Paying out of pocket while waiting for your health card

Key rules

• Emergencies: Emergency care in public hospitals is guaranteed to everyone, but you may still be billed if no insurer or agreement pays.
• Private GP visit: Budget 40 to 80 euros for each private GP visit while you wait.
• Waiting time: The card usually comes within a few weeks, but can take a couple of months depending on your region.
• Travel insurance: Travel policies often exclude routine care and pre-existing conditions, so an expat or temporary private policy is usually a better bridge.

How much cash to set aside

Plan to pay for any routine care yourself until your tarjeta sanitaria works. A private GP visit costs 40 to 80 euros, and home visits and big-city private hospitals cost more. If you expect two or three visits, keep a few hundred euros free. Add more if you take regular medicines or have a long-term condition.

How long the gap lasts

Once you are registered with Social Security and with your regional health service, the card normally arrives within a few weeks. Reported times run from a few days to a couple of months, depending on the region. You need your padrón, your NIE and proof of your Social Security registration, so get those first. Some regions give you a provisional document or number while you wait. Ask at your health centre whether yours does.

What care you can get before the card

• Emergencies: Emergency care in public hospitals is guaranteed to everyone until discharge. The hospital may still bill you if no insurer or agreement pays.
• Pregnancy and children: Pregnant women and minors receive full care, including childbirth.
• Everything else: Without a card, you generally need your entitlement recognised first. That means paying for routine visits yourself, or using a policy. Some regions let you register provisionally, so ask your health centre.

Using insurance as a bridge

Short-term travel policies often exclude pre-existing conditions and routine care, and sometimes exclude residents. An expat or temporary private health policy usually fits better. Prices depend on your age, the cover and waiting periods, and they vary widely. Read the policy terms with the insurer before you buy. The decision block below helps you choose between paying per visit, a policy, or waiting.

Medicines stay a cost even with the card

The public system does not fund everything. Expect to pay in full for medicines without a prescription, such as common painkillers, cold and flu remedies and antacids. The same goes for cosmetic and dietary products, many vitamins and supplements, and hair-loss drugs. Some medicines are funded only under restricted conditions. A pharmacist can tell you whether a specific medicine is funded.

What to do now

1. Get your padrón and NIE, and make sure your Social Security registration is done.
2. Apply for the card at your regional health service or health centre.
3. Set aside cash for private visits, or buy a bridge policy if you need ongoing care.

Pay privately now or wait for your health card?

Should you pay privately now or wait for your health card?

• Pay for each visit yourself: You are healthy, need only occasional care and can afford a private GP visit, which costs about 40 to 80 euros, more for home visits or big-city private hospitals.

• Buy an expat or temporary private health policy: The wait may last weeks, you have an ongoing condition or need routine care, or you want protection against a large bill.

• Wait for your tarjeta sanitaria: Your Social Security registration is done, the card should arrive within days or weeks, and you do not need care in the meantime. Emergency care in public hospitals is still available, but you may be billed; a basic emergency visit for an uninsured patient is usually a few hundred euros.

If you need care you cannot postpone, or the wait may run to months, pay or take a bridge policy. If the card is close and you feel well, waiting is reasonable. A serious event is where the cost risk is highest, so choose a bridge policy if you cannot absorb a bill of a few hundred euros or more.

Prices vary by city, clinic and region. Check current private fees and the public price for uninsured patients with the clinic or your regional health service.

Health costs timeline: before the move, first months and steady state

• Buy private health insurance if your long-stay visa requires it: it must come from a company authorised in Spain, with no co-payments or waiting periods, and cover your whole stay: before you apply for the visa

• Ask the consulate if it wants a medical certificate, and if so get it legalised or apostilled and translated: before you apply for the visa

• Skip the visa insurance if you will work as an employee: Social Security covers you instead: before you start

• Employer registers you with Social Security (alta), and your public healthcare right starts from that date: on your first day of work

• Register at your regional health service or health centre with your NIE, padrón and proof of alta to get your tarjeta sanitaria: as soon as you have the alta

• Pay for a private GP visit (about 40 to 80 euros) or use a bridge policy if you need care: while you wait for the card, usually days to a couple of months

• Pay your insurance premium monthly, quarterly or annually, or your Social Security contributions monthly: every month once settled

• Expect premiums to be revised and often to rise with age: at each yearly renewal

• Pay for dental, optical and physiotherapy as the need arises: usually once or twice a year

Documents you need

• Padrón certificate: proof of your address, issued by your town hall, needed to get your health card.

• NIE: your foreigner identification number, needed to register for your health card.

• Proof of Social Security registration: the confirmation that you are registered with Social Security, shown when you register for your health card.

Frequently asked questions

How long does it take to get a health card in Spain?

Getting a tarjeta sanitaria usually takes from a few days to a couple of months, depending on your region. It goes faster when you already have your padrón, NIE and Social Security registration.

Which medicines do I still pay in full once I have a health card?

You pay the full price for medicines the public system does not finance, even with a card. These include medicines sold without a prescription, such as common painkillers and cold remedies, many vitamins and supplements, and cosmetic products.

Are pregnant women and children treated before the health card arrives?

Yes, pregnant women and minors receive full care, including childbirth, even without a card. Other adults without a card generally need their entitlement recognised first, though some regions let you register provisionally.