Healthcare for UK nationals living in Spain (2024)

All residents in Spain need to register to access healthcare.

Once registered for healthcare, basic state services are free, but there are some things that patients need to pay for. For example, you usually have to pay something towards prescriptions – either a reduced price or the full price.

UK nationals usually access the Spanish national health system in one of these ways:

• through entitlement to healthcare if they’re employed or self-employed and make social security contributions in Spain
• registering a UK-issued S1 form with the social security office (see ‘UK-funded healthcare: getting and using an S1 form in Spain’ below)
• through entitlement to healthcare as a permanent resident if they’ve lived in Spain for 5 years
• paying directly into the public health insurance scheme (Convenio Especial)
• using a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for temporary stays when studying, or as a posted (detached) worker

Healthcare if you live and work in Spain

You must register as resident or apply for the appropriate visa if you want to stay in Spain for more than 3 months. See the guidance on Living in Spain for more information about visa and residency requirements in Spain.

You must show proof of healthcare cover:

• before you can register as a resident
• when you apply for a visa

This will usually be through social security contributions as an employee, private insurance or paying voluntary contributions (the ‘Convenio Especial’).

If you’re working or self-employed in Spain, you’re entitled to state healthcare on the same basis as a Spanish worker. Your dependants are also entitled (see ‘If you’re a dependant of someone living or working in Spain’ below).

Register at your local health centre with your social security number. You can get a social security number from your local National Social Security Institute (TGSS) office in Spain.

Your dependants need to register separately with the INSS.

You may be entitled to a Spanish EHIC for travel, including visits to the UK.

If you are not working and not entitled to an S1 form

If you’ve been a resident in Spain for 5 years or more, you can apply for permanent residency. This will give you access to state healthcare on the same basis as a Spanish citizen.

Once you’re a permanent resident, you need to register for healthcare at your local INSS office.

You’ll need to show a ‘legislation letter’ (‘documento de no exportación’ in Spanish) stating that you are not covered by the UK for healthcare. You can request this by calling NHS Overseas Healthcare Services.

The INSS will give you a document which you need to take to your local health centre.

If the UK pays for your healthcare, for example through an S1 form, you cannot register for healthcare as a permanent resident.

If you are not a permanent resident and you are not working

If you’ve lived in Spain for over one year, you can apply to join the public health insurance scheme. This is called the Convenio Especial. You pay a monthly fee to join the scheme, which gives you access to the Spanish health system.

You can apply if you’ve been registered on the ‘padrón’ (at your local town hall) for at least one year.

Find out how to apply on your regional health authority’s website.

If you’ve lived in Spain for less than one year and cannot get healthcare cover, you’ll need to buy private health insurance.

If the UK pays for your healthcare, for example through an S1, you cannot join the Convenio Especial.

You may have the right to apply for a UK S1 if you start drawing a UK State Pension.

If you’re a dependant of someone living or working in Spain

Dependants and family members are classified differently in Spain than the UK.

Find out who’s considered a dependant under Spanish law.

If you classify as a dependant of someone entitled to state healthcare in Spain (because they’re either working in Spain, a permanent resident or receiving Spanish benefits) you’ll need to apply at your local INSS office.

If you live in Spain but work and make social security payments in Gibraltar

If you are covered by the Withdrawal Agreement, you are entitled to access state healthcare in both Spain and Gibraltar for as long as you continue to live in Spain and work and make social security payments in Gibraltar. You can apply for an S1 form from Gibraltar.

If you are not covered by the Withdrawal Agreement, from 1 July 2022 you are no longer covered for state healthcare in Spain under reciprocal healthcare arrangements. You must check if you are entitled to access state healthcare in Spain via another route, or take out private healthcare insurance.

Contact the Spanish social security office (INSS) or the Gibraltar Health Authority if you are unsure of the status of your healthcare cover.

How to access healthcare services

Once you’re registered for healthcare, you’ll get a health insurance card. Take it with you whenever you visit a doctor, hospital or pharmacy.

Find your nearest clinic or hospital on the Spanish Ministry of Health website (in English)

How much you’ll pay

Once registered for healthcare, basic state services are free.

There are some things that you may need to pay a percentage of the cost for, such as orthopaedic services.

Spain uses a co-payment system where residents usually pay between 10% and 60% of the cost of prescription medication. How much you pay depends on your circ*mstances.

If you’re paying into the Convenio Especial, you’ll pay the full cost for prescription medication. You’ll also pay for:

• non-urgent transportation
• orthopaedic supplies
• prostheses
• dietary supplies

Some basic dental treatment is available under the state system, but most people use private dentists. Many private insurance companies have specific dental policies.

If your UK employer has sent you to Spain temporarily (‘posted workers’)

A posted worker, also known as a ‘detached worker’, is someone employed or self-employed in the UK, but temporarily sent to a European Economic Area (EEA) country.

UK posted workers can access healthcare in Spain using a GHIC, EHIC or S1 form.

HMRC has a helpline for National Insurance enquiries from non-UK residents. They can answer questions about posted worker status and explain which documents you will need to get healthcare while posted.

UK-funded healthcare: getting and using an S1 form in Spain

There’s different guidance if you’re a ‘posted worker’ (see ‘If your UK employer has sent you to Spain temporarily (‘posted workers’)’ above).

You may be entitled to state healthcare paid for by the UK if you’re a resident in Spain and receive a UK State Pension or an exportable benefit. See Planning your healthcare abroad on the NHS website for more information about eligibility.

You may also be entitled to an S1 form if you’re a frontier worker (someone who works in one state and lives in another). You must contact HMRC National Insurance enquiries to find out if you’re eligible.

When you get your S1 form, you must register it with the INSS.

This will mean you and your dependants will be entitled to state healthcare on the same basis as a Spanish citizen.

You’ll also get:

• a UK-issued GHIC or EHIC for travel
• planned treatments in other EU countries

You can find out more about using your GHIC or EHIC abroad and the rules on planned treatments in other EU countries on the NHS website.

If you’re entitled to an S1 form as a dependant of a State Pensioner, your health cover will be cancelled once you begin claiming your UK state pension.

You will be sent a new S1 form to your registered address from NHS Overseas Healthcare Services. You must register this form with the INSS to ensure continuation of healthcare cover.

You are responsible for informing NHS Overseas Healthcare Services if you change your address or your circ*mstances change.

How to get an S1 form

If you have a UK State Pension or another qualifying exportable benefit, you must request an application form by phone from the Overseas Healthcare Services (see contact details above). This is part of the NHS Business Services Authority (BSA).

How to use an S1 form in Spain

You must register your S1 at your local INSS office or via the INSS online portal.

Read the guide to registering your S1 form online.

If you are experiencing delays registering your S1 with local authorities and require emergency or urgent treatment, contact the Overseas Healthcare Services on 0044 191 218 1999.

You can also check the status of your application online on the INSS website.

Once your registration has been processed, the INSS will send you a Spanish social security number by post. Take this to your local healthcare centre to register.

You’ll be given a medical card which you can use when you visit a doctor, hospital or pharmacy.

Studying in Spain

You should apply for a Student GHIC to get medically necessary, state-provided healthcare for the duration of your study period in Spain, whether this is for part or all of your course. This means that you’ll get necessary healthcare services on the same basis as a Spanish citizen either for free or at a reduced cost.

If you already hold a valid Student EHIC you can use this until the card expires.

Read more about eligibility and how to apply on the NHS website.

Getting treatment in the UK

Because the NHS is a residency-based system, under NHS rules UK nationals who move abroad on a permanent basis may lose their entitlement to free NHS healthcare.

If you are a UK national and move to the EU, you should not expect to be able to use NHS services for free when visiting the UK unless you have an EHIC, PRC or S2 to show your healthcare costs are funded by the EU country in which you now live, or another exemption applies.

Some former UK residents do not have to pay for NHS treatment when visiting England. This includes:

• UK war pensioners
• UK government employees
• UK nationals living in the EU on or before 31 December 2020, once they have a registered, UK-issued S1

Read more about using the NHS when you no longer live in the UK (see ‘UK nationals who no longer live in the UK’ in Healthcare for visitors to the UK from the EU).

If you return to live in the UK you’ll be able to use the NHS like any other UK resident.

Read more about using the NHS when you return to live in the UK.

1. 27 July 2022

   Added healthcare information you need to know if you live in Spain, but work and make social security payments in Gibraltar.

2. 14 October 2021

   Updated 'Healthcare if you live and work in Spain' to include information about how to find your nearest hospital or clinic. Updated 'UK-funded healthcare' to include information for S1 dependants who begin claiming a UK state pension, and guidance for S1 holders who are experiencing delays in registering their S1. Updated 'Getting treatment in the UK' to provide additional detail about NHS access when visiting the UK.

3. 12 February 2021

   Updated 'posted worker' section to reflect that posted workers can continue working and accessing state healthcare in Spain, how to register an S1 form in Spain online, and added detail to ‘getting treatment in the UK’ section about healthcare when you no longer live in the UK.

4. 31 December 2020

   Updated sections on living and working in Spain, using an S1 form in Spain, posted workers and studying in Spain. Changes reflect healthcare arrangements for people moving to Spain under the new rules of the UK’s deal with the EU.

5. 9 November 2020

   Updated 2 sections: ‘Healthcare if you’re using an S1 form in Spain and ‘Healthcare if you’re studying in Spain’. Students and people with a registered S1 in Spain can now apply for a new UK European Health Insurance Card (EHIC) that will remain valid from 1 January 2021.

6. 31 January 2020

   Details on the ways that you access healthcare have been updated. The guidance now only covers living, working and studying.Information on visiting has been moved to: https://www.gov.uk/guidance/healthcare-for-uk-nationals-visiting-spain

7. 23 September 2019

   First published.