What is free in Spain's public system and what you still pay

Key rules

• Free care: Family doctor, specialist, hospital and emergency care are free when you use them.
• Medicines: You pay a share of the price, set by your status and previous-year income, and pensioners pay 10% with a monthly cap.
• Dental and glasses: Adult dental work and glasses are mostly not covered, so plan to pay for them yourself.
• Regional differences: Charges for orthopaedic items and transport vary by region, so ask your regional health service.

The short version

Doctor visits and hospital care are free when you use them. You pay a share of the cost for medicines and some extras. Adult dental care and glasses are mostly not covered.

What is free

If you have access to the public system, these cost nothing at the point of use:

• Visits to your family doctor and nurse.
• Visits to specialists, once your doctor refers you.
• Hospital care, including surgery and stays in hospital.
• Urgent and emergency care.

Regions can add services to their own list, so some extras depend on where you live.

Medicines: you pay a share

Medicines you collect from a pharmacy on a public prescription carry a copayment. The share depends on your status and your income from the previous year.

• If you work (and for your dependants): you pay 40% if your income is under €18,000, 50% if it is €18,000 to €100,000, and 60% above €100,000. The top tier has a monthly cap.
• If you are a pensioner: you pay 10% of the price, with a monthly cap. The cap is about €8.14 on low income, about €18.32 on mid income and about €61.08 above €100,000.
• Hospital-dispensed and certain chronic-illness drugs: you pay 10%, capped at about €4.26.
• Exempt: people on minimum-income benefits, people on the integration income, people on non-contributory pensions, unemployed people who have lost their benefit, and treatments for work accidents or occupational disease.

The caps are updated each year and a reform of copayments has been under discussion. Ask your pharmacist or regional health service what applies to you now.

Other items with a charge

• Orthopaedic items: aids, prostheses, wheelchairs and some special footwear can carry a charge. The amount depends on the item and your region.
• Special nutrition: this is generally funded only for specific medical conditions.
• Non-urgent ambulance transport: it is normally free when a doctor prescribes it because you cannot travel any other way, for example for dialysis or rehabilitation. Some regions may apply a charge or stricter rules, so ask your regional health service.

Dental and vision

Dental cover is limited. The public system covers advice and prevention, treatment of acute problems and extractions. Children, roughly ages 6 to 15, get preventive and restorative care through regional programmes. Adults generally pay for fillings, crowns, implants, dentures and braces. Some regions add programmes for pregnant women or people with disabilities.

Eye exams with an ophthalmologist are covered, as are cataract surgery and treatment of eye disease. Glasses and contact lenses are not covered, apart from limited exceptions.

The comparison and the questions below show typical costs against paying privately.

Common services: public cost versus paying privately

Where paying privately buys you time

Paying privately mostly buys speed and choice of appointment, not a different kind of care. For a GP visit, the private price is modest. For an MRI, the price depends on the body area, the centre and whether contrast is used.

How to decide

• Routine GP visit: private costs little, so it is worth it if you need to be seen quickly or you are not yet registered with a public health centre.
• MRI or other scan: this is where private buys the most time, and also where the price varies most. Diagnostic imaging chains are often cheaper than hospital groups.
• Before you book: ask the clinic or imaging centre for the full price, including contrast and the radiologist's report, so there are no surprises.

Prices change by city and by clinic type, so get a quote from two or three providers before choosing.

Frequently asked questions

How much do I pay for medicines if I am a pensioner?

Pensioners pay 10% of the medicine price, with a monthly cap that depends on income. The caps are about €8.14 for low income, about €18.32 for mid income and about €61.08 for income over €100,000. Some groups pay nothing, such as people on the minimum-income benefit (IMV) or non-contributory pensions.

How much do I pay for medicines if I am working?

Working people and their beneficiaries pay 40%, 50% or 60% of the price, depending on income. The rate is 40% under €18,000, 50% from €18,000 to €100,000 and 60% above €100,000, and the top tier has a monthly cap. Hospital-dispensed medicines and some chronic-illness drugs cost 10%, capped at about €4.26.

Is non-urgent ambulance transport free in the public system?

Yes, it is normally free when a doctor prescribes it for a medical reason, such as dialysis or rehabilitation. A copayment is allowed on paper but is rarely applied, and rules on who qualifies vary by region. Ask your doctor whether you qualify.

Does the public system cover dental care and glasses?

Only in a limited way: adults get emergency treatment, extractions and prevention advice, but not fillings, crowns, implants, dentures or orthodontics. Children usually get preventive and restorative dental care through regional programmes, roughly ages 6 to 15. Eye exams and cataract surgery are covered, but glasses and contact lenses generally are not.

Do wheelchairs, prostheses and special nutrition carry a charge?

Yes, orthopaedic aids and prostheses can carry a contribution, and the amount depends on the item and your region. Special dietary products are generally paid for only for specific medical conditions. Ask your regional health service for the current price list.