Most Spanish residence visas are not issued until you prove health cover. For the non-lucrative, student and digital nomad visas that normally means a private policy from an insurer authorised in Spain, with no copays and no waiting periods, unless an S1 or Spanish Social Security already covers you. After a year on the padrón, residents who are not working can buy into the public system through the Convenio Especial, at €60 a month under 65 and €157 from 65.
The top results for this search are mostly insurers selling a policy. This page looks at it from the immigration file instead: what each permit asks for in 2026, who gets public healthcare without paying a premium, how the Convenio Especial works, and what meeting the requirement costs for three common profiles.
Which visas need health insurance, and what kind
Spanish law usually says only that you need a seguro de enfermedad. The consulates fill in the detail. Washington’s list for the non-lucrative visa is typical: the insurer must be authorised to operate in Spain, and the policy must cover every risk the public system covers, run for a full year and carry no waiting periods (carencias), no copayments and no coverage limit. Travel insurance is not accepted.
| Permit | Legal basis | What the policy must show | Can public cover replace it? |
|---|---|---|---|
| Non-lucrative visa | RD 1155/2024, art. 61.2.b (renewal: art. 64.2.c) | Insurer authorised in Spain, full public-system cover, no copays, no waiting periods, no limit, one year | Yes, a registered S1: London’s list accepts the S1 registration receipt, although in practice the consulate can still ask for a private policy for the first year. After twelve months on the padrón, usually just after the first renewal is filed, the Convenio Especial |
| Digital nomad (international teleworker) | Ley 14/2013, art. 62.3.e | Public or private insurance from an insurer authorised in Spain; Washington uses the same no copay, no waiting period, no limit wording | Yes. No policy is needed if you are covered by Spanish Social Security, through your employer or as an autónomo |
| Student | RD 1155/2024, art. 35.i | Insurer authorised in Spain, cover similar to the basic public package, valid for the whole stay. Washington adds no grace periods, no copays and no deductibles, or a limit of at least €30,000 | Only while you work: registration with the Seguridad Social then meets the requirement (art. 57.5) |
| Entrepreneur | Ley 14/2013, art. 62.3.e | Public or private insurance from an insurer authorised in Spain | The law accepts public cover, but you only have it once you are registered with Spanish Social Security, usually after arrival |
| Family reunification | RD 1155/2024, art. 67.3 | The sponsor shows health insurance for themselves and for every family member joining | Partly. If the sponsor works and pays Social Security in Spain, a spouse or registered partner and children under 26 are covered through the INSS as the worker’s dependants once they live here, and that can serve as their cover. Parents are not covered that way and need a private policy |
| Non-EU family member of an EU citizen (not Spanish) | RD 240/2007, art. 7, and Orden PRE/1490/2012 | If the EU citizen works in Spain, nothing. If not, public or private insurance, Spanish or foreign, giving cover in Spain equal to the public system | Yes. A pensioner meets it with the certificate (such as an S1) from the country paying the pension |
| Non-EU family member of a Spanish citizen | RD 1155/2024, arts. 94 to 97 | Health insurance is not on the list of requirements | No policy needed for the permit |
Two rows surprise people. A non-EU spouse of a Spanish citizen does not have to show health insurance for the permit at all, because the 2024 regulation leaves it off the list. And a UK pensioner applying for the non-lucrative visa in London may not need a private policy at all: the London consulate’s list accepts the receipt of their S1 registration as the health insurance, although in practice the consulate can still ask for private cover.
What the insurance certificate has to show
Before you pay, check that the certificate says all of this:
- The insurer’s name, and an insurer that appears in the register of the Dirección General de Seguros (DGSFP). Washington sends applicants to that register.
- Start and end dates covering at least twelve months, or your whole stay if you are a student.
- Sin copagos and sin carencias, in writing.
- Cover equal to the public system: GP, specialists, tests, hospital stays, surgery and urgent ambulance.
- Spanish, or an official translation into Spanish. A membership card is not proof of cover.
- A health policy, not travel insurance.
International expat plans need a closer look. Allianz Care, Bupa Global, Cigna Global and Globality Health sell good cover for people who move between countries, but a plan with a deductible, or one issued by an insurer missing from the DGSFP register, does not match what the consulate asks for. Check the register, then ask for a Spanish-language certificate that describes the policy as sin copagos and sin carencias.
Spanish public healthcare: who is covered without a premium
Spain’s health law gives the right to healthcare to everyone who lives here legally. The catch is in who pays. The State funds a foreign resident’s care only when that person is not obliged to prove cover some other way (Ley 16/2003, art. 3.2.c). A non-lucrative visa holder is obliged to hold insurance, so the public system is not free for them. That one clause explains most of the confusion you read in expat forums.
So who is covered at no extra cost? Anyone who works in Spain, employed or as an autónomo, and pays into the Seguridad Social, and their dependants, who register through the INSS. Pensioners whose state pension comes from an EU or EEA country, Switzerland or the UK, once they register the S1 that country issues. And residents who no longer have to prove private cover: UK government guidance says that after five years, with permanent residency, you register at the INSS on the same basis as a Spanish citizen.
Registration follows the same steps in each case. The INSS recognises your right and gives you a document, you take it with your social security number to your local health centre (centro de salud), and the regional health service issues your health card. Spain has one national package of care but seventeen regional health services, which is why the card, the appointment app and the Convenio Especial all belong to the region where you live.
UK and EU pensioners: the S1 route
If you receive a UK State Pension, NHS Overseas Healthcare Services issues the S1. You register it with the INSS, online or at an office; the INSS posts you a Spanish social security number, and your health centre gives you a medical card. Because the UK pays for your care, you cannot also join the Convenio Especial. Prescriptions are not free: as a pensioner you normally pay 10% of the price, capped at €8.23 to €18.52 a month depending on your income, or 60% capped at €61.75 a month if your income is €100,000 or more (Real Decreto Legislativo 1/2015, art. 102, as amended in May 2026).
For the visa itself, the London consulate’s requirements page (July 2026) accepts the receipt of your S1 registration on the Spanish Social Security website as the health insurance for the non-lucrative visa. In practice the consulate can still ask a first-time applicant for a private Spanish policy with no co-payments for the first year, and other consulates word their lists differently, so have one ready as a fallback and check the page of the consulate that covers your address on the day you apply. Our guide for UK citizens moving to Spain after Brexit covers the rest of the move.
Retired expats from the US and other non-EU countries
A US pension does not come with an S1. Unless you work in Spain, the visa year runs on a private policy, and after twelve months on the padrón you can switch to the Convenio Especial. That is the normal path on the Spain retirement visa, which in practice is the non-lucrative route, and the cost difference is in the worked examples below.
What public healthcare covers, and the gaps
The common package (RD 1030/2006) covers GP and nurse visits, specialist care including ophthalmology, tests, hospital treatment and urgent ambulance transport. The gaps are elsewhere. Adult dental care is limited to acute problems such as infections and extractions, with wider programmes for children and some other groups, so most adults pay a private dentist or take out dental insurance in Spain. Ordinary glasses are not part of the national package.
For how the regional health services are organised, see our guide to the Spanish health care system.
The Convenio Especial: paying into the public system after a year
The Convenio Especial de prestación de asistencia sanitaria (in English, a special healthcare agreement) is the route the law gives to residents who are not entitled to free public care (Ley 16/2003, art. 3.3). Its rules are in RD 576/2013. You sign it with the health service of the region where you are on the padrón, and from the day you sign you use the same public doctors and hospitals as everyone else.
Three conditions apply (art. 3). You must have lived in Spain, really and continuously, for at least a year right before you apply. You must be on the padrón of a town in that region. And you cannot have access to public cover by any other route, whether through Spanish law, EU rules such as the S1, or a bilateral social security agreement that includes healthcare. The Spain-US agreement covers pensions only, so it does not close this door.
The fee is fixed by age, not by income: €60 a month under 65 and €157 a month from 65 (RD 576/2013, art. 6). It is per person, so a couple pays twice. A region that adds services of its own to the agreement can charge more.
What you get is the basic public package: prevention, diagnosis, treatment and rehabilitation in health centres and hospitals, plus urgent transport (Ley 16/2003, art. 8 bis). There is no health questionnaire, so a condition you already have is treated like any other. What you do not get is the supplementary package (art. 8 ter). You pay prescriptions in full at the pharmacy, and the same goes for orthopaedic products, dietary products and non-urgent transport.
The region has 30 days to answer, and if it does not, the request counts as approved. You then have three months to sign, and cover starts on the day you sign (art. 4). If you miss the initial payment, two monthly payments in a row or three non-consecutive ones, the agreement ends (art. 7). It also ends if you move your padrón to another region, so a move means signing a new one there.
For a non-lucrative visa holder the Convenio usually comes just after the first renewal, not in time for it. The initial permit lasts one year (RD 1155/2024, art. 61.4) and you file the renewal in the two months before it expires (art. 64.1), so on that day you will usually not yet have the full year on the padrón that the Convenio asks for. File the renewal with your private policy still running, because the renewal asks you to have kept health insurance for the whole permit and to keep it (art. 64.2.c). Once you reach twelve months on the padrón, apply for the Convenio, and cancel the private policy only after you have signed it, so there is never a day without cover. From then on the Convenio is the health insurance you show for the permit. Register on the padrón as soon as you arrive: every week of delay pushes that switch back.
Do not confuse it with the Seguridad Social’s own convenio especial (Orden TAS/2865/2003). That one is signed with the Tesorería by people who have paid into Spanish Social Security and stopped working, so that their contributions, and their pension rights, carry on. It is about pensions, and its cost depends on a contribution base rather than on your age.
What the health requirement costs: three worked examples
These are our own sums. Year one is the visa year, when the consulate wants a private policy unless public cover already applies. From year two, the Convenio Especial is open to anyone without another route into the public system.
| Profile | Year one | From year two | What decides it |
|---|---|---|---|
| Couple, both 66, UK State Pension with S1, non-lucrative visa | €0 in premiums if the consulate takes the S1 receipt (London’s list does, but it can still ask for a private policy). A private policy for both instead: €4,339 to €5,736 | €0. The S1 keeps covering you; the Convenio is closed to S1 holders | Prescriptions at 10%, capped at €8.23 to €18.52 a month by income (60%, capped at €61.75, from €100,000) |
| Couple, both 66, no S1 (for example, US retirees), non-lucrative visa | Private for both: €4,339 to €5,736 | Convenio for both: €3,768 (2 × €157 × 12), or keep the private policy | The Convenio saves €571 to €1,968 a year, but prescriptions are paid in full |
| Digital nomad, 35, employed by a US company and kept in US Social Security under the Spain-US agreement, which covers pensions but not healthcare | Visa policy: €537 to €1,631 | Convenio: €720 (€60 × 12), or keep the private policy | At 35 the cheapest visa policy costs less than the Convenio. Register as autónomo instead and Spanish public cover replaces the policy |
How the figures were built. For the 66-year-olds we used the age-65 price of the full no-copay plans of four large providers, Asisa, Sanitas, DKV and Adeslas (€180.81 to €239.00 a month each); the same plans cost more at 70, so at 66 expect that figure or a little above it. For the nomad, the range runs from Asisa Health Residents at age 30 (€536.87 a year) to Sanitas Residents Visado at age 50 (€1,631.04), and a 35-year-old lands inside it.
Three things stand out. The S1 couple may pay nothing for cover at all, provided the consulate takes the S1 receipt rather than asking for a private policy. The couple without an S1 saves €571 to €1,968 a year by moving to the Convenio from year two, but then pays prescriptions in full and waits in the public queues. And at 35 the Convenio is not the cheap option, since the lowest visa policy in the tool costs less than €720 a year. A young nomad gains little by switching, unless a health condition makes private cover hard to get.
Age matters for another reason too. Every insurer sets a maximum age for new customers. In the comparator’s sample, 38 of 51 products still accept a new customer at 70 and only 3 at 80, and DKV takes new customers on its visa policy up to 75. Dropping a private policy at 66 to join the Convenio is easy. Coming back to private cover at 76 may not be.
Private health insurance in Spain: plans, prices and pre-existing conditions
Private cover is common here: 14.2 million people held a health policy at the end of 2025, a count that includes civil servants whose state cover runs through private insurers (Source: ICEA, Mar 2026). Residents who already have public care usually buy it for faster access to specialists.
Plans come in two shapes. Network plans (cuadro médico) send you to the insurer’s own doctors and hospitals. Reimbursement plans (reembolso) let you choose any doctor and pay back part of the bill; DKV’s, for example, refunds up to 90%. Either kind can be sold with copays or without. For a visa, only a plan that leaves you nothing to pay per visit fits the consulate’s 100% wording.
Price follows age more than anything else. In the same tariff tool, a visa policy for a 30-year-old starts at €536.87 a year with Asisa and €1,316.16 with Sanitas, and at 50 those become €648.63 and €1,631.04. Province matters too. These are the cheapest province in the sample, so a quote for Barcelona or Madrid may come in higher.
Pre-existing conditions are the other big variable. Private insurers start with a health questionnaire and can exclude, or price in, what you declare. The Convenio Especial has no questionnaire, which makes it the natural year-two option for anyone with a known condition.
Which is the best health insurance for expats? For a visa file, the one whose certificate matches your consulate’s list. After that, look at which hospitals in the network are near the town where you will be living. We can put you in touch with insurance companies whose visa policies meet the consulate’s wording, and our lawyers read the certificate before it goes into your file.
Is healthcare free in Spain for foreigners?
It is free at the point of use for foreign residents who work and pay Social Security, for pensioners with a registered S1 and for others the law does not require to prove private cover. Non-lucrative visa holders must hold insurance, so they pay a premium or, after a year on the padrón, the Convenio Especial fee of €60 or €157 a month. Students need a policy from an insurer authorised in Spain for their whole stay, and the Convenio does not meet that rule; only registration with the Seguridad Social while they work replaces it. Prescriptions carry a share for almost everyone.
Can a US citizen get public healthcare in Spain?
Yes, but not on arrival unless you work. A US citizen employed in Spain or registered as autónomo is covered through the Seguridad Social. A retiree on the non-lucrative visa needs a private policy for the visa year and can join the Convenio Especial after twelve months on the padrón, at €157 a month from age 65.
What is the cheapest health insurance that works for Spanish residency?
For a young applicant, a visa-specific policy can cost less than €650 a year: Asisa Health Residents was quoted at €536.87 a year at age 30 and €648.63 at age 50 in a broker’s tariff tool on 5 October 2026. After a year on the padrón, the Convenio Especial costs €720 a year under 65. Whatever you buy for the visa, it must have no copays and no waiting periods.
Do I need private health insurance to get a NIE?
No. The NIE number itself is requested with the EX-15 form, your passport and the fee, and insurance is not on the list. The insurance belongs to the residence application you make with it, such as the non-lucrative or student visa.
Can I get health insurance in Spain with a pre-existing condition?
Yes, but a private insurer will ask you to fill in a health questionnaire and can exclude or surcharge what you declare. The Convenio Especial has no questionnaire and treats an existing condition like any other, but you can only join after a year of residence on the padrón.
How do I register for public healthcare in Spain as an expat?
If you work, your Social Security registration gives you the right; if you are a pensioner, register your S1 with the INSS. The INSS then gives you a document and a social security number, and you take them to your local health centre to get your health card. Residents with neither route apply for the Convenio Especial at their regional health service after a year.
Can EU citizens use Spanish public healthcare?
On a visit, a valid European Health Insurance Card covers the treatment you need while you are here. To live in Spain without working, an EU citizen needs health insurance that gives cover in Spain equal to the public system, or an S1 if they draw a pension from another EU country. EU citizens who work in Spain are covered through the Seguridad Social.
If you are preparing a non-lucrative visa application or a digital nomad, student or entrepreneur visa, our immigration lawyers in Spain check the health cover against your consulate’s list before you book the appointment, and prepare the renewal when it is time to move to the Convenio Especial.
Looking to go down the non lucrative route, we are both of good character, good health more than sufficient funds. Getting some really stupid health quotes to satisfy the insurance needs.
Hi Steve,
one of our lawyers should be in contact with your questions.
Kind regards
Looking to go down the non lucrative route, we are both of good character, good health more than sufficient funds. Getting some really stupid health quotes to satisfy the insurance needs.
Dear Danny,
one of our lawyers should be in contact with your questions about Private health insurance in Spain.
Regards,
We are trying to get health insurance for NL Visa in Spain. I am 77; my wife 67. Both In good health. Being turned down because of age by most Spanish providers (ALL, so far). Help?
Lyman,
one of our lawyers should be in contact with your questions about Private health insurance in Spain
Kind regards,
Looking at the non lucrative visa and understand that we need Private health insurance
I have 2 questions:-
1) Many sites say you need to purchase a policy with no Co-pays. What about deductibles ? ( they are different things)
2) Can I enroll in Cigna Intl or Allianz Health – or does it have to be a local plan. Both companies have rep offices in Spain I believe
thanks,
Richard
Paul,
one of our lawyers should be in contact with your questions about private health insurance in spain
Kind regards,
What level of health insurance plan do you need to apply for the Non-Lucrative Visa for Spain? We are both in our 70’s and have no serious health conditions, apart from my slight blood pressure problem.