Spain has a public health system that provides free health care for those contributing to Spanish social security through their taxes including those from other EU countries (see the section "The European Health Insurance Card" below).
Although big improvements have been made in the last few decades, the public health service is hugely over-burdened and there are long waiting lists to see specialists and have non-urgent operations in most areas.
To be insured by Spanish public health system, you need to have a Social Security number, which you get through your working place. If you pay Spanish social security (Seguridad Social) contributions, you and your family are entitled to free or subsidized medical treatment on the same terms as Spaniards.
Anyone who has paid regular social security contributions in another EU country for two full years prior coming to Spain is entitled to public health cover for a limited period from the date of their last social security contribution made in their home country.
Social security form E-106 must be obtained from the social security authorities in your home country and be presented to the local provincial office of the Instituto Nacional de la Seguridad Social (INSS) in Spain. Similarly, pensioners and those in receipt of invalidity benefits must obtain form E-121 from their home country's social security administration.
You will be registered as a member of INSALUD and you will be given a social security card (cartilla), a book of vouchers, a list of local medical practitioners and hospitals, and general information about services and charges.
When you receive your social security card, you will be assigned a general doctor (médico de cabecera) in the area where you live. You may be able to switch to another doctor in the same area, depending on availability and the doctor's number of patients. No payment is made when visiting a public health service doctor and members are simply required to produce their social security card.
To visit a specialist doctor, you must be prior referred by your general doctor. As a public patient, you do not have to pay for the consultant's services and you will not be able to choose your consultant, since it usually depends on your problem/sickness. You are going to be sent to the professional that fits the best your needs.
However, if you choose to be referred to a consultant as a private patient, you will have to pay for the consultant's services.
Private hospitals also set their own charges. If you have private health insurance, it may cover some or all of the charges.
If you are an EU/EEA national travelling or staying temporarily in another state of the European Economic Area (EEA) or Switzerland, you are entitled to receive medical care if you become ill or have an accident. If you are a student or a seconded worker, or if you are entitled to a social security pension in that state, you will be entitled to health care beyond the immediate treatment.
The European Health Insurance Card (EHIC) has been replaced by a number of other 'E' forms including the E128, making it easier for you to get medical care quickly and easily. To obtain healthcare with the Card, you can go to the nearest public system doctor, public hospital, or other public treatment centre and present your Card.
Public health care systems vary from country to country, and few countries pay the full cost of health care for holders of the Card, so there may be some element of co-payment for the services you receive.
Currently, the EEA comprises the 28 member states of the European Union together with Iceland, Norway and Liechtenstein. Your European Health Insurance Card is valid for use throughout any of these countries and in Switzerland.
With so much to deal with before leaving your home country, (taxes, moving house, paperwork etc.) the careful planning of your expatriation to Madrid is an essential step. As far as healthcare is concerned, your local social security scheme won’t be accompanying you to your host country and, once abroad, you might be surprised by the care system you find in Spain. So, before leaving, make sure you have appropriate cover!
EasyExpat.com works in partnership with APRIL International to provide specific insurance solutions for travelling or staying outside your country of nationality.
Designed for either short or long stays, APRIL International’s insurance policies offer protection against any problems that might arise before departure or during your time in Spain: cancelling your trip, medical expenses following an illness or accident, needing to be repatriated, causing damage to a third party or losing your luggage.
For more information on expat health insurance in Spain, visit our partner APRIL International