Healthcare in Spain for Expats and Non-Residents

How healthcare in Spain works for foreign residents

Spain runs a tax-funded national health system, the SNS, delivered by each region. On the Costa del Sol that is the Servicio Andaluz de Salud, the SAS. Access is tied to residence and social security status, not to owning property, so buying a home creates no entitlement by itself. The UK government's guidance for Spain lists five routes into state healthcare for foreign nationals:

• Working or self-employment in Spain, with social security contributions covering you and your dependents.
• Registering a UK-issued S1 form, for UK State Pensioners and holders of certain exportable benefits.
• Permanent residence entitlement after 5 years of legal residence in Spain.
• Paying directly into the public system through the convenio especial.
• A European or UK Global Health Insurance Card, EHIC or GHIC, for temporary stays only.

UK nationals resident in Spain access state healthcare through employment contributions, a registered S1 form, permanent residence after 5 years, the convenio especial buy-in, or an EHIC/GHIC for temporary staysSource: GOV.UK, Healthcare for UK nationals living in Spain · September 2026 · View market data →

Who gets free public healthcare

Anyone employed or registered as self-employed in Spain is covered from the first social security payment, along with their dependents. UK State Pensioners use the S1 route: request the form from NHS Overseas Healthcare Services, register it with the INSS, Spain's social security institute, and the UK funds your Spanish public care. The INSS then posts a Spanish social security number, which you take to your local health centre to register and receive the tarjeta sanitaria, the regional health card. In every case the practical order on arrival is the same: register on the padrón at the town hall, sort your social security document, then sign up at the health centre nearest your home.

The convenio especial: buying into the public system

The convenio especial is the route for residents with no other cover, early retirees above all. For a flat monthly fee the SAS gives you the public system's basic service portfolio on the same terms as any insured resident: GP, specialists, hospital and emergency care. In 2026 the fee is €60 a month under age 65 and €157 a month from 65, figures set by Real Decreto 576/2013 and confirmed unchanged by the Servicio Andaluz de Salud in May 2026. You need one year of continuous registered residence in Spain before applying, and prescriptions are not subsidised, so you pay the full pharmacy price. The main routes compare like this:

The convenio especial costs €60 a month for subscribers under 65 and €157 a month from age 65, giving access to the SNS basic service portfolio in AndalucíaSource: Servicio Andaluz de Salud, convenios especiales para la prestación de asistencia sanitaria · May 2026 · View market data →

Prescriptions: what you pay at the pharmacy

Public patients in Spain co-pay a share of each prescription, set by income and status. Real Decreto-ley 11/2026 reset the bands in May 2026. Pensioners in the system pay 10% of the pharmacy price, capped at €8.23 a month for incomes under €18,000 and €13.37 a month for incomes between €18,000 and €60,000. Working contributors pay 40% to 60% of the price depending on income, with monthly caps below €35,000 of income. Convenio especial subscribers sit outside this scheme entirely and pay 100% at the counter, which is the one real gap in that route.

Pensioners co-pay 10% of the prescription price with monthly caps of €8.23 under €18,000 of income and €13.37 up to €60,000; active contributors pay 40% to 60% by income bandSource: Boletín Oficial del Estado, Real Decreto-ley 11/2026 · May 2026 · View market data →

Private health insurance and your visa

If you need a visa to live in Spain, private health insurance is not optional. The non-lucrative visa and the digital nomad visa both require a policy from an insurer authorised in Spain, covering everything the public system covers, with no co-payments. Travel insurance does not qualify. Most new arrivals hold that policy for the first year, then keep it or move to the convenio especial once the residence requirement is met. Plenty keep both: private cover is common among internationals on this coast for English-speaking specialists and shorter waiting lists, and premiums rise steeply from the mid-60s, so the earlier you fix a policy, the better the rate.

Hospitals on the Costa del Sol, and what living near one costs

The coast is well served in both systems. The public flagship west of Málaga is the Hospital Costa del Sol on the eastern edge of Marbella, and Málaga city adds two university hospitals. Private groups run international hospitals along the shore, including Vithas Xanit in Benalmádena and Quirónsalud in Marbella, Fuengirola and Málaga, where English is standard and private policies bill directly. Healthcare access genuinely moves buying decisions for retirees, and the towns around the hospitals are not the expensive ones. Across our 7,860 active Costa del Sol resale listings in September 2026 the coast median is €652,875. Calahonda, midway between the Hospital Costa del Sol and Fuengirola's private clinics, holds 183 listings at a €450,000 median. Fuengirola itself, with 454 listings, sits at €547,000, and Benalmádena, home of the Xanit hospital, at €610,000 across 216 listings. Every town is on our live price pages.

Median asking prices, September 2026: €652,875 across 7,860 active Costa del Sol resale listings, €450,000 in Calahonda, €547,000 in Fuengirola and €610,000 in BenalmádenaSource: Hometailor market data · September 2026 · View market data →

Healthcare is one line in a monthly budget that is lower than most arrivals expect. The full picture, from groceries to electricity to town-by-town housing costs, is in our cost of living guide, and how residence itself works when you buy is covered in our guide to residency and property in Spain.