Detailed guide: Healthcare for UK nationals living in Spain

All residents in Spain need to register to access healthcare.

Once registered for healthcare, basic state services are free, but there are some things that patients need to pay for. For example, you usually have to pay something towards prescriptions – either a reduced price or the full price.

UK nationals usually access the Spanish national health system in one of these ways:

• through entitlement to healthcare if they’re employed or self-employed in Spain
• paying directly into the public health insurance scheme (Convenio Especial)
• registering a UK-issued S1 form with the social security office
• using a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for temporary stays
• through entitlement to healthcare as a permanent resident if they’ve lived in Spain for 5 years

Healthcare if you live and work in Spain

You must register as a resident if you want to stay in Spain for more than 3 months.

You must show proof of healthcare cover before you can register as a resident. This will usually be through social security contributions as an employee, private insurance or paying voluntary contributions (the ‘Convenio Especial’).

If you’re working or self-employed in Spain, you’re entitled to state healthcare on the same basis as a Spanish citizen. Your dependants are also entitled.

Register at your local health centre with your social security number. You can get a social security number from your local National Social Security Institute (TGSS) office in Spain.

Your dependants need to register separately.

You may be entitled to a Spanish EHIC for travel, including visits to the UK.

If you are not working

If you’ve been a resident in Spain for 5 years or more, you can apply for permanent residency. This will give you access to state healthcare on the same basis as a Spanish citizen.

Once you’re a permanent resident, you need to register for healthcare at your local INSS office.

You’ll need to show a ‘legislation letter’ (‘documento de no exportación’ in Spanish) stating that you are not covered by the UK for healthcare. You can request this by calling NHS Overseas Healthcare Services.

The INSS will give you a document which you need to take to your local health centre.

If the UK pays for your healthcare, for example through an S1 form, you cannot register for healthcare as a permanent resident.

If you are not a permanent resident and you are not working

You can apply to join the public health insurance scheme. This is called the Convenio Especial. You pay a monthly fee to join the scheme, which gives you access to the Spanish health system.

You can apply if you’ve been registered on the ‘padrón’ (at your local town hall) for at least one year.

Find out how to apply on your regional health authority’s website.

If you’ve lived in Spain for less than one year and cannot get healthcare cover, you’ll need to buy private health insurance.

If the UK pays for your healthcare, for example through an S1, you cannot join the Convenio Especial.

You may have the right to apply for a UK S1 if you start drawing a UK State Pension.

If you’re a dependant of someone living or working in Spain

Dependants and family members are classified differently in Spain than the UK.

Find out who’s considered a dependant under Spanish law.

If you classify as a dependant of someone entitled to state healthcare in Spain (because they’re either working in Spain, a permanent resident or receiving Spanish benefits) you’ll need to apply at your local INSS office.

How to access healthcare services

Once you’re registered for healthcare, you’ll get a health insurance card. Take it with you whenever you visit a doctor, hospital or pharmacy.

How much you’ll pay

Once registered for healthcare, basic state services are free.

There are some things that you may need to pay a percentage of the cost for, such as orthopaedic services.

Spain uses a co-payment system where residents usually pay between 10% and 60% of the cost of prescription medication. How much you pay depends on your circumstances.

If you’re paying into the Convenio Especial, you’ll pay the full cost for prescription medication. You’ll also pay for:

• non-urgent transportation
• orthopaedic supplies
• prostheses
• dietary supplies

Some basic dental treatment is available under the state system, but most people use private dentists. Many private insurance companies have specific dental policies.

If your UK employer has sent you to Spain temporarily (‘posted workers’)

A posted worker, also known as a ‘detached worker’, is someone employed or self-employed in the UK, but temporarily sent to a European Economic Area (EEA) country.

UK posted workers can access healthcare in Spain using an EHIC, GHIC or S1 form.

HMRC has a helpline for National Insurance enquiries from non-UK residents. They can answer questions about posted worker status and explain which documents you will need to get healthcare while posted.

UK-funded healthcare: using an S1 form in Spain

There’s different guidance if you’re a posted worker.

You may be entitled to state healthcare paid for by the UK if you’re a Spanish resident and receive a UK State Pension.

You may also be entitled to an S1 form if you’re a frontier worker (someone who works in one state and lives in another). You must contact HMRC National Insurance enquiries to find out if you’re eligible.

If you started living in Spain before 1 January 2021, you may also be entitled to an S1 if you receive some other ‘exportable benefits’.

When you get your S1 form, you must register it with the INSS.

This will mean you and your dependants will be entitled to state healthcare on the same basis as a Spanish citizen.

You’ll also get:

How to get an S1 form

If you have a UK State Pension, you must request an application form by phone from the Overseas Healthcare Services. This is part of the NHS Business Services Authority (BSA).

How to use an S1 form in Spain

You must register your S1 at your local INSS office or via the INSS online portal.

Read the guide to registering your S1 form online.

Once your registration has been processed, the INSS will send you a Spanish social security number by post. Take this to your local healthcare centre to register.

You’ll be given a medical card which you can use when you visit a doctor, hospital or pharmacy.

Studying in Spain

You can use an EHIC or GHIC to get medically necessary healthcare until the end of your study period.

Getting treatment in the UK

Some former UK residents do not have to pay for NHS treatment when visiting England. This includes UK nationals who started living in the EU before 1 January 2021.

Read more about using the NHS when you no longer live in the UK.

If you return to live in the UK you’ll be able to use the NHS like any other UK resident.

Read more about using the NHS when you return to live in the UK.

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