The Spanish Healthcare system ranks among the best in the world. Social security payments fund the system, meaning that most residents don’t require private insurance to access health services. The 2019 Health Care Index ranks Spain seventh out of 89 countries on overall healthcare, behind only Austria and Denmark in Europe. While the Spanish state system is excellent, some expats choose to take out additional private coverage, which can cut waiting times and make it easier to see an English-speaking doctor. Who needs health insurance in Spain? If you are living and working in Spain, you generally pay Spanish income tax and social security in Spain that goes towards providing you with state healthcare. If you’re ineligible for health insurance, you can pay for treatment yourself or take out a private health insurance plan. In some regions, you can register for a government-run scheme called convenio especial which provides social security cover for a basic monthly fee. Public health insurance in Spain Who does public health insurance cover in Spain? Employees: all employees and self-employed workers in Spain must make social security contributions. This then entitles them to Spanish health cover. Self-employed, freelancers and business owners: freelancers in Spain are responsible for paying your own social security contributions towards public healthcare. You can apply for a social security number at your nearest Social Security Office. Spouses and children: the spouse and any children of workers are also entitled to state healthcare, as long as they also reside in Spain. EU/EEA/Swiss nationals: EU, EEA, and Swiss nationals who have reached retirement age in their home country are entitled to free healthcare in Spain. In order to qualify they must obtain an S1 form from their country of residence. Preparing this form before moving helps simplify the registration process. EU, EEA and Swiss residents staying in Spain on a temporary basis can use their European Health Insurance Card, which entitles them to receive medical treatment at the same cost as a Spanish national. Non-EU nationals: non-EU/EEA nationals may have to provide proof of private health insurance before getting a Spanish visa. Some non-EU nations, however, have an agreement in place with Spain. It’s important to know what you’re entitled to, so check with the consulate or embassy in your home country before arrival. Students: EU nationals studying in Spain will be covered by their EHIC throughout their period of study. Non-EU students, however, might need a private health insurance plan prior to arrival. Your university can provide more detail. What does Spanish health insurance cover? The TSI health card covers care from doctors and hospitals. It also covers treatment at home, which can be particularly useful to the elderly and disabled. Presenting a TSI card means you pay no fees when receiving treatment at hospitals or from a doctor in Spain. The prescription fee at pharmacies, however, must be paid by you at the time of purchase. TSI covers between 40–60% of the cost of prescription drugs, depending on your earnings (90% for pensioners). Although individuals are liable for the remaining cost, prescription drugs in Spain are relatively cheap. Dental work in Spain does not fall under the public care system and must be paid for in full by the individual unless they have private health insurance. Dentist fees are relatively inexpensive and the general quality of care is of a high standard. However, private health insurance can halve the costs, with dental insurance costing as low as €10–20 per month. Private health insurance in Spain If you require additional healthcare services, you can opt for private health insurance. Spanish private health insurance companies offer a range of packages that cater specifically to your circumstances. As ever, it’s important to thoroughly research your health insurance options and seek as much advice as possible before committing to a specific plan. Foreigners should check if their package provides the same protection in Spain as it does back home. EU nationals who travel frequently outside of the EU may also consider private health insurance, as the EHIC card only covers travel within the EU. The advantages of getting private health insurance coverage in Spain While the quality of public healthcare is high, some residents opt for private coverage. This helps patients avoid the lengthy waiting times often found in the state system. This is an important factor to consider when weighing up the private care avenue, and is particularly important if you will require regular treatment. A private health insurance plan enables you to select a doctor with a strong grasp of English. Lists of English speaking doctors are also available from tourist offices and