How does Spanish healthcare work for Brits?

Spain has a public National Health System, free at the point of use for most care once you are registered. How you get into it depends on whether you work, draw a UK pension or neither, and most visas need full private insurance first.

How the system works

Spain’s National Health System (Sistema Nacional de Salud) brings together the health services of the state and the autonomous communities (regions). Each region runs its own service, so booking apps, health cards and some rules differ between, for example, Madrid, Catalonia (Barcelona), the Valencian Community (Valencia and Alicante), Andalusia (Málaga) and the Balearic Islands (Palma). You register at your local health centre (centro de salud) and get a health card to show at the doctor, hospital or pharmacy.

Ways in for UK nationals

You must show proof of health cover before you can register as a resident and when you apply for a visa. That is usually through work, private insurance or the Convenio Especial. See Social security number, NIE and TIE.

Private insurance for your visa

For the non-lucrative, digital nomad and student visas, the Spanish consulate asks for health insurance from an insurer authorised to operate in Spain that covers all the risks the Spanish public system covers. In practice, lawyers and insurers report that consulates expect a policy with no co-payments and no waiting periods, starting from your arrival, for at least a year. Ask the insurer for a certificate in Spanish that says so before you apply. Travel insurance isn’t accepted. See Which Spanish visa do I need?

The Convenio Especial

• You can join once you’ve been on the town hall register (padrón) for at least a year and have no other public cover
• You apply through your regional health authority, which sets its own process and price. The state rates are €60 a month under 65 and €157 from 65 (about £51 and £133)
• You pay the full price of prescriptions, and some extras such as non-urgent transport and orthopaedic items
• If you have an S1, you can’t join

In your first year, if you are not working and have no S1, you need private health insurance.

What you pay

Basic care is free, but you pay towards prescriptions, based on the income on your last Spanish tax return. Workers pay 40% to 60% of the price; since a 2026 reform, lower earners have a monthly cap. Pensioners pay 10%, capped at €8.23 to €18.52 a month for incomes under €100,000. Some basic dental care is available, but most people use private dentists. See Bringing medicines to Spain.

GHIC and the NHS

A UK GHIC or EHIC covers necessary state healthcare on a visit to Spain. It doesn’t replace travel insurance and isn’t a way to live in Spain. Once you move permanently, you may lose free NHS care in the UK unless you have, for example, a registered UK-issued S1. In an emergency in Spain, call 112.