Is Spanish public healthcare free? What you actually pay

Key rules

• Premium: There is no premium for public healthcare if you have access to it.
• Hospital care: Covered hospital stays, surgery, specialist visits and tests are free when you use them.
• Charged items: You pay only for specific items, mainly a share of outpatient prescriptions.
• Exemptions: People on low incomes and some other groups can be exempt from these charges.

Do you pay for public healthcare?

If you have access to the public system, you pay no premium for it. It is funded mainly through general taxes, so there is no monthly insurance bill. Your social security contributions as a worker do not add a separate health fee either.

The one exception is a special paid scheme for people with no other way into the system. See the last section.

What is free when you use it

Covered care in the public system costs you nothing at the point of use. That includes:

• hospital stays
• surgery
• specialist consultations
• tests

You do not get a bill after a covered hospital stay. This applies to people who are entitled to public care. Private care and services the public system does not cover are different, and you pay for them.

What does carry a charge

Charges apply only to specific items:

• Outpatient medicines. You pay a share of the price at the pharmacy for prescriptions. Medicines given to you during a hospital stay are not charged this way.
• Orthoprosthetic products. Prostheses, wheelchairs and orthoses carry a contribution from you.
• Dietary products. Special dietary products and tube-feeding nutrition are charged in specific cases.
• Non-urgent transport. Transport that is not an emergency can carry a charge in some cases.

Amounts depend on the item and on your region, and some regions refund or reduce these payments. People on low incomes and certain other groups, such as people with a disability, can be exempt. Ask at your health centre or regional health service what applies to you.

Hospital rooms and extras

Public hospitals normally put you in a shared room at no charge. You also get an individual room at no charge when there is a clinical reason, such as infection risk, isolation, children or end of life.

A private room just for comfort is not guaranteed. A few hospitals may offer one for a fee, but that is rare. Extras such as TV or telephone may be charged separately. Rules are set by each hospital or regional health service, so ask the hospital before you pay for anything.

Companions can often stay for free, for example with children, dependent people or patients at the end of life. They must follow the hospital's visiting rules.

If you have no other access

If you are not otherwise entitled to public care, you may be able to join a paid scheme, such as the convenio especial. It has a monthly payment set by the government, and that amount changes. If you are not entitled and not enrolled in any scheme, a hospital may bill you for care. Check your options with your regional health service before you need treatment.

The questions below cover rooms, companions and other charged items in more detail.

Frequently asked questions

Do I pay extra for a private room in a public hospital?

Usually no, because public hospitals put patients in shared rooms at no charge. An individual room is also free when there is a clinical reason, such as infection risk, isolation, a child patient or end of life. A room requested only for comfort is not guaranteed, and a few hospitals may offer one for a fee.

Can a family member stay with me in a public hospital for free?

Yes, companions can often stay for free, for example with a minor, a dependent person or someone at the end of life, within the hospital's visiting rules. Rules vary by hospital and region, so ask the ward when you are admitted.

Which items besides prescriptions can carry a charge in the public system?

Orthoprosthetic products such as prostheses, wheelchairs and orthoses carry a contribution from you. So do dietary products and enteral nutrition in specific cases, and non-urgent transport.

Do I pay a monthly fee if I have no other access to public healthcare?

Yes, if you have no other way into the system, you may need a monthly payment under a special agreement, called the convenio especial. Some foreigners pay under a public-health agreement too. The fee is set by the government and changes, so ask your regional health service for the current amount.