanish Health care system for foreigners, expats and others is regulated in the Organic Law on the rights and Freedoms of Foreigners in Spain and their Social Integration. The main result of of this law on respect of the Spanish Health care for foreigners is that  to confirm the basis of a universal public and free health care so that anyone with the status of “Spanish resident” in Spain, independently of the “national” status of “Spanish national” or “Foreign national”.

So, expats, immigrants and any other citizen who come to Spain to reside for whatever reason , will have the same plenty coverture and care as the Spaniards. And this, independently of the legal or illegal stay in Spain.

Thus, the right to public health care is not linked to the Social Security contribution. As result, it is not  necessary to be a holder of a Spanish valid health card, or to be registered in a determinate area  to profit about this service.  It also means that Spaniards who never worked in Spain, will also be covered by the Spanish public system.

With full health care in Spain for foreigners, it is possible for anyone, regardless of their situation, to be treated in a public health center or hospital.

However, in order to control possible abuses that may occur in this regard, a number of measures have been taken. 

For example:

 –  To prove permanence residence in Spain for more than 90 days. In this way, access to public health is prevented for foreigners who have their own medical coverage in their country of origin and intend to make fraudulent use of this service.

 – Undocumented immigrants will also have health care. For this, a report by social services will be demanded in order to proof that they do not have the minimum resources.  Regarding the purchase of medicines, this group must will pay the same amount as Spaniards who have an income of less than 18,000 euros, that is, 40% of the total.

 – Organ transplantations. To enter the list of this type of interventions it is mandatory to justify a period of residence of more than two years in the country

In any case, the universal public health of our country is only recognized within the Spanish territory, so this right does not give rise to it being enjoyed elsewhere.

Migrants and expats who reside in Spain on a regular basis must meet the requirements established by the corresponding autonomous community to access health coverage.

EU CITIZENS AND EXPATS

Belgium, German, Dutch , French etc.  citizens who are resident in Spain temporarily will have plenty of coverture in Spain using the European Sanitary Card, which gives the same right of care as for the Spanish.

Thus, EU expats from Germany, France, Belgium,  Italy, etc, who decide to come to Spain to retire and to live as pensioners, and/or to work, will have plenty of rights of health care at the Spanish system.

Right to medical care in EU pensioners and expats: Pensioners receiving a EU pension and residing in another Member State of the European Union are fully insured. During a temporary return to their countries, they will have access to health care and their reimbursement, just like an insured person who resides permanently. Permanent residence is possible at any time and without additional formalities. However, there is one condition: join or rejoin a the health insurance fund and pay the contribution for this purpose. They will then receive an SIS card. The CAAMI auxiliary fund does not request any contribution but does not grant the advantages linked to the contributions paid. For the prices of hospitalization insurance, please inquire with the Belgian health insurance fund of your choice.

AMERICAN, CANADA, UK, MEXICO, etc.

American, British, Canadian, Mexican, etc. citizens living or traveling abroad should be sure they have adequate medical insurance that will cover expenses incurred abroad. 

Medicare and Medicaid are only valid in the United States.  

Some private American, UK, etc. medical insurance companies will pay for expenses abroad, but most require that the patient pay the bill first, then file for  reimbursement. 

Hospitals and health care providers will expect payment if you are not covered by the Spanish public health care system.  The United States Embassy does not have funding to help cover medical expenses of American citizens in Spain.

On the other hand, third-country nationals must prove private health insurance in Spain before obtaining a visa. Medical insurance is required for the non-profit visa, golden visas or any other residency Spanish visa

WHO HAS RIGHT OF PUBLIC HEALTH CARE IN SPAIN?

 The following shall be entitled to the provision of health care from the Social Security:

  • Workers (affiliated and registered or in a situation assimilated to that of registration).
  • Social Security pensioners.
  • Receivers of periodic benefits and subsidies, including receivers of unemployment benefit or subsidy.
  • Those who, having completed the unemployment benefit and subsidy, are unemployed and reside in Spain.
  • Those who sign a Special Agreement.
  • Minors under the guardianship of the Administration.
  • In addition, when they do not comply with the above assumptions, people with Spanish nationality or of a Member State of the European Union, the European Economic Area or Switzerland who reside in Spain, and all those foreigners holding an authorization to reside in Spanish territory. In these cases they may hold the status of insured provided that they prove that they do not obtain higher incomes, in annual calculation, to one hundred thousand euros (100.000 EUR) , nor mandatory coverage of the health benefit by another means.
  • The beneficiaries of all the above:
    • The spouse or person with a similar relationship of affectivity.
    • The former dependent spouse of the insured, entitled to alimony.
    • Descendants and assimilated persons (guardians, legal guardians, and siblings), under 26 years of age or who have a disability equal to or greater than 65%.

All of them must meet the following requirements:

  • Living with the holder (except separated and divorced) and be in his charge (except spouse and common-law partner).
  • Do not receive incomes higher than twice the IPREM (Minimum Salary in Spain).
  • Not be entitled to this benefit by different title.
  • Foreigners who are in Spain and do not have their legal residence in Spanish territory will also have the right to health care. In this case to obtain health care they will have to go directly to the Health Service of the Autonomous Community where they reside.

SPECIAL AGREEMENT FOR THE PROVISION OF PUBLIC HEALTH CARE FOR EXPATS OUTSIDE EU

There is  special agreement for the provision of health care that non-resident foreigners can sign will be contracted with the corresponding regional public administration, or with the National Institute of Health Management.

The subscription fee will be: 60 euros per month if you are under 65 years old; and 157 euros per month if you are over 65 years old.

So expats or citizens out the EU who are registered in a municipality in Spain who do not have the status of insured or beneficiaries of the National Health System, nor have access to a system of public health protection by any other title, and who prove effective residence in Spain for a continuous period of at least one year immediately prior to the date of the application for the special agreement.

They may not request the formalization of a new special agreement for the provision of health care until the period of one year has elapsed from the day following the extinction of the previous one, those people who, having previously signed a special agreement for the provision of health care, this has been extinguished for any of the following reasons:

a) By decision of the person who has signed the special agreement communicated in a reliable manner to the Ministry competent in matters of health.

b) For lack of payment of the first installment or the fees corresponding to two consecutive monthly payments or three alternatives.

c) For breach of the particular conditions established by the agreement.

Requirements

  1. Prove effective residence in Spain for a continuous period of at least one year immediately prior to the date of the application for the special agreement.
  2. Be registered, at the time of submitting the application for subscription of the special agreement, in a municipality belonging to the territorial scope of the specific community.
  3. Not have access to a public health protection system by any other title, either by application of national legislation, Community regulations on Social Security or bilateral agreements in this area that have been signed by Spain with other countries.

EXPATS OR FOREIGNERS NOT REGISTERED OR NON-AUTHORIZED RESIDENTS IN SPAIN:

Foreigners not registered or authorized as residents in Spain, will receive health care in the following modalities:

– Emergency health care for serious illness or accident, whatever its cause, until the situation of medical discharge.

Foreigners under eighteen years of age residing in Spain with the same extension recognized to citizens who hold the status of insured, being the type of contribution of the user for the benefits of the portfolio of services of the SNS that require it corresponding to active insured persons.

– Pregnant foreign women will have the right to have the SNS provide them with assistance to pregnancy, childbirth and postpartum with the same extension recognized to people who hold the status of insured, being the type of contribution of the user for the benefits of the portfolio of services of the SNS that require it that corresponding to active insured persons.

Click here to visit the official site of the Spanish Social Security in Spain

 Other assumptions:

 Spanish returnees, pensioners and employed and self-employed workers: Health care for returned Spaniards of origin and for Spanish workers and pensioners of origin residing abroad temporarily displaced to Spain, and for the relatives of the previous ones who settle with them or accompany them.

Returned Spaniards of origin and pensioners and employed and self-employed workers, as well as their relatives, who do not reside in the EU/EEA/Switzerland, who temporarily move to Spain, will have the right to health care, charged to public funds, through the National Health System when, in accordance with the provisions of the Spanish Social Security,  those of the state of origin or the international social security regulations or agreements established for this purpose, did not provide for this coverage.

Family members entitled to health care:

The spouse of the persons indicated or who lives with them with a relationship of affectivity analogous to the conjugal one, constituting a de facto couple.

The descendants of the persons indicated or those of their spouse or those of their common-law partner, who are in charge of them and are under 26 years of age or older with a disability recognized to a degree equal to or greater than 65 percent.

The recognition of the right to health care in all these cases corresponds to the INSS, which will issue the document accrediting the right. This right will be retained until the beneficiary meets the requirements established to obtain it in accordance with the provisions of Spanish Social Security, those of the State of origin or international Social Security standards or agreements.

Returned Spaniards of origin will justify their status by presenting the consular leave in the country of residence and the certificate of registration in the municipality where they have established their residence in our country.

Asylees or refugees. Provision of healthcare for applicants for international protection:

Applicants for international protection whose stay in Spain has been authorized for this reason will receive, while they remain in this situation, health care with the extension provided for in the basic common portfolio of care services of the SNS.

Necessary care, medical or otherwise, shall also be provided to applicants for international protection with special needs.

The competence for the recognition of the right to health care corresponds to the Autonomous Communities/Public Health Services.

Special agreement for the provision of health care to persons who do not have the status of insured persons or beneficiaries of the NHS:

For the purposes of the provisions of article 3.5 of Law 16/2003, of May 28,  those people who, not having the status of insured or beneficiaries, do not have access to a public health protection system by any other title, may obtain the provision of health care through the “payment of the corresponding consideration or fee” derived from the signing of a special agreement.

This way of access to the provision of health care establishes the basic requirements of the special agreement for the provision of health care to people who do not have the status of insured or beneficiaries of the SNS,  which allows people who subscribe to it to access, through the payment of an economic consideration, the benefits of the basic common portfolio of care services of the SNS, with the same guarantees of extension, continuity of care and coverage enjoyed by people who hold the status of insured or beneficiaries of the SNS,  in the field corresponding to the public administration.

The competence for the recognition of the right to health care through the Special Agreement corresponds to the National Institute of Health Management.