Expat Healthcare In Spain After Brexit

Lisa Smith, BA (Hons), CeFA
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Brexit has changed the way British expats access healthcare in Spain.

Once registered, British expats can access basic medical services for free, but there are still a lot of treatments that are paid for.

These include discounted or full priced prescriptions.

How expats access the Spanish healthcare system depends on their residence and working status.

This guide explains the latest post-Brexit Spanish healthcare guidance and how to keep up-to-date if the rules change with email alerts.

Registering For Healthcare In Spain

All Spanish residents need to register to receive free, basic healthcare – including British expats.

There are five paths to registering, so make sure you choose the right way for you:

  • If you have lived in Spain for five years or more, you are entitled to healthcare on the same basis as a Spanish citizen
  • If you are employed or self-employed, you can access healthcare
  • If you pay public health insurance or Convenio Especial
  • If you register a Form S1 with a social security office
  • If you are a temporary visitor with a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC)

Healthcare When You Live And Work In Spain

If you live and work in Spain, even if you are self-employed, you are entitled to state healthcare on the same basis as a Spanish national.

The first step in qualifying is to register at a local health centre but you must have a Spanish social security number. 

You can get a number from your local  National Social Security Institute (TGSS) office 

Your dependants must register separately – and in Spain ‘dependant’ has a different meaning than in the UK.

After registration, you will get a Spanish health insurance card that you must show when you go to the doctor or hospital.

If you are permanently in Spain, registration also allows you to apply for a Spanish EHIC that will cover any medical care you receive if you come back to the UK or visit another EU or European Economic Area country.

Once you reach UK state pension age, you can apply for a Form S1 that entitles you to free state healthcare in Spain. 

Remember, if you have a Form S1, the UK National Health Service foots the bill for your healthcare in Spain, which means you cannot register for healthcare as a Spanish resident.

Britain has reciprocal healthcare and social security agreements with Spain, learn more here.

Not resident and not working

If you are not working and not a Spanish resident, you can pay monthly into the Convenio Especial – but only if you signed on at your local town hall (padron) for at least a year.

If you have been in Spain for less than a year, you should apply for private health insurance.

If you are covered by a UK Form S1, you cannot apply to the Convenio Especial.

Learn the difference between residence and domicile.

Dependents of a UK expat in Spain

If you are a dependent of a British expat who lives or works in Spain, you should apply for state healthcare at your local INSS office.

Before applying, you will need a letter from the UK NHS to show you are not cover3ed for healthcare in the UK.

To get the letter, call NHS Overseas Healthcare Services:

Telephone: +44 (0)191 218 1999 Monday to Friday between 8am and 6pm or Saturday from 9am to 3pm

Spanish Healthcare For Expats On Assignment

Expats on assignment are ‘posted workers’ or someone who is employed or self-employed in the UK temporarily working in an EU or EEA country.

Currently, healthcare arrangements for posted workers are still under discussion, but should be confirmed by the end of January 2021.

If Spain opts to follow post Brexit arrangements for posted workers, you should be covered by an EHIC or Form S1. If not, you will have to join the public healthcare scheme in Spain or pay for private medical cover.

HM Revenue & Customs has a helpline for posted worker inquiries – call on 0300 200 3500 from the UK or +44 191 203 7010 from Spain between 8am and 6pm weekdays.

Form S1 For British Expats In Spain

Spanish state healthcare paid for by the UK NHS is available to Spanish residents receiving the UK state pension – but not posted workers.

Expats living in Spain before January 1, 2021, who were paid certain UK state benefits may also qualify.

To find out if you qualify, speak to NHS Overseas Healthcare Services on +44 (0)191 218 1999 Monday to Friday between 8am and 6pm or Saturday from 9am to 3pm.

To register for Spanish healthcare, you will need to show a Form S1 at your local INSS office.

Expat Healthcare In Spain After Brexit FAQ

Spain has a reputation for offering one of the world’s leading state healthcare services that is free to all.

Registering for healthcare can be complicated, so expats need to know they have followed the rules before taking treatment.

Here are some most asked questions from expats to help.

What is Convenio Especial?

The Convenio Especial is a fall-back way to access public healthcare in Spain for British expats who may not qualify for healthcare by work or residence.
 
Covenio Especial is a paid-for health scheme that with a monthly cost of €60 for expats under 65 years old and €157 over 65. Public healthcare is mainly free, although some services come with a fee.

What is the National Social Security Institute (TGSS) in Spain?

The National Social Security Institute (TGSS) is the official body in Spain that runs the country’s social security system.

What is the Spanish equivalent of the NHS?

The Instituto Nacional de la Salud is the Spanish version of Britain’s NHS.

Can expats take out private health insurance in Spain?

Yes. Spain has a network of private hospitals and clinics, but the take-up is low due to the free state health service. About one in 10 of the population have private cover and generally opt to go private to jump waiting lists.
 
Costs vary depending on the expat’s health history, but range between €50 and €200 a month.

Watch out for ambulances going to private hospitals

Many expats and visitors to Spain complain about ambulances taking them to private hospitals where huge medical bills are racked up rather than to public hospitals offering free emergency care.

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