Healthcare in Spain for Expats 2026: Public Access, S1, Insurance

Foreigners in Spain get into the public health system in one of four ways: they work or are self-employed and pay Spanish social security, they hold a UK S1 form, they pay the convenio especial (€60 a month under 65, €157 from 65, after a year of residence), or, once they have lived in Spain for five years, as permanent residents. Anyone else buys private insurance, which visa holders must do anyway.

Which route applies to you

Your situation	Route	Where it is set out
Employed or self-employed in Spain	Public system through social security; recognition is automatic	Seguridad Social; GOV.UK
UK state pensioner (or other exportable UK benefit)	S1 form issued by the UK, registered with the INSS	GOV.UK
Not working, resident for 1+ year, no other cover	Convenio especial, €60 or €157 a month	Ministerio de Sanidad
Legal resident for 5 continuous years (EU/EEA citizens)	Permanent residence, public cover without the convenio	Ministerio de Sanidad
Non-lucrative visa, first year	Private insurance required by the visa	RD 1155/2024, art. 61.2.b

The Seguridad Social describes the general right this way: people who are foreign nationals with legal and habitual residence in Spain are entitled if they are not obliged to prove mandatory coverage by another route.

Through work or self-employment

If you are employed or self-employed in Spain, you are entitled to state healthcare on the same basis as a Spanish worker, and so are your dependants (GOV.UK). The Seguridad Social states that workers, pensioners and people receiving social security benefits do not need to file a request: the INSS recognizes the right on its own.

You still have to register. GOV.UK tells UK nationals to register at the local health centre with their social security number, which comes from the local TGSS office. Dependants register separately with the INSS. You need an NIE first; the Spanish forms ask for it.

S1 for UK state pensioners

The S1 is a UK-issued form for people who live in Spain but whose healthcare is paid by the UK. GOV.UK says you may be entitled if you are resident in Spain and receive a UK State Pension or another exportable benefit. You request it by phone from NHS Overseas Healthcare Services (part of the NHS Business Services Authority), and not every UK benefit that can be claimed abroad qualifies.

To use it you register the S1 with the INSS, at an office or online. The online route needs your S1, the INSS healthcare application form, your passport, your residence certificate or TIE (or the approval letter if the card has not arrived), proof of dependants’ relationship, an email address, a Spanish phone number and your NIE. After registration the INSS posts your Spanish social security number, which you take to your health centre. You then have cover on the same basis as a Spanish citizen.

Two limits. If the UK pays for your healthcare, you cannot join the convenio especial or register as a permanent resident (GOV.UK). And the GOV.The GOV.UK pages on the S1 were last updated in 2021 and 2022, so confirm current steps with NHS Overseas Healthcare Services before you move. For the visa side, see the UK visa guide.

Convenio especial

The convenio especial is a public-system subscription for foreign nationals who are economically inactive and have no other access. The Ministerio de Sanidad lists three requirements:

• One year of effective residence in Spain immediately before applying. Time lived in other EU/EEA states, Switzerland or the UK counts.
• Registration at a Spanish town hall when you apply (empadronamiento).
• No access to public health protection by any other route.

Subscriber age	Monthly fee
Under 65	€60
65 or older	€157

It covers the common basic portfolio of the national health system, in primary and specialist care and in hospital, with no copayments and no waiting periods. Outpatient prescriptions, orthopedic items, dietary products and non-urgent patient transport are paid 100% by the patient.

You subscribe with the regional health service where you are registered on the padrón. Documents include ID or passport, proof of residence for the past year, the padrón certificate and, for people coming from countries covered by the EU social security regulations or the EU-UK agreement, a declaration or certificate that your home country does not export health coverage to Spain.

Permanent residents (five continuous years of legal residence, EU/EEA citizens) have the right to public care and do not need the convenio.

Private insurance for visa holders

Non-lucrative visa applicants need health insurance when they apply and must keep it through the permit (RD 1155/2024, arts. 61.2.b and 64.2.c). Consulates add the detail: no deductible, copayment, waiting period or limit, from an insurer authorized in Spain. All of that is in non-lucrative visa health insurance. The first-year rule means the convenio especial, with its one-year residence condition, cannot be your cover for the application. Neither the regulation nor the ministry page says whether a visa holder with a convenio can drop private insurance at renewal; ask the immigration office before you cancel.

Getting the tarjeta sanitaria

The tarjeta sanitaria individual is the card you show at the health center. The Seguridad Social describes the order:

1. Get the right to care recognized. Workers, pensioners and benefit recipients do not apply. Other legal residents file INSS form 6-071 through the Seguridad Social electronic office with a digital certificate or Cl@ve, by post, or at an INSS office with an appointment (phone 901 10 65 70 or 91 541 25 30).
2. Take the recognition document to your health center (centro de salud). It processes the card for you and each beneficiary and sends it to your home.
3. Beneficiaries. A holder can add a spouse or partner, children, grandchildren and siblings under 26 (older if they have a disability of 65% or more), and minors in guardianship.

The Seguridad Social page says the INSS (or the Instituto Social de la Marina) recognizes the right. Regional health services issue and manage the cards, so details and waiting times differ by region. There is no national processing time; it depends on the region.

What the official sources leave open

• Whether a non-lucrative visa holder can swap private insurance for the convenio especial at renewal. Ask the immigration office before you cancel a policy.
• The GOV.UK S1 guidance was last updated in 2021 and 2022, so confirm the steps with NHS Overseas Healthcare Services.
• How long the card takes to arrive, which varies by region.