Public, private or both

It is for anyone thinking about, planning or carrying out a move to Spain. By the end, you will be able to decide whether private cover is needed, or worth paying for, in your situation.

Start with "Public, private or both: which cover fits you in Spain?" It helps you choose a strategy from your status, health, budget and location.

Then read the pages that match your situation:

• If you already pay for public access, read the page on paying for public cover and private insurance together.
• If you want to know what private cover changes in practice, read what it adds to the public system.
• If you are choosing where to live, check how private healthcare differs by region, city and island.
• If you work for an employer, or are about to leave one, read the page on employer health insurance.
• If you are a registered freelancer, read the page on private cover for the self-employed.
• If you have a policy from home, read the page on whether you can keep it in Spain.

This topic does not cover how to get public entitlement, price lists for out-of-pocket care, or the wider map of insurance you may need.

Key rules

• Convenio fee: The convenio especial costs about 60 euros a month under age 65 and about 157 euros a month from age 65.
• Tax-free limit: Employer-paid health insurance is free of income tax up to 500 euros a year per person covered, or 1,500 euros for a person with a disability.
• Freelancer deduction: Autónomos can deduct private health premiums up to 500 euros per person a year, or 1,500 euros for a person with a disability.
• Visa policy: A policy for a visa must come from an insurer authorised in Spain, with full cover, no copago and no waiting periods.
• Convenio residence: The convenio especial needs at least one year of registered residence in Spain.
• Group conversion: Insurers that allow moving from a group policy to an individual one usually want you to apply within about 30 days of leaving.

Public, private or both: the whole process, step by step

• Work out which public route you qualify for, then decide if you want private cover too (Public, private or both: which cover fits you in Spain?): before you arrive or as soon as you register as a resident

• Check how long public waits are where you live (What private health insurance adds to the public system): before you decide on private cover; non-urgent surgery has recently averaged about 100 to 120 days and a first specialist visit about 90 to 100 days, with big differences between regions

• Check that private cover works well in your region or island (How private healthcare differs by region, city and island): before you choose a city or insurer

• If you have no other public route, apply for the convenio especial (Paying for public cover (convenio especial) and private insurance together): once you have one year of registered residence; it costs 60 euros a month under 65 and 157 euros a month from 65

• Answer the insurer's health questionnaire truthfully when you apply for a private policy: at application; hiding a condition the insurer asked about can lead to the policy being cancelled within one month of the insurer finding out

• Check the waiting periods (carencias) in the policy: before you sign; surgery and hospital stays often wait about 6 months, childbirth about 8 months, and some policies wait 6 to 12 months for transplants or prosthetics

• If you are on an employer group policy, ask HR and the insurer when cover ends (Employer health insurance in Spain and what happens when you leave): before your last working day; cover normally ends on the day employment ends or at the end of that month

• Apply to move from the group policy to an individual one, if the insurer allows it: within about 30 days of leaving; ask the insurer in writing before your leaving date

• If you need a policy for a visa, buy one from an insurer authorised in Spain with full cover, no copago and no waiting periods (Can you keep your home-country health insurance in Spain?): before you apply for the visa

Documents you may need

• The policy contract — What private health insurance adds to the public system

• A private health insurance policy from an insurer authorised in Spain — Public, private or both: which cover fits you in Spain?, Can you keep your home-country health insurance in Spain?

• The insurer's health questionnaire — What private health insurance adds to the public system

• A certificate from the insurer stating that the policy meets those conditions — Public, private or both: which cover fits you in Spain?, Can you keep your home-country health insurance in Spain?

Public, private or both: questions that cross several articles

Do I need private health insurance to live in Spain?

No, private insurance is optional unless your visa or residence route demands it. Non-lucrative, student and some family routes ask for it, while people paying into Seguridad Social usually do not need it. Read "Public, private or both: which cover fits you in Spain?" to choose.

Will a visa policy have waiting periods for pre-existing conditions?

No, a policy for a visa must have no waiting periods, no copago and no exclusion of pre-existing conditions. It must come from an insurer authorised in Spain, so many foreign policies do not qualify. See "Can you keep your home-country health insurance in Spain?" for details.

How much does the convenio especial cost compared with private insurance?

The convenio especial costs about 60 euros a month under age 65 and about 157 euros a month from age 65, and you need one year of registered residence. Private premiums rise with age and are lower with copago, so get quotes for your age and province. Read "Paying for public cover (convenio especial) and private insurance together".

What happens to my health cover if I lose my job?

Employer group cover normally ends on the day your job ends or at the end of that month. Some insurers let you move to an individual policy if you apply within about 30 days, but you will usually pay standard individual rates. Read "Employer health insurance in Spain and what happens when you leave".

Do I have to declare health problems when I take out private insurance?

Yes, you must answer the insurer's health questionnaire truthfully, and the insurer may then exclude the condition, raise the price, add longer waiting periods or refuse cover. Hiding a condition it asked about can get the policy cancelled. Read "What private health insurance adds to the public system" for what to compare.