Getting and replacing equipment and supplies in Spain

Terms used

• Prestación ortoprotésica — The prestación ortoprotésica is the public benefit that pays all or part of prostheses, orthoses, wheelchairs and similar aids prescribed by a doctor.
• Importe máximo de financiación — The importe máximo de financiación is the most the public system will pay for an item; you cover any difference.
• Ortopedia — An ortopedia is a shop that sells and fits orthopaedic products such as braces, crutches, wheelchairs and prostheses.
• Factura — A factura is the itemised invoice from the shop, which you need to claim a refund.

Key rules

• Public funding: The public system pays only for catalogue items, often only in part, and each region sets its own amounts and procedure.
• Health card first: You can claim only once you have public health cover and a health card; earlier purchases are not reimbursed.
• Private insurance: Private health policies usually exclude outpatient equipment such as wheelchairs, hearing aids and prostheses.
• Invoice: Keep the factura and prescription for any catalogue item you may claim back.

Public funding is partial, and it depends on your region

The public health system pays for some equipment, but only in part, and only for items in its catalogue. Each region runs the scheme and sets its own amounts and procedures. Anything outside the catalogue you buy privately.

You must be covered by the public system and hold a health card before you can claim. Items bought before you are registered are not reimbursed. Tourists and uninsured non-residents are generally excluded.

What the public system covers

The catalogue of the prestación ortoprotésica has these groups:

• External prostheses, such as limbs, breast and eye prostheses.
• Custom-made orthoses, such as spinal and limb supports.
• Orthopaedic footwear and insoles.
• Wheelchairs, manual and electric.
• Special aids, such as hearing aids and communication aids.
• Implantable prostheses, which the hospital handles.

Regions can add items to this list. Your regional health service publishes the catalogue that applies to you.

What you pay

You pay the difference between the item's price and the importe máximo de financiación. This is the maximum amount the public system will finance for that item. Some items are fully financed and others only partly. There is no single national percentage. Exemptions or reductions for low incomes or specific groups differ by region.

Some regions make you pay first and claim a refund. Others pay the supplier directly. Ask which applies before you buy. A prescription must come from a specialist doctor of the public health service. The steps are in the process below.

Buying privately

Basic items, such as braces, crutches and walking sticks, can be bought at an ortopedia without a prescription. Custom items are usually made after measurement and often need a prescription or medical report.

Prices vary a lot between shops and depend on the item, brand and custom work. Simple items are cheap. Manual wheelchairs and walkers are mid-priced. Custom orthoses, electric wheelchairs, scooters and prostheses cost far more. Get quotes from several shops.

VAT is reduced to 4% or 10% on many products and 21% on others. Ask the shop which rate applies.

Always keep the factura (invoice). If the item is in the catalogue and you are covered, you normally need the prescription, the invoice and a claim form to get money back.

Private health insurance

Private policies usually pay for consultations, hospital care, tests and surgery. They usually exclude outpatient equipment such as wheelchairs, hearing aids and prostheses. Implants used in covered surgery are often included. Travel and expat policies often exclude equipment too. Read your policy's exclusions before you rely on it.

Diabetes supplies

Under the public system, your doctor or endocrinologist prescribes insulin, needles, test strips, lancets and glucose meters. You collect them at a pharmacy on the electronic prescription. Pensioners pay no co-payment. Active workers pay a percentage, and insulin is usually in the reduced group. Quantities and brands depend on your region.

Continuous glucose monitors are funded for type 1 diabetes and some other groups, but regions differ on age groups, other eligible patients and how they are supplied. Insulin pumps are prescribed at designated hospital units, with brands and waiting times set by the region. Check the current criteria with your regional health service or hospital endocrinology unit. If you are a private patient, you pay the full price.

Choosing between options

Should you use the public system or buy privately?

• Use the public system: Your item is in the catalogue, you are covered by the public health system and you have a prescription from a public specialist. You pay only the difference above the maximum financed amount.

• Buy privately at an ortopedia: Your item is not in the catalogue, you are not yet covered, or you need it quickly. You pay the full price, so compare quotes.

• Buy first, then claim a refund: Your region repays you after you pay the shop.

Check the catalogue and your region's maximum financed amount first. If the item is listed and you are covered, go public. Otherwise buy privately. For glucose sensors and insulin pumps, your region's criteria decide.

Rules for amounts, sensors and pumps vary by region, so confirm with your regional health service or hospital endocrinology unit.

How to get a prescribed device funded or reimbursed

• Check that the item is in the catalogue and that you are covered by the public health system: before you start

• Get a prescription (prescripción ortoprotésica) from a specialist doctor of the public health service: first step, before you buy anything

• Choose an authorised orthopaedic supplier (ortopedia) with sanitary authorisation; ask your regional health service for its supplier list: before you buy

• Ask whether your item needs prior authorisation or a review by the health service: before the supplier makes or fits the item

• Have the supplier dispense or make and fit the item, and pay the price, or only your share if your region uses direct supply: after the prescription and any authorisation

• Collect the itemised invoice showing the product, its catalogue code and price, marked as paid: when you pay

• Send the refund request (reintegro) with the application form, prescription, invoice, ID or NIE, health card and your IBAN bank details to the regional health service. Add a signed authorisation if someone applies for you: after you pay and receive the invoice

• Go back to the prescriber for a check that the item fits, if your region asks for it: after you receive the item

• If the supplier is not authorised or the invoice is missing details, ask the supplier for a corrected invoice or choose an authorised one before you apply: if your request is refused or cannot be filed

Checklist

• Check whether your item is in the public catalogue, which covers external prostheses, custom orthoses, orthopaedic footwear, wheelchairs and hearing aids.

• Ask your regional health service for the maximum financed amount for your item, because you pay the difference above it.

• Ask whether your region makes you pay first and claim a refund, or pays the supplier directly.

• Compare quotes from several ortopedias before buying any item that is not covered.

• Ask the shop whether the item needs a prescription, and what VAT rate applies.

• Read your private health policy's exclusions before expecting it to pay for equipment.

• Ask your endocrinology team how many diabetes supplies and which brands your region allows.

• Ask your hospital endocrinology unit whether you qualify for a glucose sensor or insulin pump in your region.

What if your device breaks or supplies run out in Spain?

Start with whoever supplied the device. If you are in immediate danger, skip straight to the emergency section below.

If the public system supplied it

This applies to oxygen, CPAP machines and ventilators.

1. Call the contracted company's 24-hour technical service. The number is printed on the equipment or on the delivery paperwork. Keep a photo of it on your phone.
2. If that fails, contact the hospital unit that prescribed the device (usually pneumology), or your GP.

The company is generally obliged to repair or replace a failed respiratory device, and normally brings a replacement unit. How fast depends on the contract, so say clearly if you cannot go without the device.

If you bought it privately

1. Go back to the shop or the ortopedia (a specialist medical-supplies shop) where you bought it.
2. If they cannot fix it, contact the manufacturer's Spanish distributor under warranty. New goods carry a legal guarantee of at least 3 years.

A loaner is not guaranteed. Some distributors, larger ortopedias and specialist rental firms offer a replacement or a short-term rental during repairs, often with a deposit and a daily or weekly fee. Ask about this when you call, and ask before you buy. Pharmacies rarely lend devices, though some rent basic items such as crutches, wheelchairs or breast pumps.

Implanted and insulin devices

For pumps, pacemakers and similar devices, call the manufacturer's support line and the hospital unit that treats you. Do both on the same day.

Emergencies

• Life-threatening situation: call 112. It is the single emergency number across Spain, and operators speak English in most regions. Some regions also have their own ambulance number, such as 061.
• Oxygen or ventilation equipment has failed: if the patient is stable, call the contracted company's 24-hour line first. If there is breathlessness or any risk, call 112.
• Where to go in person: the hospital emergency department (urgencias), or a 24-hour primary-care emergency point.
• Medicine or supplies run out: the on-call pharmacy (farmacia de guardia) is open outside normal hours.

Emergencies are treated whatever your insurance status.

Serious safety incidents

If a device causes or nearly causes serious harm, report it through the national medical device vigilance system run by AEMPS, the Spanish medicines agency. Your treating hospital unit can help you do this.

Frequently asked questions

Does private health insurance in Spain pay for wheelchairs or hearing aids?

Usually no, because most Spanish private health policies exclude outpatient orthopaedic equipment, wheelchairs, hearing aids and prostheses. Implants used during covered surgery are often included, and some policies offer limited cover or discounts. Read the exclusions in your policy before you buy.

Can I get diabetes test strips and needles paid for by the public system?

Yes, if you are covered by the public health system, because your doctor prescribes insulin, needles, test strips and lancets and the pharmacy dispenses them on the electronic prescription.

Are continuous glucose monitors and insulin pumps funded everywhere in Spain?

No, funding for continuous glucose monitors and insulin pumps differs by region, including eligible age groups, supply route, brands and waiting times. Monitoring is funded for type 1 diabetes and some other groups. Pumps are prescribed at designated hospital units, so ask your hospital endocrinology unit.

Can I buy a brace or crutches at an ortopedia without a prescription?

Yes, basic items like braces and crutches can be bought without a prescription, but custom items usually need a prescription or medical report. Many products carry 4% or 10% VAT, and others 21%. Keep the invoice, as you need it to claim a refund.