Retiring in Spain: how your healthcare route changes

Terms used

• S1 — The S1 is a form that makes the state paying your pension responsible for your healthcare costs in Spain.
• INSS — The INSS is Spain's national social security institute, which handles pensions and registers S1 holders.
• Tarjeta sanitaria — The tarjeta sanitaria is the health card issued by your regional health service to use public healthcare.
• Empadronamiento — The empadronamiento is your registration on the town hall's residents' list (padrón).
• Convenio especial — The convenio especial is a paid public health scheme for residents with no other cover, with a monthly fee by age.

Key rules

• Spanish pension: A Spanish contributory pension gives you your own right to public healthcare.
• S1: With a pension from another EU or EEA state or the UK, the paying state covers the cost through an S1 you register at the INSS.
• No pension, no S1: You rely on universal cover, the convenio especial or private insurance, and fees differ by route.
• Medicines: Pensioners pay 10% of prescription prices, up to a monthly cap based on income.

Which route applies to you

Your route depends on who pays your pension.

• You get a Spanish contributory pension (retirement or widow's): you have pensioner status and your own right to public healthcare.
• You get a pension from another EU or EEA country, or the UK: you can usually get healthcare through an S1 from the country paying your pension.
• You have neither: you use a fallback route, which has different charges.

The decision below helps you choose between them.

If you get a Spanish pension

Pensioner status gives you public healthcare in your own right. Your spouse and dependent children can be covered as beneficiaries if they meet the usual conditions, or they may have their own entitlement.

Once your pension is granted, the INSS (the national social security body) updates your health record. Your regional health service then issues or renews your tarjeta sanitaria. Claim the pension with the INSS, stay registered on the padrón (empadronamiento), and update your health card with the regional health service.

If you get a pension from another EU, EEA state or the UK

Ask the institution that pays your pension for an S1. You can get one if that state is responsible for your healthcare costs. Then register it at the INSS (CAISS office). The documents are listed below.

The INSS records you as an S1 holder, and the regional health service issues your tarjeta sanitaria. Family members named on the S1 are covered too. The paying state reimburses Spain, so you do not pay for the cover itself. Which documents are asked for can vary by province, so check with your local office.

If you have a UK S1 and were covered before the end of 2020, it continues under the Withdrawal Agreement.

If you have no Spanish pension and no S1

You have three possible routes:

1. Universal cover. This is for residents with no other cover. Ask the INSS whether you qualify.
2. Convenio especial. This is a paid scheme for people who have been resident for a set period (at least a year). You pay a monthly fee that depends on your age.
3. Private health insurance. You usually need it anyway for a non-lucrative residence permit. Keep it until another route starts.

Which one you get depends on your residence history, any other state cover, and what your regional health service accepts. Eligibility and fees are set by the INSS and the regions, so ask them locally.

What you pay for medicines

As a pensioner you pay 10% of the price of prescription medicines, up to a monthly cap based on your income. The 2025 caps were:

• 8.23 euros a month if your income is below 18,000 euros
• 18.52 euros a month for income between 18,000 and 100,000 euros
• 61.75 euros a month for income above 100,000 euros

You pay nothing if you receive a non-contributory or minimum-income pension (such as the IMV), have a disability integration allowance, are unemployed and have lost your benefit, or were injured in a work accident or have an occupational illness.

Choosing between options

Which healthcare route applies to you at retirement?

• Spanish pensioner status: You receive a Spanish contributory pension, such as retirement or widow's. You get your own right to public healthcare, and you pay 10% of prescription medicines up to a monthly cap based on income.

• S1 from the state paying your pension: You receive a pension from another EU or EEA state or the UK, and that state is responsible for your healthcare costs. You register the S1 with the INSS, and the paying state reimburses Spain.

• Universal cover: You have no Spanish pension and no S1, and no other cover. This comes from the 2018 reform for residents.

• Convenio especial: You have no pension or S1 and have been resident long enough, at least a year.

• Private health insurance: None of the routes above fits yet, or you need it for a non-lucrative residence permit.

Documents you need

• The S1 form, issued by the institution of the state that pays your pension, if you register under an S1.

• Your passport or NIE (foreigner identification number), to register the S1 with the INSS.

• Your certificate of registration (residence), to register the S1 with the INSS.

• Your empadronamiento (certificate of registration at your town hall), needed for the S1 registration and to keep your pensioner cover up to date.

• Your Spanish pension award from the INSS, if you receive a Spanish pension, so your health record and tarjeta sanitaria can be updated.

Checklist

• Ask the institution that pays your pension abroad for an S1, if you live in Spain on an EU, EEA or UK pension.

• Register the S1 at the INSS (CAISS) with your passport or NIE, residence certificate and empadronamiento.

• If you have no Spanish pension and no S1, ask the INSS whether you qualify for universal cover or the convenio especial.

• Keep private health insurance in place until another route starts, since it is also usually needed for a non-lucrative residence permit.

• Check which monthly medicine cap applies to your income and whether you are exempt from the 10% co-payment.

Frequently asked questions

Does my spouse get cover when I receive a Spanish pension?

Yes, your spouse and dependent children can be beneficiaries of your pensioner cover if they meet the usual conditions. They can also have their own entitlement instead. Ask the INSS which option applies to your family.

How much do pensioners pay for prescription medicines?

Pensioners pay 10% of the price of prescription medicines, up to a monthly cap based on income. In 2025 the cap was about 8.23 euros a month with income below 18,000 euros, about 18.52 euros between 18,000 and 100,000 euros, and 61.75 euros above 100,000 euros.

Are any pensioners exempt from the medicine co-payment?

Yes, some pensioners pay nothing, such as people on non-contributory or minimum-income pensions like the IMV. Exemptions also cover people with a disability integration allowance and people with an occupational illness or injured in accidents at work.

Can I keep my UK S1 if I retire in Spain?

Yes, a UK pensioner S1 continues if you were covered before the end of 2020. The family members listed on the S1 are covered too, and the UK reimburses Spain.