Healthcare without a residence permit in Spain: what you can get

Key rules

• Adults: Adults without a residence permit usually need to show at least 90 days in Spain to get the health document.
• Children: Children under 18 are covered without waiting for the 90 days.
• Pregnancy: Pregnant women get care during pregnancy, birth and after birth whatever their status.
• Other cover: You qualify only if no other cover, such as an EU/EEA or bilateral agreement, applies to you.
• Where to apply: Apply through your local health centre or your region's health service, as rules and forms differ by region.

What you can get

Adults without a residence permit can use public healthcare on the same terms as Spanish residents, once they meet a few conditions and hold a health document from their region. This has been the law since 1 August 2018. Before that, most undocumented adults only had emergency care.

The document covers primary care, specialist care, hospital care, emergency care and prescribed medication. You still pay the usual pharmacy co-payment, which depends on income and age. Some regional extras outside the common services depend on the region. The document is not residence status or insurance. It does not cover short-stay visitors.

Who qualifies

As an adult, you need all of these:

• No other route to cover, such as an EU/EEA or bilateral agreement, or being an insured person or beneficiary.
• No obligation to be covered by a third country's system, and no way to use healthcare rights from your home country.
• At least 90 days in Spain.

You prove the 90 days with a padrón certificate. Other documents can also work, such as travel tickets, medical records, or rental or utility papers. Accepted proof differs by region, so ask your health centre what it takes.

You usually sign a declaration that these conditions apply to you.

Children and pregnancy

Children under 18 have the right to public healthcare on the same terms as Spanish children, whatever their or their parents' status. The 90 days do not apply. You normally need the child's passport or ID and, in practice, padrón registration or an equivalent document.

Pregnant women are entitled to care during pregnancy, birth and after the birth, whatever their status. This includes prenatal checks, delivery and postnatal care. Ask for it straight away. You do not need to wait for the 90 days.

How to apply

The regional health service where you live issues the document. In Ceuta and Melilla, the national health management institute (INGESA) does. You apply at the admissions desk of your local centro de salud, or through the regional service's office or online form.

Some regions require an appointment. Some route applications through social services or NGOs. Waiting times run from days to a few weeks. The card or temporary document is often valid for a limited time and can be renewed, so ask how long yours lasts and how to renew it.

The steps, documents and checklist are below. If you are refused, see the "What if" section below.

Timeline and deadlines

• Register on the padrón at your town hall, where possible: as soon as you settle, before you apply

• Sign the declaration that no other healthcare cover applies: when you apply

• Apply at your local health centre admissions desk or through the regional health service's office or online form: after the 90 days are met; some regions require an appointment

• Apply for a child under 18 without waiting for the 90 days: at any time after arrival

Documents you need

• Your passport or other ID, shown at the health centre or regional health service office when you apply.

• Proof that you have been in Spain for at least 90 days. A padrón certificate (proof of registration at your town hall) is the usual proof; travel tickets, medical records, or rental or utility documents can also show your stay. Children under 18 do not need to show the 90 days.

• A signed declaration that no other healthcare cover applies to you, such as an EU/EEA or bilateral agreement, insurance, or cover from another country. Most applicants sign this when they apply.

• For a child under 18, the child's passport or ID and, in practice, padrón registration or an equivalent document.

• The regional health card or temporary health document, issued by the regional health service of the region where you live (in Ceuta and Melilla, by INGESA). It is not residence or insurance status.

Checklist

• Register on the padrón at your town hall if you can.

• Collect your passport or ID and proof that you have been in Spain for at least 90 days.

• Sign the declaration that no other healthcare cover applies to you.

• Apply at your local health centre admissions desk, or through the regional health service's office or online form, and ask whether you need an appointment.

• Ask the health centre how long your card or temporary document is valid and how to renew it.

• If you are pregnant, ask for prenatal checks, delivery and postnatal care straight away: you are entitled to them whatever your legal status.

• If you have a child under 18, apply for their health card with their ID and padrón registration; the 90 days do not apply.

What if the health centre refuses you because you have no papers?

If a health centre turns you away because you have no residence permit, you can name your legal right, ask for the refusal in writing and complain. This page is for people without papers who are refused care or registration.

What to say at the desk

The law gives you the right to public health care even without a residence permit. Say this calmly and clearly: people without authorised residence have the right to health protection on the same terms as Spanish nationals. Emergency care is guaranteed in every case. Care during pregnancy, childbirth and after birth is also guaranteed, and so is all care for children under 18.

This does not cover tourists who are only visiting. They usually pay or use insurance for non-urgent care.

Bring what the centre usually asks for:

• a passport or other ID
• proof of address, normally your padrón registration (in some regions a signed declaration is accepted)
• proof that you have no other health cover

Some regions also ask for a document showing you have been in Spain for 90 days, and some use their own form. Ask the centre which documents it needs, so a missing paper is not used as a reason to refuse you.

Ask for the refusal in writing

If the answer is still no, ask for three things:

1. The refusal in writing, with the reason for it.
2. The name of the official who refuses.
3. The hoja de reclamaciones, the complaint form.

A written refusal is your proof. Staff often change their answer once they are asked to put it on paper.

Where to complain, step by step

Start with the patient service of the health centre or hospital. It handles complaints and can often fix registration problems quickly. Ask for it at the desk or look on the regional health website.

If that does not work, follow these steps:

1. Fill in the complaint form. Describe the facts, the dates and the place.
2. Attach copies of the refusal and your ID.
3. File it in person, through the regional online portal or at any public registry.
4. Keep a stamped copy.

The administration must acknowledge your complaint and reply. The reply time depends on the region, so ask when you file.

If there is no reply or the reply is unfair

Take it to an ombudsman. Each region has its own, such as the Síndic de Greuges in Catalonia, the Defensor del Pueblo Andaluz, the Ararteko in the Basque Country or the Valedor do Pobo in Galicia. The national Defensor del Pueblo also takes complaints. They are free and you do not need a lawyer.

You can also complain to the regional health department.

Go to an organisation that gives free practical and legal help as soon as you are refused. Médicos del Mundo, Red Acoge, CEAR, Cruz Roja and Cáritas can help, and so can the campaigns Yo Sí Sanidad Universal and Reding. They know how your region applies the rules.

Court routes

A lawyer can take the case further. An administrative appeal must be filed within one month. A court action must be filed within two months of the decision. A claim for damages must generally be filed within one year.

Quick answers on care without full status

Will a doctor report me to immigration?

No, doctors in Spain do not report patients to immigration, and health staff have no duty to check or report your status. Your health data is protected by law and by medical secrecy. It can only be shared without your consent in narrow cases, such as a court order or a serious criminal matter.

Do tourists pay before or after treatment in a Spanish public hospital?

Tourists are generally treated first and billed afterwards for emergency care. For planned, non-urgent care, a hospital may ask for payment, a deposit or proof of insurance in advance. This differs by hospital and region.

Can asylum applicants get a health card?

Yes, asylum applicants can get a health card once their application is formalised, usually shown by the resguardo, the receipt for the application. Regions usually also ask for your passport or ID and your municipal registration (empadronamiento). Some accept the appointment document or a referral from a reception NGO instead.

What care can I get before my asylum application is formalised?

Before formalisation, emergency care is guaranteed, as is care for pregnant women and for minors. The reception system also gives an initial medical check.