How can I winter in Spain or emigrate to Spain in a healthy way? You may be one of many who are currently walking around with the idea of emigrating to Spain or spending the winter there, and wondering how healthcare is arranged in Spain.

Healthcare in Spain

Healthcare can be a barrier to emigrate to Spain, especially if you are sick or in need of care, but in general, healthcare in Spain is at least as good as in the UK. Because many things are organized differently in Spain, this is also the case in health care. And that takes some getting used to! To help you with this, CasaLasDunas offers you as a (potential) customer the necessary information and if you choose to emigrate to Spain, CasaLasDunas can provide guidance and mediation in healthcare. The information we help you with will cover the following topics:

  • Healthcare in Spain in general
  • What to do in concrete situations?
  • How can I get insurance and what am I entitled to?

In Spain, there is a clear separation between the state health care provided by the government and private health care. There are state hospitals, state nursing homes, state general practitioners, etc. and there are also private hospitals, private nursing homes, private general practitioners, private dentists, etc.

  1. State health care: the Spanish health insurance fund
    If you live in Spain and you are registered in the population register in your place of residence (the so-called empadronamiento), you are entitled to state health care provided by the Seguridad Social. You are then entitled to a general practitioner at the general practitioner post (Centro Salud) in your place of residence and you are designated to a state hospital in your region (if you wish, you can choose a doctor from a general practitioner post in another municipality or go to a state hospital in another region). Home care also falls under the Seguridad Social in Spain. 
  2. Private health care   
    In addition to your health insurance, you can always choose for private health insurance in Spain. You are then entitled to a private general practitioner and in most cases you can go to a private hospital of your choice. The major advantage of private health care is that you can always approach a general practitioner who speaks English or is English and in private hospitals you always have an interpreter at your disposal. A disadvantage is that your private insurance does not reimburse medicines and that you are dependent on the Seguridad Social for this. The medical care in the Spanish health insurance fund and private health care is of the same level. You really don't have to worry about that. The organization of care may be different in the Spanish health insurance fund: somewhat less service-oriented and is more simplistic.

What to do in concrete situations?

Your move to Spain

If you have decided to move to Spain, it is important to take the following actions:

  • Inform your benefit or pension agency about your move;
  • Inform your current health insurance provider as soon as you know the date when you move;    
  • Register in the population register of the municipality where you live in Spain; 
  • Register in the Seguridad Social;
  • If necessary, apply for private health insurance;
  • Apply for your healthcare card at the local Centro Salud;
  • If you do not receive a benefit or pension from the UK, you do not of course have to inform those authorities (although it is always important that your pension fund has your current address in Spain).

Once you live permanently in Spain

If you are going to live permanently in Spain, you must apply for the facilities of the Seguridad Social in Spain. You can possibly add additional insurance via a Spanish private health insurance. From the moment you live in Spain, your benefits or pension agency in the UK will deduct a contribution from your benefit or pension. This is generally less than the premiums you have paid up to that point. If you do not receive a benefit or pension from the UK, the premiums for the Spanish health insurance fund are deducted from your Spanish wages (if you work in Spain) or Spanish benefits. Below you can see in a number of concrete situations that you can claim.

You need a doctor

Then go directly to your local GP (Centro Salud). In the larger municipalities it is always open (24 hours a day) and if not, you will be referred to a neighboring municipality. Just as in the UK, your GP plays a role in the referral to the hospital. You always take your healthcare card with you for identification. If you are prescribed medicines, the prescription will be written out on a green form (if you are under 65 years old). You then pay the pharmacist 40% of the medicine costs. If you are older than 65, you will receive a prescription on a red form. In that case, the medicines are free for you.

You will be referred to a hospital

If your general practitioner refers you to a hospital, you must go to the state hospital of your region. Your doctor will tell you which hospital that is. You also register with your health insurance card in that hospital. Talk to your doctor if you'd rather visit another state hospital.

You have an emergency

You check-in directly with your healthcare card at the first aid of the state hospital. If you call an ambulance, state that you are a member of the Seguridad Social and that you want to end up in a state hospital. Spain has two types of ambulances: (1) the trauma ambulance with a doctor present in case of serious accidents or disorders and (2) the ambulance with only a driver who transports you to the hospital in a stable condition. If you call an ambulance in a serious situation, always try to convey the seriousness of the matter well!

You need a physiotherapist or a dentist

In Spain, a physiotherapist or dentist is not insured in the health insurance fund. You must therefore pay this yourself or take out private health insurance for this.

You need home care

Since 1 January 2007, you have been entitled to home care by a state institution in Spain through the Spanish health insurance fund. However, the practice is not yet in place to implement the associated new law (La Ley de la Dependencia), which means that you may have to wait quite some time before you are indicated and can receive home care. Just as in the UK, there is a system of indication and urgency: people who need it most receive care first. Unfortunately, there is still a general capacity problem in Spain (insufficient staff available).

You must be admitted to a care or nursing home

Here too, you are entitled to admission to a (state) nursing home. Nursing homes do not exist in Spain. It is common for you to be admitted to a nursing home only if you no longer have anyone to take care of you and if you really need nursing home care. If admission is urgent, a place will always be found for you, but then you have no say in which nursing home. As with home care, it is possible that you are lucky and that the Seguridad Social refers you to a private nursing home, because they have made agreements with you. There is no option to insure you privately for admission to a private nursing home. So suppose you opt for admission to a private nursing home, you have to pay those costs yourself.

If you live temporarily in Spain (winter)

If you only stay in Spain for a few months per year, you will simply remain insured for medical expenses by your current health insurance (except if you start working in Spain). Before you go to Spain, read the policy conditions of your health insurance carefully and contact your health insurer, because it is good to know what to do when you need a doctor or are hospitalized. Apply for the European Insurance Card from your insurer before you leave for Spain. With this you are assured of care (via the Seguridad Social). A (continuous) travel insurance is certainly not an unnecessary luxury (because in some cases a health insurance company reimburses less than the costs incurred in Spain). So you always have 2 options: to a state institution or doctor (reimbursement based on the treaty scheme using your European Insurance Card) or to a private institution or doctor (reimbursement based on your current health insurance)

Do you need a doctor?

Go directly to a local (state) general practitioner post (Centro Salud) or visit a private general practitioner. In most cases it is better to visit a private doctor, because he speaks English with you, for example. In some - urgent - cases it is better and faster to visit the GP post in your place of residence. In case you visit a private doctor, you may have to pay the consultation. In most cases, you can declare the bill that you receive from this doctor with your health insurer.

Are you being referred to a hospital?

If you are referred to a hospital, choose a private hospital near you. If you only consult a specialist, you will be asked to pay the costs for that consultation immediately. Again, you can declare the bill you receive for this with your current health insurer. If you need to be admitted you will be asked for your insurance papers. In many cases you will be asked to pay a deposit. As soon as the hospital has received a financial guarantee from your current health insurer, you can reclaim your deposit. In that case, you do not have to pay anything more for your stay in the hospital. In a limited number of cases, you got health insurance in the UK that reimburses the costs of hospitalization abroad and not to the hospital. In that case, you must first pay the costs for your admission in Spain yourself. So always check what kind of insurance you have before going abroad and if in doubt always contact your insurer to make sure what to do in case of medical care in Spain.

You have an emergency

Again, you have to weigh up the urgency. Which hospital are you going to? Preferably to a private hospital, but if the problem is very urgent and a state hospital is closer, you would rather go to the state hospital. In a number of cases you will also be asked to pay a deposit during an emergency admission. Fortunately, this does not apply to all private hospitals.

You need a physiotherapist or dentist

Depending on your current health insurance, you can claim the costs you paid for your physiotherapist or dentist in Spain from your health insurer in the UK. Please also inform yourself before your departure to Spain.

You need home care

You can contact a private home care institution. In the majority of cases, the Social Insurance Bank (SVB) will not deduct your Statutory Personal Contribution from your benefit or pension if you reside abroad. This will be immediately deducted from the costs reimbursed to the home care institution in Spain and they will ask you to pay your Statutory Personal Contribution to them.

You must be admitted to a care or nursing home

In this case, you can turn to a private care or nursing home. In this case, the financial settlement is the same as for home care. You pay your Statutory Personal Contribution directly to the institution in Spain.

How can I take out insurance in Spain and what am I entitled to?

If you are not satisfied with the health insurance facilities in Spain, you may consider private health insurance in Spain. Of course, taking out private health insurance in Spain also has many advantages: you can always contact a doctor who speaks your language or has an interpreter and in general the medical care in the state and private system is the same, but the service you receive as a patient in private health care is always much better than in state health care. In Spain you can choose from a large number of private health insurers. Many insurers offer a policy specifically intended for foreigners. However, read the policy conditions carefully, because the benefits do not always apply to you. All policy conditions can be viewed on the website of the relevant insurer. Unfortunately in many cases only available in Spanish language and the amount of text doesn't make it any easier. There are a number of things to consider when choosing a particular health insurance company:

  • Do you want your insurer to settle directly with your therapist or hospital?
  • Do you want total freedom when choosing a hospital or doctor?    
  • Do you want a waiting period for treatment or not?

Private health insurers in Spain - as in the UK - have roughly two types of policy, namely a (1) reimbursement policy and a (2) in-kind policy. In the event of a refund policy, you pay for your consultation, treatment or admission and the insurer pays you back the costs incurred on the basis of original invoices. With a in-kind policy, your doctor, practitioner or hospital will immediately settle the costs with your insurer without you having anything to do with it. Nearly all insurers give you the freedom to choose a doctor, therapist or hospital yourself. With many insurers you can also opt for a so-called 'cuadro médico': that is, the insurer has a contract with a number of doctors and hospitals that you can choose from. In the latter case you pay less premium! Unfortunately, it is not possible to insure you today and make an appointment for treatment tomorrow. In almost all cases there is a so-called waiting time. Except in case of emergency, of course; then you will be helped in all cases. When choosing private health insurance, it is advisable to compare the waiting times. In addition to the above, you naturally compare on price, reimbursements, benefits in kind and other important policy conditions. It is also important to know that no private Spanish health insurance company reimburses medicines, except those that are provided during your hospital stay. You can always contact Seguridad Social, the Spanish health insurance fund, for your medicines. This is a difficult side effect of the insurance system in Spain. After all, you should visit your GP in the Centro Salud of your place of residence with your private doctor's prescription. Especially if it concerns expensive medicines, this doctor will ask questions about the necessity and possibly consider an examination in a state hospital necessary. However, in most cases this is not necessary.

Spas and salt lakes

It is now a fact that the Spanish living environment is healthier than in the northern European countries. The stress and wet cold or the humid climate have negative effects on rheumatism patients.

One in ten: One in ten Europeans suffer to a greater or lesser extent from rheumatism. Without going into too much medical detail about rheumatic diseases, we would like to mention the following; Rheumatism patients regularly have a pain attack every year, which is unthinkable for many of us, in good health. A large number of them then necessarily take the step to the doctor to suppress the pain. We also speak from experience here and can confirm that the climate of the southern Costa Blanca is the best medicine that currently exists for rheumatism patients due to the high salt content in the air.

Spas and salt lakes: There are spas, located on the salt lakes, especially for rheumatism patients, where expert guidance is available. There are cases when the doctor gives a referral letter for Bad Bramstedt Spa. Perhaps consider renting a holiday home in this area first and experience for yourself what the climate does to you.