Convenio Especial Spain >> How to Access Public Healthcare

The Convenio Especial Spain is a public healthcare program designed for residents who do not have access to the regular social security-based healthcare system. It is especially useful for U.S. citizens and other non-EU residents living in Spain on visas like the Non-Lucrative Visa (NLV), particularly during the early years of residency before qualifying for permanent residency and full public healthcare access. Below is a comprehensive guide on how the program works, eligibility requirements, regional variations, and more.

What is the Convenio Especial Spain?

The Convenio Especial is a voluntary healthcare program that allows individuals to access Spain’s public healthcare system for a monthly fee. It is ideal for non-EU citizens who are not employed in Spain and, therefore, not contributing to the Social Security system, which is the standard route for residents to access public healthcare.

The program provides access to most medical services offered through the Spanish healthcare system, although some limitations exist regarding specific treatments and prescriptions.

READ ALSO: Private Health Insurance Spain >> How To Pick Perfect Cover

Eligibility for the Convenio Especial

To apply for the Convenio Especial, non-EU citizens (such as U.S. nationals) must meet the following criteria:

Residency Requirement

• You must have been a legal resident in Spain for at least 12 months.
  • Non-EU citizens (including UK and U.S. citizens) can only apply after completing one full year of residency.
  • Student visa holders are also eligible to apply after completing one year of residency in Spain. However, since they are required to have private health insurance for visa approval, most students rely on private insurance during the first year. The Convenio Especial can become a viable option for students planning to stay in Spain for extended periods, especially if they transition to another visa type or intend to stay long-term after completing their studies.
• Temporary residents, such as tourists or people on short-term visas, are not eligible.

Non-Working Individuals

• The program is designed for individuals who are not employed or self-employed in Spain. Those who work typically contribute to the Social Security system and automatically gain access to public healthcare.
• If you are employed or self-employed and paying into Social Security, you do not need the Convenio Especial, as you already have public healthcare coverage.

Pre-existing Conditions

• One of the benefits of the Convenio Especial in Spain is that it does not exclude pre-existing conditions, meaning you’ll receive medical care regardless of any ongoing health issues.

Each Individual Must Apply Separately

• The Convenio Especial does not provide coverage for dependents. Every individual, including spouses and children, must apply and pay the monthly fee separately.

What the Convenio Especial Covers

The Convenio Especial provides access to the full range of services offered by Spain’s public healthcare system. These include:

• Primary care (general practitioners).
• Specialist consultations (dermatologists, cardiologists, etc.).
• Hospital care and surgeries.
• Emergency services.

However, there are some key limitations:

• Prescriptions are not covered, so you must pay out-of-pocket for any medications.
• Dental care is not included; you will need private insurance or pay privately for these services.
• Prosthetics and other specialized medical devices may not be fully covered.

Many private health insurance policies in Spain will cover all these exclusions.

“The coverage is almost complete, except for some medicines and medical tests that must be paid for separately.”

Raquel Moreno – Immigration Lawyer

Cost of the Convenio Especial

Using our tool, you can explore the cost of private health insurance in Spain. You note that for many people, there isn’t a massive difference from the cost of this program. The monthly fee for the Convenio Especial depends on your age:

• Under 65: Approximately €60 per month.
• 65 and older: Approximately €157 per month.

This fee gives you access to most of the public healthcare services, but as noted above, prescription medications and some specialized services must be paid for separately.

When considering healthcare options in Spain, it’s essential to understand the tax implications of both the Convenio Especial and private health insurance. Payments made toward the Convenio Especial are not tax-deductible in Spain and do not contribute to your Social Security benefits, meaning they won’t affect future pension or unemployment claims.

However, if you are a U.S. citizen, you might be able to claim healthcare costs, including private insurance premiums, as part of your foreign earned income exclusion or medical expense deductions on your U.S. tax return, provided they meet IRS criteria. For UK citizens, tax implications will depend on individual circumstances, especially for those who remain UK tax residents.

It’s advisable to consult with a tax advisor familiar with both countries’ laws to ensure compliance and optimize potential deductions.

How to Apply for the Convenio Especial

To apply for the Convenio Especial, follow these steps:

1. Wait until you have lived in Spain for 12 months under your Digital, Nomad Visa, Non-Lucrative Visa, student visa, or another valid residency permit.
2. Gather the necessary documents:
   • Passport and NIE or TIE Card (foreigner’s identification number).
   • Proof of residency (such as your padrón registration, showing that you are registered with the local city hall).
   • Evidence of income or financial means (this may vary by region).
3. To apply, visit the local Social Security office (INSS – Instituto Nacional de la Seguridad Social).
4. Pay the monthly fee, which grants you access to public healthcare services. After enrolling, you will have access to Spain’s public healthcare system.

READ ALSO: Private Health Insurance For Residency and Visas in Spain

Restrictions of the Convenio Especial

While the program offers broad access to healthcare, there are some restrictions to be aware of:

• No contribution to social security benefits: The payments made through the Convenio Especial do not count toward your social security contributions in Spain. This means they do not entitle you to pension or unemployment benefits.
• No automatic coverage for dependents: Each family member must apply and pay the monthly fee separately, as the program does not cover dependents.
• Non-EU Citizens Only: If you are employed in Spain and paying into the Social Security system, this program does not apply to you. It is mainly for non-working residents who lack other access to healthcare.

Convenio Especial vs Private Health Insurance

There are critical differences between the care provided through Convenio Especial and what you get with private health insurance in Spain.

Feature	Convenio Especial	Private Health Insurance
Eligibility	Non-EU citizens who have lived in Spain for at least 12 months who are not employed or contributing to Social Security	Available to anyone, including new arrivals, regardless of employment status or duration of stay
Cost	Under 65: €60/month 65 and older: €157/month	Wide range of services (varies by provider) Often includes dental care, vision, prescription drugs, and private hospitals.
Coverage	Public healthcare system Primary care, specialist care, surgeries, emergency services	Wide range of services (varies by provider) Often includes dental care, vision, prescription drugs, and private hospitals
Prescription Medications	Not covered (must pay out-of-pocket)	Usually included, depending on the plan
Dental Care	Not included	Usually covered, depending on the plan and provider
Pre-existing Conditions	Accepted, no exclusions for pre-existing conditions	May be excluded, or coverage may come with waiting periods or higher premiums
Dependents	Each family member must apply and pay separately	Can include family members under a single policy with possible discounts
Waiting Period	Typically none, though some regions may impose short waiting periods	Many plans impose a waiting period for certain services (e.g., surgeries or maternity care)
Hospitals & Doctors	Access to public hospitals and doctors	Access to private hospitals and doctors, often with shorter wait times
Language Support	Services primarily in Spanish (regional languages in areas like Catalonia and the Basque Country)	Some private providers offer services in English and other languages, particularly in expat-heavy areas. Multilingual healthcare services in Spain are critical for new arrivals.
Flexibility	Only covers public healthcare services; no choice of doctor or hospital	Greater flexibility with doctors, hospitals, and even international coverage in some cases
Travel Coverage	No coverage outside Spain; limited to the public healthcare system	Often includes coverage for emergency medical care abroad, depending on the plan
Administrative Process	Requires in-person application at the local Social Security office after 12 months of residency	This can be done entirely online or through an insurance broker, often immediately upon arrival in Spain.
Impact on Social Security	Payments do not count toward Social Security or pension benefits	No impact on Social Security contributions, but it is often considered as private healthcare only.
Best For	Non-working Expats looking for an affordable public healthcare option Expats with pre-existing conditions Those planning long-term stays	Expats seeking comprehensive coverage, faster service, or specific treatments Families looking for bundled coverage Frequent travelers or those who prefer English-speaking services

Regional Variations in the Convenio Especial

Spain’s healthcare system is decentralized, meaning that autonomous communities manage healthcare, which leads to regional variations in how the Convenio Especial is applied. Here’s a breakdown of these variations:

Availability

• The program is generally available across Spain, but some regions may have slightly different rules or administrative processes. For example, autonomous communities such as Catalonia, Madrid, and Andalusia may have specific variations in their application processes, such as additional paperwork or regional-specific conditions.

Application Process

• In certain regions, the documentation required or the process for applying may differ slightly. While the basic documents (passport, NIE, padrón, etc.) are typically required, some regions may ask for more evidence of income or financial means.

Waiting Periods

• Some regions may have a waiting period before coverage under the Convenio Especial starts.

“You will have to wait for the resolution to be issued by the responsible authorities, which may take a few weeks, depending on the city. In Madrid and in Barcelona they usually process it faster, Valencia and Andalusia usually take longer.”

Raquel Moreno – Immigration Lawyer

Healthcare Service Availability

• The availability and quality of services may vary between regions. Larger regions such as Madrid and Catalonia tend to have more comprehensive specialist care, hospitals, and shorter waiting times. In contrast, smaller regions or rural areas may have longer waiting lists and fewer specialists available.

Program Adjustments

• Some autonomous communities may adjust or expand the program. For example, regions may introduce regional benefits or additional services covered under the Convenio Especial.

Language Differences

• In regions with co-official languages (like Catalonia or the Basque Country), you may encounter healthcare services offered primarily in the regional language, though Castilian Spanish is widely spoken. This can be a big issue if you are struggling just to get your Spanish language up to speed!

Note: If you move to a different region in Spain, you must re-apply to the new authority to continue your cover.

How Does Transition to Permanent Residency Impact the Convenio Especial Spain

Once you have lived in Spain for five years and obtained permanent residency, you typically gain full access to the public healthcare system without needing to rely on the Convenio Especial. As a permanent resident, you are entitled to the same healthcare rights as Spanish citizens, and the need to pay for the Convenio Especial usually ends at this point.

Does the Convenio Especial in Spain Help You?

The Convenio Especial is an excellent option for U.S. and other non-EU citizens living in Spain who are not yet eligible for full public healthcare access. It serves as a bridge during the first years of residency before obtaining permanent resident status. While there are some costs and limitations, the program ensures that residents can access quality healthcare services at a reasonable price during their time in Spain. Be sure to check with your local authorities to confirm your region’s exact application requirements and coverage details, as the Convenio Especial requirements and provisions can vary.

FAQ – Convenio Especial Spain