What family healthcare is free in Spain and what you pay for

Key rules

• Child check-ups and vaccines: Routine child check-ups and the vaccines in your region's calendar are free in public care for children with health coverage.
• Births: Public childbirth care is free with health coverage, while private rooms, extra scans and private hospitals are paid by you.
• Medicine co-payment: Working families usually pay 40% of outpatient prescriptions with income under 18,000 euros, and hospital-supplied medicines are free.
• Regional differences: Vaccines beyond the calendar, contraceptives and dental extras vary by region, so check with your regional health service.

What is free

If you and your children have public health coverage, most core family care costs you nothing. That includes:

• Pregnancy and birth. Midwife and obstetric check-ups, the three routine ultrasounds, blood and urine tests, glucose screening, Down syndrome screening, Group B strep testing and vaccines recommended in pregnancy. Childbirth is covered too, with an epidural when available, a shared hospital room, and postpartum and newborn follow-up.
• Birth preparation classes. The public ones are normally free through your midwife.
• Child check-ups. Routine check-ups are free at your health centre, run by a paediatrician and a paediatric nurse. Visits are frequent in the first months, then happen at set ages. They cover newborn screening, growth and development checks and vaccinations.
• Calendar vaccines. Every vaccine in your region's calendar is free. Typical ones are hexavalent, pneumococcal, meningococcal ACWY, MMR, varicella, HPV and Tdap. In recent years, meningococcal B and RSV protection (nirsevimab) for babies have been added.
• Family-planning visits. Advice, prescriptions, follow-up, IUD fitting, implant insertion and sterilisation are part of the public service.

The visit schedule and the vaccine list are set by each region. Ask your health centre for the current calendar.

What can cost extra

• Pregnancy extras. Additional scans, 3D/4D scans, private rooms, choosing your obstetrician, some private birth courses, non-invasive prenatal testing outside the public criteria, and giving birth in a private hospital are usually paid privately. What is funded varies by region and hospital.
• Some vaccines. Travel vaccines and certain optional vaccines are generally not funded. Flu for healthy children is not funded in many regions, though some regions fund it for young children. Rotavirus funding is changing, so ask your paediatrician.
• Contraceptives. The consultation is free, but the products are narrower. A limited list of pills, copper and hormonal IUDs and implants is funded when prescribed in the public system, and the standard prescription co-payment applies to those bought at a pharmacy. Newer pills, patches, rings and condoms are generally not covered nationally. Emergency contraception is sold without a prescription and is free at public centres in many regions, so ask your health centre.
• Dental care. It is limited. Some regions run a child dental programme and cover some basic adult care. Extra cover varies by region.

Medicine co-payments

Children and pregnant women have no special exemption: working families usually pay 40% of outpatient prescriptions with income under 18,000 euros, and hospital-supplied medicines are free. Higher incomes pay a higher share. Pensioners and people on minimum-income support or certain benefits have different rules, and some regions add their own exemptions. Ask your pharmacist or regional health service which applies to you.

Choosing between public and private

Use the public service for anything listed as free above. Pay privately only for the extras you want, such as a private room or extra scans. The decision and FAQ below help with specific items.

Choosing between options

Should you use the public service or pay privately for this family healthcare item?

• Use the public service: The item is in your region's vaccine calendar, one of the three routine pregnancy ultrasounds, a standard pregnancy test or birth care in a public hospital. These are free with health coverage.

• Pay privately for the extra: You want additional or 3D/4D scans, a private room, a choice of obstetrician, a private-hospital birth or a vaccine outside the calendar, such as many travel vaccines.

If the item is in your region's calendar or the standard public pregnancy care, it is free. If it is an extra beyond that, you pay. If it is a prescription from a pharmacy, the co-payment applies unless you fall into an exempt group.

Frequently asked questions

Is emergency contraception free in Spain?

Often yes, in the public health centres of many regions, though the rules differ by region. It is sold in pharmacies without a prescription, so you can also buy it there. Andalusia, Catalonia and the Basque Country give it free at health centres or sexual health clinics.

Does public healthcare pay for the contraceptive pill or an IUD?

Partly, because only a limited list of methods is funded. Some hormonal pills, copper and hormonal IUDs and implants are covered when prescribed in the public system, with the standard prescription co-payment for pharmacy purchases. Newer pills, patches, rings and condoms depend on your region.

Which birth and pregnancy extras do I pay for myself?

You pay for extra scans, 3D/4D scans, private rooms, choosing your obstetrician and giving birth in a private hospital. Some private birth courses and prenatal blood tests outside the public criteria also cost extra. Public birth classes are normally free through your midwife.

Is the flu vaccine free for my healthy child?

In many regions no, but some regions fund it for young children. Travel vaccines and certain optional vaccines are also usually not funded. Ask your paediatric nurse what your region's calendar covers.