How to Apply for Healthcare in Spain


Editor’s note: Expats retiring to Spain will need to consider health care along with property rental or investment decisions. Regular legal-contributor Raymundo Larraín Nesbitt strays again from his usual property themes to give us a general overview on how to apply for healthcare in Spain.

By Raymundo Larraín Nesbitt

Lawyer – Abogado
8th of November 2014


I am going to stray in this article from my usual property-related themes to deal with a matter that is of importance to both residents and non-residents in Spain; particularly senior citizens. I will try to explain it as simply as I can muster without (hopefully) getting lost in the murky detail.

Emergency Cover vs. Full Healthcare Cover

I have to begin by distinguishing two types of health cover.

Emergency cover is universal and open to all human beings, whether EU citizens or not. The only requirement for emergency health assistance is that you need to be registered at your local town hall (‘Certificado de Empadronamiento’ or census certificate). This is explained in detail in a section below.

Access to full health care cover by the Spanish Healthcare System requires a Social Security Number (‘Número de la Seguridad Social’ or SSN for short). This allows you unrestricted access to state-run healthcare. A SSN can be attained by working for a company or else on becoming self-employed (by contributing monthly to a pay-in scheme).

1. Emergency Healthcare Cover

A registered person will have access to public emergency, primary and speciality care for common illness, maternity care during pregnancy, delivery, post-partum etc. It is highly recommended that all foreigners register at their local Town Hall (known in Spanish as ‘empadronamiento’) for this and many other advantages listed below (and it’s free). Basically the more people that are registered, the more funds the central government allocates to a town hall which – in theory – should benefit everyone.

Step-by-Step Explanation to Attain a Public Health Card (PHC)

A PHC grants you the right to health care (both primary and outpatient) in both hospitals and emergency centres.

1. As outlined, the first step is to attain a Registration Certificate (‘Certificado de Empadronamiento’) from your town hall.  This is a pretty straightforward hassle-free requirement. To register oneself at your local town hall simply follow the below:

EU members: identity document from your own country, Community card issued by a police station or else your passport. Copy of Title Deeds and a copy of a utility bill (water or electricity).
Tenants: your rental contract, a copy of a utility bill under the name of the tenant (which must match the tenancy agreement) as well as an identity card or passport.
Home owners: copy of the title deed and/or a utility bill for the property.
Under aged: if a child lacks a passport they will require the same documents as an adult except for those born in Spain (a birth certificate or Family Book will suffice in such a case).

2. Find out where your Primary Care Centre (‘Centro de Salud’) is located.
3. Take your passport (and a photocopy) together with your Registration Certificate.
4. Fill in the ad hoc form. After a period spanning normally 2 to 3 months you will be mailed your Personal Health Card.

Benefits of Registering Oneself at Your Local Town Hall (Empadronamiento)

I am digressing a bit here from the article’s topic but I feel compelled to explain the benefits of enrolling in your town hall’s census (‘Empadronamiento’ or Registration Certificate):

• Discounts on IBI tax (akin to the United Kingdom’s Council tax). In some municipalities (i.e. Estepona) this discount may reach up to 80% (!).
• Increased medical attention (more doctors).
• More fire-fighters.
• The right to State education (free, public).
• The right to vote (registered foreigners can vote only on local and European elections).
• Discounts on municipal services.
• Free access to Sports Centres.
• Free access to public libraries.
• Access to Social Services and Leisure Centres (full or partial rebates on social activities i.e. painting, music, theatre, sewing).
• Additional security.
• More ambulances.
• More schools.
• Social assistance.

2. Full Cover Health Assistance

As explained in the article’s introduction, for comprehensive cover you must attain a Social Security Number and be working (legally) in Spain. This can be attained either of two ways:

a) By working for someone else i.e. a company.
b) On becoming self-employed (‘autónomo’ in Spanish).

Either requires that you, or your employer on your behalf, contribute to a monthly state pay-in scheme.

European Healthcare Insurance Card (EHIC)

If you are visiting Spain temporarily, and reside mainly in a EEA member country, the EHIC allows you full access to Spain’s State Healthcare System. You must request information in your home country on how to apply for this card.

The EHIC will not be valid if the holder is mainly resident in Spain. It does not cover you either if you are travelling with the express purpose to seek medical treatment i.e. travel to Spain specifically to give birth.

UK State Pensioner

As a UK pensioner, if you are living in Spain and you receive a UK State Pension or long-term Incapacity Benefit, you may be entitled to state healthcare paid for by the UK.

The UK’s EHIC is only for use outside of Spain on holidaymaking within the EU; it is not intended for those whose main abode is in Spain.

Applying for Healthcare in Spain – Conclusion

Foreigners are entitled to the same healthcare as the rest of Spanish citizens. The only requirement is to be registered at the Town Hall of your residence.

For full health care cover it is mandatory that you attain a Social Security Number and contribute to a monthly state pay-in scheme.

UK pensioner’s access to the Spanish healthcare assistance is paid for by the UK.

“Tres cosas tiene la vida: salud, dinero y amor”Cristina and Los Stop.

Popular Spanish pop song from the sixties. Loosely translated as: “Only three things matter in life: health, money and love.”

Related articles

Healthcare in SpainAdvice by the Foreign & Commonwealth Office
Health Insurance and Social Security – Angloinfo Expat Network

Please note the information provided in this article is of general interest only and is not to be construed or intended as substitute for professional legal advice. This article may be posted freely in websites or other social media so long as the author is duly credited. Plagiarizing, whether in whole or in part, this article without crediting the author may result in criminal prosecution. VOV.

2014 © Raymundo Larraín Nesbitt. All rights reserved.



10 thoughts on “How to Apply for Healthcare in Spain”

  1. Sam Allan

    Great article

    A couple of point:

    We were told we needed an NIE number / residencia to even start the healthcare application

    When we applied for residencia prior to jumping through the hoops for healthcare my wife had to prove she had private medical cover, fortunately we did.

    Secondly, I understand that it is now possible to buy into healthcare, I am not sure if this meets the needs of getting NIE number / residencia

    Not sure where this fits in your article, however I suspect a lot of people are not aware of these two points.


    1. Fred Quin

      Very interesting article, thank you.
      I have 2 questions: (a) Is there a Centro de Salud in Calahonda and, if so, where is it? And (b) where is the Centro de Salud in La Cala as we failed to find it?

    2. Profile photo of Raymundo Larraín NesbittRaymundo Larraín Nesbitt Post Author

      Hi Sam,

      Thank you for your kind words.

      In last month’s article (How To Buy Property in Spain) I covered the NIE number application in detail. I even placed it in the top position for it is arguably the first step a non-resident takes oln following Spain’s complex admin maze. I post a link to it:

      A NIE number has become an ubiquitous requirement for almost any administrative procedure (always the red tape). Someone who is planning to take up residency in Spain should apply for a NIE number as a priority. It is the first step in the whole process that opens the gateway to everything else. Attaining a NIE number is fairly quick and cheap; it normally takes under 10 days. Please follow the link within my article which explains in detail how to apply for one. Any lawyer can assist you to obtain one.

      As for buying into healthcare you may of course apply for private healthcare for a monthly fee which varies depending on the chosen company. It can go from 80€ a month for a family to several hundred euros (allowing you unrestricted access to hospitals and healthcare specialists of your choice). It’s a matter of personal choice really. My article only focuses on state-run healthcare, not private.

      Full healthcare cover in Spain requires someone to fund it. Normally this is achieved on being self-employed or working for someone else and joining the ‘Seguridad Social’ (Spain’s equivalent to the UK’s NHS). Alternatively a UK pensioner has it funded by the UK (NHS).

      I hope that helps out Sam.


      1. Carmel Saulino

        Hello Raimundo

        Interesting article but I am particularly interested in the PHC..Personal Health Card.

        My husband and I are registered in our local village, which does have a Centro de Salud. We also have private health insurance, and at present,are preparing an application to become “autonomo”, beginning next year.

        Recently my husband suddenly became very ill, and I rushed him to the local Centro de Salud. They were very reluctant to take him in, because we did not have the social security card, even though we told them we lived in the village, and were registered. Eventually the doctor did attend as my husband was so bad, and I asked them to send me a factura.

        We inquired at the ayuntamiento how we may use the centro de salud in future if necessary, but were advised only when we pay social security and receive that card. At no time was there mention of a PHC….(what is the Spanish translation of this???) or that we may use the centre in case of emergency!

        Nobody we have spoken to seems to be aware of this PHC……please advise.

        Many thanks and regards



  2. Profile photo of Raymundo Larraín NesbittRaymundo Larraín Nesbitt Post Author

    Hi Carmel,

    The translation for PHC is ‘tarjeta sanitaria’. My bad, I should have specified it in my article.

    Healthcare is largely a devolved matter, so each of Spain’s 17 autonomous communities have set up their own systems. I am unsure on where in Spain you live but if it is the autonomous community of Andalucía I supply you with a link to the SAS’s homepage (Servicio Andaluz de Salud) in which the ‘tarjeta sanitaria’ is explained (specifically for Andalucía) and the requirements on how to attain it:
    Portal de Igualdad, Salud y Políticas Sociales

    It distinguishes between the PHC and the EHIC (labelling both as ‘tarjeta sanitaria’). The former for use on being resident in Andalucía and the latter (‘tarjeta sanitaria europea’) on travelling abroad in Europe. Both give you access to full healthcare so long as the monthly fee is paid.

    If you become ‘autónomo’ (self-employed) next year you may apply for a Social Security Number (‘Número de Afiliado a la Seguridad Social’) and opt for full cover with access to a PHC. You will of course have to pay a compulsory a monthly fee as it is a pay-in scheme (regardless if you make any money or not). You will need to apply for a NIE number to work as self-employed (legally) besides obtaining the ‘Certificado de Empadronamiento’ (joining the local town hall’s census) as explained in my article above.

    As explained in the article’s conclusion, healthcare must be financed by someone at all times.

    I hope that helps Carmel.


  3. Carmel Saulino

    Gracias Raymundo for your response.

    I accessed the link you gave me…..I do reside in Andalucia ……and reading through it, my understanding is that the Tarjeta Sanitaria is for “Personas con cobertura sanitaria públilca”

    Does this also encompass persons with private health insurance, and to apply we just need to have an Insurance Card from a company (Sanitas) accredited by La Seguridad Social, accompanied by Nie + Certificate of Enpadronamiento??

    You mention a monthly fee….what is this and to whom is it to be paid??

    Many thanks again


  4. Profile photo of Raymundo Larraín NesbittRaymundo Larraín Nesbitt Post Author

    Hi Carmel,

    I believe we are writing at cross purposes.

    My article focuses specifically on State-run healthcare; that is public, not private.

    You are asking questions pertaining to private healthcare i.e. SANITAS.

    To put a UK example, I’m explaining how to benefit from the NHS (‘Seguridad Social’) but you are querying on BUPA (‘Sanitas’).

    SANITAS, ADESLAS and other such companies are private entities. You pay a monthly premium and you are covered by them, period. Regardless of holding a public healthcare card or not. It’s irrelevant.

    SANITAS should supply you with a booklet which lists all the private healthcare specialists you can consult, at your choice, which form part of its approved expert’s network. Any specialist you deal outwith said booklet will be paid out of your own pocket.

    The link I supplied in my previous reply explains how you can attain a public healthcare card (PHC or ‘tarjeta sanitaria’) specifically for Andalusia region within the public system (‘Servicio Andaluz de Salud’ or SAS).

    When I mention paying a monthly fee I mean to the government, not to a private company. Public healthcare is not free; users should ideally contribute towards its maintenance.

    Hope that clarifies.


  5. kathryn rance

    I am British born, was 20 years in Canada, have a Canadian pension. I am non-resident in Spain but resident in Malta. Britain would accept monthly payments but would not pay out as I am not resident in the UK. Malta would not accept as I did not have Maltese employer. I never sorted out payment as self-employed. Therefore I have a private health policy which covers all countries except US.

    My question is, in an emergency, am I entitled to treatment at Centro de Salud or Spanish hospital as a visitor to Spain? Should I register at town hall? I am concerned that in an emergency you need the nearest place and no hassle or payment problems before being treated.

  6. Profile photo of Raymundo Larraín NesbittRaymundo Larraín Nesbitt Post Author

    Hi Kathryn,

    I don’t really think it is necessary to register in your particular case. It would be optional and for other reasons outlined below.
    No Spanish hospital is going to refuse you treatment, don’t worry. You, your insurance provider, will however be expected to pay the medical services incurred in full. As a precaution, and to do some forward-planning, it might be a good idea to drop by your local hospital or ‘centro de salud’ and ensure they accept payment through your private company. Just to be on the safe side of things.

    My article above is really aimed for those who rely on Public healthcare; not for those who are already on Private healthcare. As you are already covered by a private policy, I honestly do not foresee a problem.

    Registering at your local town hall’s census (‘Padrón’ in Spanish) would be unrelated to healthcare. I strongly recommend everyone to register (or ‘empadronarse’) at your town hall for the above-listed advantages in my article that benefit society at large. And besides, it’s free.


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