Spanish private health insurance is a legal requirement for most non-EU residency applications, including the Non-Lucrative Visa, Digital Nomad Visa, and Student Visa. UK pensioners with a valid S1 certificate, and Digital Nomad Visa applicants registering as autónomo, may qualify for Spanish public healthcare instead. For everyone else, a visa-compliant policy from an insurer authorized in Spain is required before your consulate appointment. Costs range from €600 to €4,500 per person per year , depending on age, and are consistently 50–70% lower than equivalent US or UK cover.
Most people who buy health insurance in Spain through us are broadly similar. They are American or British. They are over fifty. They are applying for a Non-Lucrative Visa or a Digital Nomad Visa, often as a couple. And four out of five disclose at least one pre-existing condition. This guide is written for them, and for everyone who falls outside that profile but needs the same answers.
Spanish private health insurance is a legal requirement for most non-EU residency applications. It is also far cheaper and far better than most newcomers expect. A comprehensive policy in Spain typically costs less per year than a single month of comparable American cover. The Spanish system as a whole, public and private combined, is consistently ranked among the best in the world. None of that, however, makes the buying process simple. The wrong policy can derail a visa application. A non-disclosed condition can void cover entirely. And the cheapest quote often turns out to be the most expensive when you actually need to claim.
This guide is built on what our clients actually do. We track 5,000+ healthcare quote requests a year, cross-reference them with our partner network’s policy data, and review every successful and unsuccessful application we see. The figures and patterns in this article are drawn from those records, supported by named experts in insurance, immigration law, and Spanish residency.
Do you need private health insurance in Spain?
For most non-EU citizens applying for residency, yes. Private health insurance is required by Spanish immigration authorities for the Non-Lucrative Visa, the Digital Nomad Visa, the Student Visa, and several other long-stay categories. A small number of applicants qualify for an exception. The rest must hold an approved policy at the moment of application, before they ever set foot in Spain as a resident.
The general rule for non-EU applicants
If you are American, Canadian, Australian, South African, or from any other country outside the EU and EEA, your visa application requires private health insurance. The policy must come from an insurer authorized to operate in Spain. It must cover all of Spain, including the Balearics and Canary Islands. It must be free of co-payments, free of deductibles, and free of waiting periods. And it must be in force from the day your residency begins.
Travel insurance does not satisfy this requirement, regardless of how comprehensive the cover. Foreign private insurance does not satisfy it either. Public healthcare from your home country does not transfer, with one exception for UK citizens covered below.
The exceptions: when private cover is not required
UK citizens with an S1 certificate
UK citizens entitled to a UK State Pension can obtain an S1 certificate before leaving the UK. The S1 entitles you to use Spanish public healthcare, with the cost reimbursed by the UK government. Spanish consulates accept the S1 in place of private insurance for the Non-Lucrative Visa and the Digital Nomad Visa. For a retired couple, the saving is typically €2,500 to €4,000 per year. Eligibility, application, and registration are covered in our dedicated S1 guide.
EU and EEA citizens
If you hold citizenship of an EU or EEA country, you can register for Spanish public healthcare directly through your social security number once you become a resident. Most EU citizens do not need to buy private insurance at the visa-application stage. Many still choose to, for reasons covered in section 4 of this guide.
Digital Nomad Visa applicants registered as autónomo
If you apply for the Digital Nomad Visa as a self-employed worker (autónomo) and register with the Spanish social security system, you may be eligible to access public healthcare through your social security contributions. Most consulates still expect to see private health insurance at the initial visa-application stage, then accept the transition to public cover at the first renewal.
Existing residents transitioning to Convenio Especial
After 12 months of legal residency in Spain, those who do not qualify for public healthcare through work or pension can pay into the Spanish public system through a scheme called Convenio Especial. Convenio is not accepted at the original visa-application stage. We cover it in detail in our Convenio Especial guide.
Quick check – Do you need it?
> Applying for an NLV from a non-EU country: Yes.
> Applying for a DNV from a non-EU country: Yes (until you transition to autónomo cover).
> British and drawing, or about to draw State Pension: S1 instead, where eligible.
> EU citizen registering as resident: Public route is available; many still buy private.
> Existing resident, year two+: Convenio Especial may apply; private remains the simpler option.
How healthcare in Spain actually works
Spain runs a parallel system. The public network, Sistema Nacional de Salud, covers anyone with a Spanish Social Security number through their employment, pension, or contributions. The private network operates alongside it, with its own hospitals, specialists, and direct access for policyholders. Most residents use both at different times: public for chronic conditions and emergencies, private for speed of access and English-language support.
The public system
Spain’s public health service is genuinely excellent. The OECD Health at a Glance 2025 found Spain better than the OECD average on eight of ten key health indicators, with life expectancy at 84, 2.9 years above the OECD average. Hospitals are well-equipped, doctors are well-trained, and the cost to the patient at the point of care is effectively zero. Prescription medications are heavily subsidized. Most major specialists are accessible through GP referral.
Where the public system struggles is with non-urgent specialist appointments. Wait times for non-emergency cases can run weeks or months in some regions. Many people also find the public system harder to use in English, particularly outside major cities. This is where private insurance earns its place, even for people who could use the public route.
The private system
For Americans living in Spain, private health insurance in Spain often costs significantly less than equivalent US premiums. Many report better access and shorter wait times.
Private healthcare in Spain costs roughly half to a third of equivalent cover in the United States, and works very differently from American health insurance. Most policies are structured as direct-access cover with a hospital and specialist network. You see whoever you want from your network, often without GP referral, with no co-payment at the point of care. This saving is a major benefit for Americans moving to Spain.
In practice, an American couple aged 60 buying a visa-compliant policy from one of our partner insurers pays around €4,500 a year in 2026. The same couple’s US private cover would typically cost between $1,200 and $2,500 a month, with deductibles and co-pays on top. The difference is not a coverage gap. It is the structural difference between two healthcare economies.
Using both: the typical long-term path
After five years of legal residency, many of our clients move toward a hybrid approach: keep a smaller private policy for English-language access and faster specialists, while using the public system for routine and chronic care. Some drop private cover entirely once their Spanish improves. The right answer changes by household and is worth revisiting every few years.
How much does private health insurance cost?
Visa-compliant private health insurance in Spain costs between €600 and €4,500 per person per year in 2026, depending overwhelmingly on your age. A healthy thirty-five year old pays around €700 a year. A sixty-five year old without conditions pays around €2,000. A seventy-five year old in good health pays around €3,500 to €4,000 with the small number of insurers who accept new applicants in that age band. Pre-existing conditions can add 10 to 30 percent on top.
Cost by age and household type
These figures are indicative 2026 quotes for visa-compliant, no-copayment policies. Actual premiums vary by region, condition status, coverage tier, and provider.
| Profile | Monthly | Annual |
|---|---|---|
| Single, age 30–40 | €50–€80 | €600–€960 |
| Single, age 40–55 | €80–€150 | €960–€1,800 |
| Single, age 55–65 | €150–€250 | €1,800–€3,000 |
| Single, age 65–75 | €200–€350 | €2,400–€4,200 |
| Single, over 75 | €300+ | €3,600+ |
| Couple, both under 40 | €100–€160 | €1,200–€1,920 |
| Couple, both 60–70 | €350–€500 | €4,200–€6,000 |
| Family of four (two adults under 50, two children) | €200–€320 | €2,400–€3,840 |
| Single retiree, age 75 | from €240 | from €2,900 |
Children added to a family plan typically cost €20–€40 each per month and provide complete cover, including pediatrics, vaccinations, and school health checks. Couples almost always pay less than two singles bought separately, often by 10 to 20 percent.
What drives the cost up or down
- Age: The single biggest factor. Premiums roughly double between the ages of 40 and 70.
- Pre-existing conditions: May add 10–30%, narrow your choice of insurers, or result in specific exclusions.
- Coverage tier: Standard versus premium affects hospital network access, diagnostic limits, and whether dental and maternity are included.
- Region: Madrid and Barcelona policies cost slightly more than those in smaller cities. Rural areas may have a smaller network.
- Family vs individual: Family policies are almost always cheaper than the sum of individual policies. Get both quotes.
Premium escalation at renewal
Premiums rise modestly at most renewals, typically two to five percent a year. Spanish insurers cannot cancel your policy at renewal, but they can raise the premium and add exclusions for new conditions that emerged during the previous year. This is one of the most overlooked factors in policy choice.
Alastair Johnson of MovingtoSpain.com advises asking every insurer one question before committing:
“What has your average annual premium increase been over the past three years?”
A €1,500 policy that rises five percent a year is cheaper than a €1,400 policy that rises ten percent a year, by the fifth year.
Why Spain compares so well to the US and UK
Like-for-like, Spanish private insurance costs roughly 50–70% less than equivalent cover in the US, the UK, Germany, or the Netherlands. A 65-year-old retiree pays around €2,000 a year in Spain, against $7,000–$12,000 a year for Medicare Advantage and supplementary cover in the US. The Spanish premium is the only number you pay; the US figure assumes co-pays, deductibles, and prescription costs you absorb separately.
Need Spain Private Health Insurance?
We constantly monitor the market and recommend only insurers whose policies meet visa requirements for all of our clients and who are recommended by friends and the community.
one form – up to three quotes. EASY!
Pre-existing conditions: the realistic majority case
Eight out of every ten of our clients who buy private health insurance in Spain disclose at least one pre-existing condition. This is not a complication for the few. It is the realistic majority. The good news is that the vast majority of cases find suitable cover. The path to that cover is simply more careful, and the consequences of getting it wrong are more severe.
What counts as a pre-existing condition
In Spanish private insurance, a pre-existing condition is any medical condition, treatment, or diagnosis you had before your policy began. This includes conditions you were diagnosed with but no longer actively treat, conditions you currently manage with medication, and conditions you experienced symptoms of but were never formally diagnosed with. The standard is broad on purpose.
Common conditions in our clients’ applications include diabetes (both types), hypertension, high cholesterol, asthma, arthritis, prior cancers in remission, mental health conditions including depression and anxiety, prior cardiac events, prior surgeries, autoimmune conditions, and chronic pain. None of these automatically rules out cover.
How insurers handle conditions
Three things can happen when you disclose a condition. First, the insurer can accept you with no exclusion, sometimes with a small premium loading. Second, the insurer can accept you with an exclusion: cover is in force, but the specific condition (and its treatment) is not covered. Third, the insurer can decline cover entirely. This is rare for most conditions, but does happen for active cancer treatment, recent major cardiac events, or conditions requiring frequent specialist intervention.
As Alastair Johnson notes:
“We know that generally speaking, ASSSA is one of the few insurers with a higher upper age limit and a track record of accepting cases other insurers decline.”
Disclosure: why honesty is the only option
The single most damaging thing a buyer can do is conceal a condition. We see this happen, occasionally, when someone is anxious about being declined or charged more. The consequences are disproportionate to the savings.
Case Study: John (name changed)
John, an American applying for an NLV, bought a private health insurance policy in Spain without disclosing a known heart condition. The policy was issued. The visa was approved. For a year, everything seemed fine. When John tried to claim for cardiologist treatment, the insurer identified the non-disclosure within days. The policy was voided in full. The claim was refused. Cover for unrelated conditions — including conditions John had developed during the policy year — was also withdrawn. John then had to apply for a new policy as a now-known case, with all conditions disclosed and at a higher premium. The error was not the heart condition. It was the non-disclosure.
As Alastair puts it:
“Bring your medical history, be open with the company. The vast majority of people can find qualifying cover. The process of finding it is far less painful than what happens if you don’t.”
If a condition is excluded, you still have options
An exclusion does not mean you have no cover. It means cover for everything except that one condition. For most clients, this is acceptable: they continue to use private cover for everything else, and access the Spanish public system if treatment for the excluded condition becomes necessary. Spain’s public hospitals provide comprehensive treatment for most conditions, regardless of whether you have private cover.
By country of origin
US citizens
American expats face the most extreme cost contrast and the largest gap in expectations. Most Americans we speak to are surprised, on first quote, that comprehensive cover in Spain costs less per year than their US insurance costs per month. Americans are also our largest client group: roughly half of all our healthcare quote requests come from US-based applicants.
- Medicare does not work in Spain. Original Medicare and Medicare Advantage do not provide coverage abroad. If you are retiring to Spain on Medicare, you replace it with Spanish private cover; you cannot supplement it.
- ACA cover does not transfer. Marketplace plans are limited to the US. Some employer plans have international add-ons, but these are not visa-compliant for Spain.
- Pre-existing conditions are handled differently. ACA’s pre-existing condition protections are American law. They do not apply to Spanish insurers, who underwrite on disclosed history.
UK citizens
British citizens face two questions that other applicants do not. The first is whether the S1 certificate applies. The second is whether the GHIC covers them in the interim. If you are receiving, or about to receive, a UK State Pension, the S1 is the right starting point — with an annual saving of typically €2,500–€4,000 for a couple.
Raquel Moreno, immigration lawyer at BeGlobal Attorneys and MovingtoSpain.com partner, makes an important point:
“UK consulates are very clear: the S1 certificate must be fully issued and registered with the Spanish health authorities before your visa appointment — not simply applied for. An application reference number alone will not satisfy the consulate requirement.”
The GHIC covers emergency and necessary care during temporary stays. It is not accepted as visa-compliant cover for residency and does not entitle you to long-term registration with the Spanish public system.
Australia, Canada, South Africa, New Zealand, Ireland, and others
Other English-speaking applicants face a smaller, simpler picture: no S1 equivalent, no Medicare interaction, no GHIC. Private cover is required at your visa application. One detail for Canadians and Australians: some provincial healthcare plans or reciprocal Medicare arrangements may provide supplementary protection during the early period of residency — but they do not replace your visa-compliant private cover at the application stage.
Irish citizens, as EU members, can register directly for Spanish public healthcare once resident, the same as other EU nationals.
EU citizens moving to Spain
EU and EEA citizens can register directly for Spanish public healthcare once they are resident. This is achieved via Spanish Social Security contributions if they are working or self-employed, or via an S1 certificate if they are pensioners from another EU/EEA country or the UK. Many EU citizens still buy private cover for faster access to specialists, English-language support, and a more comfortable experience for those who do not yet speak Spanish.
The policy types and what visa-compliant means
Full Spanish private medical insurance
This is the comprehensive product. It covers GP consultations, specialist referrals, inpatient and outpatient hospital care, diagnostics, physiotherapy, maternity, and most other standard care. It meets the visa-compliance requirements automatically. This is what most of our clients buy.
Visa-compliant minimum policies
Some insurers offer products designed specifically to meet immigration minimum requirements at the lowest possible price. They include the non-negotiable elements (no co-payments, no waiting periods, full coverage of all of Spain) but cut back on network size, extras, and language support. They will get your visa approved. They may not give you the healthcare experience you want once you are using them.
International health insurance
If you split your time between Spain and elsewhere, or you are not yet certain that Spain is permanent, international cover from providers such as Cigna Global, Allianz Care, or AXA may be worth considering. Most are accepted by Spanish consulates if they meet the visa requirements (no co-pays, minimum €500,000 cover, no waiting periods, valid in all of Spain). Confirm explicitly with your insurer before assuming compliance.
Policies with waiting periods (not visa-compliant)
Standard private policies sold to existing Spanish residents often include waiting periods of three to nine months for diagnostics, surgery, and hospitalization. These policies are perfectly good for established residents, but cannot be used for any visa or residency application. If you are applying for a visa, your certificate must explicitly state “sin periodos de carencia” (no waiting periods).
The compliance checklist (what your certificate must say)
Spanish consulates check the insurance certificate, not the underlying policy document. Two documents arrive when you buy a policy, and most people do not know which one matters.
Certificate vs policy: the distinction that catches people out
Your insurance certificate (certificado de seguro médico) is a one or two-page summary issued specifically for use in visa applications. It is what you hand to the consulate. The full policy document sets out your terms and conditions. Both documents matter, but for different reasons.
As Ciaran O’Toole, specialist insurance adviser at InnoInsure and MovingtoSpain.com partner, explains:
“The insurance certificate is often reviewed more closely than the full policy wording. Consulates are checking the certificate, not the policy document. Therefore, the certificate must clearly confirm every compliance requirement, regardless of what the full policy contains.”
The seven things your certificate must confirm
Before submitting your visa application, check your certificate against each of the following. All seven must be present or clearly implied. If anything is missing or ambiguous, contact the insurer before your appointment.
- Authorized insurer: Licensed to operate in Spain (DGSFP register).
- Full coverage: Emergencies, inpatient and outpatient hospitalization, no exclusions for standard treatments.
- Coverage limit: Unlimited or minimum €500,000. Below this threshold, applications fail.
- No co-payments or deductibles: Look for “sin copago“. Any fee at the point of care is a red flag.
- No waiting periods: Look for “sin periodos de carencia“. Cover must be in force from day one.
- Coverage of all of Spain: Including the Balearics and Canary Islands. Regionally limited policies will fail.
- Repatriation provision: Some consulates specifically check this. Ensure the certificate addresses it.
The red flags: walk away if you see these
- Any mention of a co-payment, even a small one (€3 per GP visit is enough to fail).
- A coverage cap below €500,000.
- Waiting periods on surgery, hospitalization, or diagnostics.
- Cover is limited to a single autonomous region.
- Travel insurance presented as long-stay cover. This never qualifies.
If you are working with a broker, they should confirm compliance against each of these points before payment. If you are buying directly, ask the insurer for a written statement confirming the policy meets the Spanish consulate’s requirements for your specific visa type. Reluctance to provide it is a red flag in itself.
Need Spain Private Health Insurance?
We constantly monitor the market and recommend only insurers whose policies meet visa requirements for all of our clients and who are recommended by friends and the community.
one form – up to three quotes. EASY!
Comparing the major insurers
There is no single best insurer for every applicant. The right choice depends on your age, your location in Spain, your pre-existing conditions, and how much you value English-language support.
Sanitas (premium tier, owned by Bupa)
Sanitas is the premium option in the Spanish market and earns that reputation. It owns its own hospitals and clinics. Its English-language support is the strongest in the industry, and its app and digital infrastructure are widely considered the best in the Spanish health insurance industry. The maximum entry age is up to 75.
Best for: Madrid- or Barcelona-based applicants; those who prioritize English-language support; digitally-minded applicants.
ASSSA (specialist for older applicants and those with conditions)
ASSSA accepts new applicants up to age 74 as standard, with case-by-case acceptance up to age 79, the highest of any mainstream Spanish insurer. This is a useful feature when most other insurers cap between 65 and 74. They also offer guaranteed renewals. Their network is strongest on the Costa Blanca and the Mediterranean coast.
Best for: Applicants over 65, retirees seeking long-term continuity, applicants with conditions other insurers have declined.
Asisa (best value, family-friendly)
Asisa is the value option among the major insurers, founded by a doctors’ cooperative and still physician-owned. The network is large, particularly in rural and smaller cities. The maximum entry age is up to 69.
Best for: Families, single professionals on DNV, value-conscious applicants under 60, applicants outside major cities.
DKV (the middle ground)
DKV is part of the German ERGO/Munich Re group and offers balanced cover: solid coverage, reasonable pricing, accommodating underwriting, and a good national network including rural areas. The maximum entry age is 74 — the highest among the major mainstream insurers.
Best for: Applicants aged 65–74; applicants with conditions wanting better terms; applicants in rural areas.
The comparison: a guide, not a substitute for quotes
| Insurer | Max entry age | Strongest for | Network | English support |
|---|---|---|---|---|
| Sanitas | 75 | Premium-tier, urban | Excellent in cities | Strongest |
| ASSSA | 74 (up to 79 on a case-by-case basis) | Older applicants, conditions | Strong on Mediterranean | Strong |
| Asisa | 69 | Families, DNV, value | Largest national | Adequate |
| DKV | 74 | Mid-60s, conditions, rural | National incl. rural | Good |
We have built a 21-criterion scorecard you can use to compare insurers against your specific situation, including condition handling, English support, and local network coverage. The scorecard is available for download during our quote process. Your quote includes the scorecard pre-filled with the insurers we recommend for your case.
Choosing the right policy for your situation
If you are a retiree (60+)
If you are British and approaching State Pension age, check S1 eligibility before getting a private quote. The S1 saves typical retired couples €2,500–€4,000 a year. If S1 does not apply, three things matter most:
- Get quotes early. Premiums rise steeply after 70 and the pool of insurers narrows. Six months before your move is not too early.
- Disclose every condition. The right broker will work with multiple insurers to find the best terms for your specific medical history.
- Add dental. Spanish public healthcare does not cover most adult dental care. Add it from the start rather than later when premium loadings can apply.
For applicants over 75 specifically, ASSSA is often the best route, sometimes the only route. See our dedicated guide for over-75s. When picking retirement locations, always consider regional tax differences.
If you are applying with a partner or family
Family and couple policies are nearly always cheaper than individual policies summed, by 10–20 percent. Three things to consider:
- Get a family quote alongside individual quotes. The right answer is not always obvious.
- Check children’s cover. Pediatrics, vaccinations, and school health checks are typically included. Confirm explicitly if your child has any known conditions.
- Maternity matters. Visa-compliant policies cover maternity from day one. Check that your certificate confirms this if you are pregnant or planning.
If you are a Digital Nomad or remote professional
Most DNV applicants buy private cover at the application stage and consider transitioning to autónomo-route public cover after their first year. Confirm with your insurer that the certificate is acceptable for the specific consulate handling your application — some apply slightly different documentary standards.
If you are a student
Student visa applicants need private cover that meets the same compliance requirements as other visas. Specialist student policies (often through Asisa) typically cost around €700–€900 a year. Confirm the policy meets full visa-compliance requirements; some “travel-style” student policies do not.
If you have a complex situation
Dual nationals, applicants with significant medical history, retirees not yet receiving a pension, and people with non-standard visa types should work with a broker rather than buy directly. The differences between insurers in how they handle conditions and set renewal pricing are larger than they appear on a comparison site.
Choosing from a visa angle
Non-Lucrative Visa (NLV)
The NLV is the most common visa among our converted clients. The healthcare requirement is straightforward: visa-compliant private cover, certificate confirming all seven compliance points, in force from your residency start date. US consulates — particularly Washington DC, Los Angeles, Miami, and New York — apply some of the strictest documentary standards. Confirm your certificate is accepted by your specific consulate before paying.
Digital Nomad Visa (DNV)
The DNV’s healthcare requirement is the same as the NLV’s at the initial application stage. Where the DNV differs is at first renewal: applicants registered as autónomo can transition to public healthcare through social security contributions, removing the need for ongoing private cover.
Student Visa
Student visa applicants need a policy with no co-payments and no waiting periods. Specialist student policies are typically cheaper than full adult policies. EU students under 26 may have reciprocal coverage through their home country’s social security; non-EU students need a private Spanish policy.
Other categories
Family reunification, work visas, and entrepreneur visas each have their own variations. The compliance requirements are largely the same; the documentary differences are minor. If your situation is non-standard, work with a broker who regularly handles your visa type. Our partner network covers all standard residence categories.
How and when to buy
Get a personalised quote early. Buy four to six weeks before your consulate appointment. Start the policy on your residency arrival date. Pay the full annual premium upfront.
Timing
The single most common mistake is leaving the purchase of insurance until the last few days before the consulate appointment. Consulates do not accept certificates issued the same day. Start the process four to six weeks before your appointment. If you are over 65 or have any pre-existing condition history, give yourself eight weeks.
Future-dated start dates
You can buy your policy now and start the cover later. The certificate is issued immediately, showing your residency start date as the policy’s effective date. You pay the full annual premium upfront, but the cover does not begin until you arrive in Spain.
As Ciaran O’Toole of InnoInsure explains:
“Most reputable insurers will allow you to set a future start date. You purchase the policy and pay the premium now, the certificate is issued immediately showing your arrival date as the start date, and you don’t pay for the time you’re not yet in the country.”
Annual upfront payment
Visa-compliant policies require payment of the full annual premium upfront. Multi-year visas do not mean multi-year upfront payments — you pay annually, on each renewal date, regardless of the visa term. Once you are an established resident and no longer need visa compliance, monthly payment options sometimes become available.
Quote validity
Standard quotes are valid for 30 days and can be reissued easily if your timeline shifts. Costs rarely change significantly across a few months, and for applicants over 60, getting quotes early can lock in a better age band before your next birthday.
Switching providers later
Switching health insurance providers in Spain is possible and sometimes the right thing to do. Your circumstances change, premiums rise, and the insurer that was right at the start of your residency may not be the right fit three years later. Switching carries genuine risks that are not widely discussed:
- Re-underwriting from scratch. Any condition that has developed since your original policy began may be added to your exclusions list by the new insurer.
- Medical history is not shared. You must disclose everything to the new provider yourself. Non-disclosure carries the same consequences as at the original purchase.
- Treatment continuity. If you are mid-course with a specialist, check whether the new provider will continue coverage from day one.
- Visa renewal timing. Always switch around your annual renewal date, never mid-policy or in the weeks before a visa renewal submission. A gap in cover, however brief, can complicate a renewal.
A cooling-off period of 14–30 days typically applies to new policies in Spain. Never cancel the old policy until the new one is confirmed in force. If you are switching primarily because of a sharp premium increase at renewal, ask your current insurer directly what they can offer before going to market. Renewal negotiations are often more productive than people expect.
Where to go from here
Spanish private health insurance is more straightforward than it looks. The principles are clear: visa-compliant policy, full disclosure on conditions, a certificate that meets the seven requirements, four to six weeks of buying time, and an annual upfront payment. The complexity is in the matching — which insurer is right for your age, your situation, your conditions, and your part of Spain.
We work with a vetted network of brokers who specialize in visa-compliant health insurance for expats moving to Spain. They know what consulates look for, understand the nuances that catch people out, and can compare policies across major providers to find the right fit for your specific situation. Getting a quote is free, takes a few minutes, and comes with no obligation.
Get your free, no-obligation quote →
If you have questions before you’re ready to get a quote, the following guides are a good next step:
- Health insurance for Spanish residency and visas
- Private health insurance with pre-existing conditions
- Health insurance in Spain for over-75s
- S1 form Spain — register and use it
- Convenio Especial Spain
- Healthcare in Spain — overview
Re: Health insurance
Last year (2022) my wife and I applied for NLVs which were approved but due to personal circumstances we had to cancel the application at the last moment. The Spanish consulate in London accepted our S1 forms for Spanish health care so we did not need to get private health insurance.
We are now in a position to move to Spain again and are thinking of making a fresh application.
Has anything changed re acceptance of the S1 ?
Hi John. The S1 acceptance position has not changed substantially, but the broader context around visa processing has shifted — worth flagging before you re-apply.
On the S1 specifically:
– Spanish consulates and BLS continue to accept S1 forms for NLV applications, where the applicant qualifies (typically UK pensioners receiving state pension at retirement age).
– The London consulate accepted your S1 in 2022. Practice has remained consistent in 2025-2026, the S1 is generally accepted in lieu of private health insurance for the NLV.
– The S1 should be issued by the UK NHS Overseas Healthcare Services and presented with the visa application.
A few changes since 2023:
1) Since RD 1155/2024 (effective May 2025), documentation requirements across the board for the NLV have tightened. Bring clean, recent versions of everything — including a fresh S1 form rather than a 2022 one.
2) The post-2025 NLV review is stricter on financial means and the cessation-of-work demonstration. If either of you is still working when you re-apply, you will need formal documentation of how that ends.
3) Apostille and translation: birth and marriage certificates need fresh apostilles dated within 3 months of submission. Same for the S1 — get it issued close to the application date.
The cancellation last time should not negatively affect your re-application. The Spanish system does not treat a withdrawn application as a refusal.
For the fresh application, our immigration partners can run through your documentation and ensure everything is current. The post-2025 standards mean a bit more paperwork than 2022, but the route is the same.
All the best, Alastair
This answer was updated May 2026 to reflect the post-RD 1155/2024 documentation tightening, the importance of fresh documents (within 3 months), and the post-2025 NLV scrutiny on cessation of work.
Hi Alastair,
Your website has helped greatly. Private health insurance was our major concern at our age. We look forward to utilizing some of your services.
Regards,
Randy Klein, USA
All the best the move, Randy. Regards, Alastair
Hi I have previously had thyroid cancer and type 2 diabetes would this exclude me from private health insurance
Hi Cheryl. One of our partners has a product covering pre-existing conditions; however, many companies in Spain won’t offer coverage. Be aware they will cost more (as the insurer carries more risk), but Spanish immigration authorities accept the policy for visa applications. I suggest getting quotes from our insurers (using the form) – it is zero obligation, and you’ll get a clear picture of your ability to obtain suitable private health insurance in Spain. All the best, Alastair
Are the cost examples above the monthly payments or yearly?
Hi Dave. All the examples given are annual policy premiums. Please use our free Spanish Healthcare quote tool for confirmation .Regards, Alastair
I have been trying to get educated as much as I can before starting the NLV process. The San Francisco Embassy has this note under the “Health Insurance” requirement section: “The health insurance must not have a deficiency-exclussion due to pre-existing conditions, copayment, or coverage limit; it must cover 100% of the medical, hospital, and out-of-hospital expenses.”
I got in contact with ASSSA (on of the companies you recommend) and due to pre-existing conditions we have they told us:
“If you may need any further treatments, operations or hospitalization related to the pre-existing conditions, it won´t be covered by ASSSA and you need to pay yourself because it is something you had before getting health policy with us.”
My questions are: are we wasting our time with the visa process since we will fail this requirement? or are there other insurance companies that do not discriminate due to preexisting conditions that can give us full coverage?
Hi Gerardo. Some policies will cover pre-existing conditions but are more expensive (as they carry more risk for the insurer). We’ve just signed a deal with a company that finds insurance for cases like yours – please use our standard Spain Private Health Insurance quote tool, and you’ll get a response from them (we promise we’ll update the website with this information in the next few days!). All the best, Alastair
Hi Alistair, I have been successfully on Home Dialysis for 2 years. Could I continue this in Spain? I cope at home but would need supplies delivered. It is our dream to continue our retirement, moving to Spain.
Thanks for any advice.
Sheila.
Hi Sheila. I’d suggest contacting our health insurance partners to discuss your requirements. They’ll be able to give you a clear answer on arranging cover and support for your medical requirements. Where you live in Spain may also have a bearing on the availability of these services. All the best, Alastair
Hi Alistair,
I am planning to move my family to Spain in June on a Digital Nomad visa. I currently have a company in Chile but work remotely. As I pay every year a 35% tax on my income in Chile, will that be credited towards the 24% flat tax that I would have in Spain? Many thanks,
Michael
Hi Michael – Spain and Chile have a double taxation treaty, so you should only be taxed once on the same income. However, where you pay tax and the amount will depend on where you are a tax resident and where you declare the income. Our Spanish Expat tax experts can advise you on the best approach. Cheers, Alastair
Hi, usually how long does it take to be approved for a private healthcare provider?
Also, if you are just visiting Spain and don’t have public or private- would you still be able to receive healthcare?
Thanks!
Hi Elaine. You can get a private insurance policy quickly approved if you provide all the required documentation. Spain will offer emergency health care to visitors in most circumstances, but only if the care is considered emergency. EU citizens with an EHIC can get care, and travel insurance will cover other situations. All the best, Alastair
Is it possible to pay for the health insurance monthly or do all companies require the premium be paid in full upfront?
Hi Laurie. Many policies have a monthly premium – however, if your policy is for a visa or residence permit it needs to cover the duration of the visa – most usually an annual payment in advance. All the best, Alastair
HI Alistair and Allison,
I am slowly going through your free material, as we are interested in Retiring from Portland, OR, USA to Spain in 2028. It is a few years off, but we want to do our homework to see if it will be possible for us.
In reading your Private Healthcare information, I did not see anything regarding prescriptions. Do private companies offer free prescriptions? What about new specialty medications? If they are out of pocket, are prescriptions cheap? Do you have any examples of costs?
Thanks so much for all your information. It is really helpful to see it all in one spot. Overall, when we started to think about this the information was patchy and overwhelming.
Mark and Bob
Hi Mark and Bob. Most private cover in Spain excludes prescriptions or has a small provision. For example, our current policy includes up to €200 per annum for our family of three. However, medication costs in Spain are generally much lower than in the USA, and generic versions of many pharmaceuticals are available and freely dispensed in Spain. We plan on comparing medication costs between the US and Spain later this year in an index, but until then, you can always contact a pharmacy in the area you plan to move to and ask them for the price of specific medications. All the best, Alastair
Hello, I filled out the form twice but only got one quote. I’m 67 and my husband is 72. Are there no insurance companies that will cover someone of his age?
Thanks
Kathi
Hi Kathi – apologies. Our other insurance partner had a technical issue and has yet to send the quotes we referred to them for a short period last week. They have resolved the issue, and you can expect a quote from ASSSA in the next day or so. Apologies for the delay. Alastair
We are nearing our one year anniversary in Spain on non lucrative visas. Because of our ages – 78 & 83- our private insurance is 8.000 euros and going to 10.000 a year in 2025 for the two of us. We are in a very small town in Galicia and having private insurance has not netted us English speaking doctors or the other benefits you often mention in your articles. We are very interested in the Convenio Especial which would save us thousands a year but are not clear from your articles if it meets the visa requirements. Since our private insurance doesn’t cover prescriptions or dental, it looks to us like the coverage is identical.
Hello. I am moving to Spain and need a private health insurance that covers multiple sclerosis. All insurances have rejected me. However, here it say that there are insurances that do cover existing conditions at a higher cost but it doesn’t say which. Coul you please tell me which private health nsurances cover pre-existing conditions?
Hi Camila. Please use our quote request form, and it’ll pass your request to the most appropriate option. As we say in the article, not everyone can get coverage. We cannot find coverage for some conditions, but we will try our best. Regards, Alastair
I am grateful for all the information you provide; not only on Health Insurance, but all aspects regarding Moving to Spain.
I have been denied coverage from DKV and Salus based on a heart preexisting condition. You indicated that there are insurance companies that might cover me to meet the visa requirements. Can you recommend who they are as I have had no luck findng them. I also understand that insurance companies that do not have questionaires are designed for those of us with preexisting conditions. Can you recomment these companies as well.
Hi Pamela. Sorry to hear DKV and Salus have declined cover. The reality of the Spanish private market is that most mainstream insurers (DKV, Sanitas, Adeslas, ASSSA, Salus, Mapfre) underwrite quite mechanically on cardiovascular conditions and will decline rather than offer cover with exclusions.
Our [partner specialising in pre-existing conditions](https://movingtospain.com/spain-private-healthcare-pre-existing-conditions/) is the route that usually works in this situation. Their product is structured to cover applicants the mainstream market declines, and the policies they issue are accepted by Spanish consulates and BLS for visa applications. The premium is higher than mainstream cover, but for someone with a heart condition needing visa-compliant insurance, it is generally the available route.
You are correct that some insurers in Spain offer “no-questionnaire” policies, but the trade-off is usually a longer waiting period before the pre-existing condition is covered (often 12-24 months, sometimes permanently excluded), and the premium reflects the underwriting risk. They can be useful for visa compliance but you would want to read the policy wording carefully on what is actually covered for the condition.
The best next step is a quote request via the [pre-existing conditions partner page](https://movingtospain.com/spain-private-healthcare-pre-existing-conditions/) with your specific situation included. That will get you a real-cost answer rather than a generic one, and lets the team confirm whether a policy can be issued for your case.
All the best, Alastair
Hi, once you get a price for private insurance, is that fixed at the same amount for following years, or will it increase every year? If it does increase, does the quote show what it would be each year?
Is there a fee to get your quote, we are not ready to move yet, but trying to put prices/budget together.
Also interested to see if they would cover a few conditions we already have.
Looking at about 12 months till we go.
HI Steve. No costs on getting the quotes – it is a free service. Some companies do have a fixed fee for life (including ASSSA) while others reserve the right to increase premiums over time. You won’t get a binding quote on future rates rises but I can tell you that ours have been marginal (all sub 3%) since we arrived 10 years ago. All the best, Alastair