Health budget for retirees and long-term conditions

Terms used

• INSS — The INSS is Spain's national social security institute, which pays pensions and registers S1 forms.
• S1 — The S1 is a form from an EU/EEA state or the UK that gives a retiree public health cover in Spain.
• Renta de integración social — The renta de integración social is a social-assistance income benefit; people who receive it are exempt from medicine copayments.
• PNC — The PNC is a non-contributory pension paid to people with little or no contribution record.
• Nomenclátor — The Nomenclátor is the Ministry of Health's list of medicines, showing whether each is financed and its price.

Key rules

• Pensioner rate: Pensioners with public cover pay 10% of a medicine's price, up to a monthly cap that depends on income.
• S1 holders: A retiree with an S1 or a Spanish pension is treated as a pensioner; one with neither usually pays 40% to 60%.
• Refunds: The regional health service, not the pharmacy, refunds anything above your cap.
• Unfinanced medicines: Medicines outside the public list are paid in full and do not count toward your cap.

The short version

If you count as a pensioner in the public system, you pay 10% of a financed medicine's price, up to a monthly cap based on your income. Some groups pay nothing. Many hospital-dispensed treatments are free. Medicines the public system does not finance are paid in full, on top.

Do you get the pensioner rate?

You get it only if you are registered in the public health system and recognised as a pensioner. For a foreign retiree, that normally means one of two routes:

• You receive a Spanish pension.
• You hold an S1 form issued by another EU/EEA state or the UK, registered with the INSS. S1 holders are treated as pensioners for copayments.

Retirees on a private pension without an S1 or a Spanish pension are generally not classed as pensioners. They usually pay the active-worker rate of 40% to 60%, depending on income. If you are a non-EU retiree on a non-lucrative visa, you will normally have private insurance and no public cover, so none of the caps below apply. Check your status with the INSS and your regional health service.

Your monthly cap

The cap depends on your yearly income:

• Below 18,000 euros: roughly 8.23 euros a month.
• 18,000 to 100,000 euros: roughly 18.52 euros a month.
• 100,000 euros or more: roughly 61.75 euros a month.

The Ministry of Health revises these amounts, so confirm the current figures before you build a budget around them.

Who pays nothing

These groups are exempt from paying for prescribed medicines:

• People receiving the renta de integración social.
• Recipients of a non-contributory pension (PNC).
• People who have lost unemployment benefit and have no other income.
• People with a disability who receive social-assistance benefits.
• People treated for an industrial accident or occupational disease, for the related medicines.
• Hospital inpatients.

The health service verifies your eligibility, so ask it before you assume you qualify.

Free hospital dispensing

Some medicines are given to outpatients by the hospital pharmacy. These are normally for conditions such as cancer, HIV and transplants. In general there is no copayment, because they count as hospital-use medicines. Some outpatient treatments are dispensed at ordinary pharmacies with a copayment instead, and regions can differ. Ask your specialist whether any of your treatments can move to the hospital pharmacy. That can cut your budget noticeably.

Getting money back above the cap

If you pay more than your cap in a month, the regional health service refunds the excess, not the pharmacy. It works this out from its records of dispensed prescriptions. It usually pays by bank transfer, often quarterly. In most regions you do not need to apply, though some need your bank details registered. Ask your regional health service how it works where you live.

What you pay in full

The public system does not finance:

• Medicines without a prescription, such as common painkillers, cold and flu remedies and antacids.
• Cosmetic and dietary products.
• Medicines for minor symptoms, such as mild laxatives.
• Many vitamins and supplements.
• Hair-loss drugs and some erectile dysfunction drugs.

Some other medicines are financed only under restricted conditions. Look up each of yours in the Ministry of Health's Nomenclátor to see whether it is financed and what it costs.

Generics for blood pressure, cholesterol, diabetes (metformin) or thyroid usually cost a few euros to low tens of euros a month. Branded newer drugs, such as insulin pens, inhalers or newer diabetes drugs, cost much more. Ask a pharmacy for the full price.

Realistic budgets

Yearly spend on financed medicines is your monthly copayment, up to your cap, times twelve. Then add the full price of anything unfinanced.

• Pensioner with several chronic medicines, income below 18,000 euros: the monthly copayment cannot go above the cap, roughly 8.23 euros. That is roughly 99 euros a year at most. Add vitamins or over-the-counter products at full price.
• Pensioner with income from 18,000 to 100,000 euros: the cap is roughly 18.52 euros a month, so roughly 222 euros a year at most.
• Person in an exempt group: nothing for prescribed medicines, only unfinanced items.
• Cancer or transplant patient: hospital-dispensed treatment is normally free. Budget only for medicines bought at ordinary pharmacies.
• Retiree without pensioner status: the rate is 40% to 60%, so costs can be several times higher. Get your status checked first.

The decision, checklist and questions below help you work through your own case.

Choosing between options

How should you cover a medicine that the public system does not finance?

• Pay full price at the pharmacy: Fits when the medicine is a generic or an over-the-counter product, where the monthly cost is usually only a few euros to low tens of euros.

• Ask your doctor for a financed alternative: Fits when the medicine is branded or costly, such as newer diabetes drugs, and a financed medicine with the same active ingredient may exist, so you pay only the pensioner copay of 10%, up to your cap.

• Plan for private cover: Fits when you are a retiree without a Spanish pension or S1 form, since you are usually not classed as a pensioner and pay the active-worker rate of 40% to 60%, or have no public cover at all.

Look the medicine up in the Nomenclátor first. If it is financed and you are recognised as a pensioner, you pay the capped copay. If it is not financed, ask your doctor about a financed alternative before paying the full price.

Checklist

• Confirm you are registered in the public health system as a pensioner, through a Spanish pension or an S1 form registered with the INSS.

• Find your monthly cap: roughly 8.23 euros below 18,000 euros of income, roughly 18.52 euros from 18,000 to 100,000 euros, and roughly 61.75 euros at 100,000 euros or more.

• Check whether you fall in an exempt group, such as non-contributory pension recipients, social integration income recipients or people on disability social-assistance benefits.

• Ask your regional health service whether copayments above your cap are refunded automatically and whether it needs your bank details.

• Ask your doctor whether any of your treatments can be dispensed by the hospital pharmacy, where there is normally no copay.

Frequently asked questions

Do I have to apply to get back copayments above my monthly cap?

In most regions you do not have to apply, because the regional health service pays the excess back automatically. The refund usually comes by bank transfer, often every quarter or so.

Are hospital pharmacy medicines for outpatients free?

Usually yes, medicines dispensed by a hospital pharmacy to outpatients, such as cancer, HIV and transplant treatments, carry no copay. Some outpatient treatments are dispensed at a normal pharmacy with a copay instead. Rules vary by region and by medicine, so ask the hospital pharmacy.

Does a retiree from abroad get the pensioner rate?

Only if you are registered in the Spanish public system and recognised as a pensioner, normally through a Spanish pension or an S1 form registered with the INSS. Retirees on a private pension without S1 usually pay the active-worker rate of 40% to 60%, depending on income. Retirees on non-lucrative visas typically have private insurance and no public cover.

Which everyday medicines do I pay in full even with a health card?

You pay the full price for medicines without a prescription, such as common painkillers, cold and flu remedies and antacids. The same goes for many vitamins and supplements, cosmetic products and hair-loss drugs. These costs come on top of your capped copayments.