Do you pay for public emergency room (urgencias) care?

Key rules

• Covered patients: If you are covered by the Spanish public health system, urgencias care, admission and follow-up are free at the point of use.
• Other payers: Insurers or other liable third parties are billed instead of you in accident cases.
• Ambulances: Charges for ambulances depend on the region, so check with the regional health service.
• Visitors: A valid EHIC or GHIC lets you be treated in the public system, but not in private hospitals.

The short answer

If you are covered by the Spanish public health system, you pay nothing at the door of a public hospital's urgencias. Admission and follow-up are free too. Bills come only in specific cases, set out below.

When you can be billed

A public hospital can send a bill in these cases:

• Someone else is legally liable. For example, a traffic accident insurer, a work-accident insurer (mutua) or a private insurer. The hospital bills them, not you.
• You are a visitor whose home system or insurer should pay. The hospital claims the cost from them.
• You are not entitled to the public system. Emergency care itself is guaranteed, but how billing works differs by region. Ask the hospital's admissions or billing desk.
• You ask for extras. A private room or other non-medical extras are charged to you.

Regional health services set their own prices and procedures, so the same case can be handled differently in different regions.

Ambulances

A medically necessary emergency ambulance is free for covered patients in most regions. Non-urgent transport is free only when a doctor justifies it. Some regions charge non-entitled people or insurers. A few also charge for certain services, such as non-medical transport or air transport. Prices are set by each region, so ask your regional health service what applies where you live.

Follow-up care and medicines

If you are covered, admission, tests, hospital stays and specialist follow-up after an emergency are free. You pay only the usual copayments for outpatient medicines, and for a few items such as some orthopaedic products, dietary products and non-urgent transport. If you are not entitled to the public system, follow-up beyond the emergency itself may be billed. Ask before you book appointments.

If you are a visitor with a European health card

An EHIC or GHIC covers medically necessary care in the public system during a temporary stay, on the same terms as insured Spaniards. The hospital copies the card and your passport or ID, then claims the cost from your home country. You normally pay nothing except copayments that residents also pay, such as for medicines. Private hospitals are not covered. Some hospitals ask for a deposit if you do not show the card. This card is not valid if you are moving to live in Spain.

The checklist below lists what to bring and keep. The questions below answer common worries about ambulances, medicines and the European card.

Choosing between options

Could a public hospital bill you for this emergency visit?

• No bill expected: You are covered by the Spanish public health system and asked only for medical care.

• Bill goes to someone else: A traffic insurer, a work-accident mutua or a private insurer is legally liable, or you are a visitor whose home country pays through the EHIC or GHIC.

• You may be billed: You are not entitled to the public system, you are an uninsured visitor, or you asked for a private room or other non-medical extras.

If you are covered, you pay nothing for the visit. If someone else is liable, the hospital bills them. Otherwise the regional price list applies, and emergency care is still given.

Checklist

• Show your health card (tarjeta sanitaria) at urgencias so the visit is registered as covered.

• Ask the regional health service whether it charges for the type of ambulance transport you used.

• Ask the hospital before follow-up appointments whether any part is billed, if you are not entitled to the public system.

• Hand over your EHIC or GHIC and passport or ID at admission if you are a visitor, and ask whether a deposit is needed.

• Keep every receipt and paper you are given, including any deposit receipt.

Frequently asked questions

Do I pay for an ambulance after an emergency?

Usually not, if you are covered by the public system and the transport was medically necessary in an emergency. Some regions charge for certain services, such as non-medical transport, air transport or cases paid by a private insurer.

Will I pay anything for medicines after leaving urgencias?

Yes, you pay part of the price of outpatient medicines, even though the visit and follow-up care are free. Pensioners pay a share linked to their income.

What happens at urgencias if I only have a European health card?

Yes, you are treated on the same terms as insured Spaniards if your EHIC or UK GHIC is valid and you are on a temporary stay.

Can I be billed if I am not entitled to the public system?

Yes, non-entitled patients can be billed, mainly for follow-up beyond the emergency episode. Emergency care itself must still be given. Billing rules and prices vary by region, so ask the hospital's admissions office before follow-up appointments.