S1 Form in Spain >> How EU & UK Pensioners Can Get Free Healthcare

When planning your move to Spain – whether for retirement, a lifestyle change, or to reunite with family, healthcare is one of the most important (and often misunderstood) pieces of the puzzle. For many UK and EU pensioners, the S1 form is a game-changer. It provides access to Spain’s public healthcare system, meets immigration requirements for residency, and saves you from the high costs of private health insurance.

What Is the S1 Form and Why UK and EU Pensioners Want It

The S1 form is a healthcare certificate issued by your home country, such as the UK or another EU/EEA state, which allows you to access Spain’s public healthcare system if you’re retiring or receiving certain state benefits. It’s one of the most cost-effective and efficient ways for eligible expats to get healthcare without relying on expensive private insurance.

“The S1 form is used to certify that the person continues to contribute to social security in their home country and as an EU citizen, has healthcare coverage in the destination country (in this case, for example, from Poland to Spain).” Louis Williams (cross-border tax specialist) advice to a Moving to Spain client.

Once issued, you’ll take the form to Spain and register it with the Instituto Nacional de la Seguridad Social (INSS). This form confirms your entitlement to public healthcare in Spain, which includes doctor visits, hospital treatment, and subsidized prescriptions, just like a Spanish citizen.

Why It’s Called “Portable” Healthcare

The S1 is part of a broader EU agreement on social security coordination, allowing your healthcare rights to “travel with you” across borders. As the European Commission explains:

Who Issues the S1?

• UK Residents: Through NHS Overseas Healthcare Services, part of the NHS Business Services Authority (NHSBSA)
• EU Citizens: Through the social security authority in your home country

Once you’ve registered your S1 with INSS in Spain, you’ll be issued a certificate confirming your entitlement. You can then apply for your tarjeta sanitaria (Spanish health card) at your local health center.

“If you have a UK State Pension or another qualifying exportable benefit, you must request an application form by phone from NHS Overseas Healthcare Services… You will be sent a new S1 form to your registered address.” GOV.UK – Healthcare for UK Nationals

Why It’s Important for Your Move to Spain

Using the S1 instead of private health insurance can:

• Save thousands of euros per year
• Help meet healthcare requirements for visas (e.g., Non-Lucrative Visa)
• Simplify your integration into Spanish life by connecting you with local public services

In the next section, we’ll delve into exactly who qualifies for the S1 form, including some everyday situations we encounter with our clients.

Who Is Eligible for the S1 Form in Spain?

The S1 form isn’t available to everyone, but for those who qualify, it offers an outstanding way to secure state-funded healthcare in Spain. Understanding who is eligible for an S1 is key to determining whether you’ll need private insurance when you move.

UK Citizens – Common Eligibility Scenarios

If you’re a UK national, you can apply for an S1 form if you fall into one of these categories:

1. You’re Receiving a UK State Pension

This is the most common route. As soon as you begin drawing your UK State Pension, you’re eligible to apply.

“If you have a UK State Pension or another qualifying exportable benefit, you must request an application form by phone from NHS Overseas Healthcare Services…” Gov.uk

2. You’re a Dependent of Someone with an S1

Spouses and dependent family members may also qualify for healthcare rights under the main applicant’s S1.

“You should use form CA8454 if you need an S1 for: your dependents who live in an EU country… and you’re only working in the UK.” Gov.uk

3. You’re a Frontier Worker

If you live in Spain but work in the UK (or another EEA country), you might qualify as a frontier worker.

“You may be entitled to an S1 certificate as a frontier worker if you have worked and paid contributions in an EEA country or Switzerland.” Gov.uk

Note: “A frontier worker is defined by Regulation (EC) No. 883/2004, Article 1(f) as: ‘any person pursuing an activity as an employed or self-employed person in a Member State and who resides in another Member State to which he returns as a rule daily or at least once a week.” Europa.eu

EU/EEA Citizens – With Exportable Pension Rights

If you’re from another EU or EEA country and receive a state pension or equivalent benefit in your home country, you may be eligible. You’ll need to obtain the S1 (or equivalent document) from your national health authority before moving to Spain.

“Their right to sickness benefits in kind … is certified by Portable Document S1 (PD S1)… This form is issued mainly to cross‑border workers… and mobile pensioners…” European Commission

Who Isn’t Eligible for an S1?

If any of the following apply to you, you won’t be eligible for an S1 form:

• You’re not yet receiving a state pension or qualifying benefit
• You’re a digital nomad, remote worker, or self-employed in Spain
• You’re retiring early and relying on savings or private pension income
• You do not have healthcare rights in your home country

In these cases, you’ll need health insurance to meet residency or visa requirements. Don’t worry; we’ve got comprehensive guidance on choosing a Spanish private Health Insurance policy here.

Using an S1 Form for Your Non-Lucrative Visa Application

If you’re a UK national moving to Spain post-Brexit, the Non-Lucrative Visa (NLV) or Spanish Retirement Visa is one of the most common residency options. One of its key requirements is proof of comprehensive health coverage, and this is where the S1 form can make your life much easier.

“Not getting the right insurance coverage is one of the biggest problems we see for clients trying to apply for a non-lucrative visa. For our British citizen clients, if they can get an S1 form, it can make the retirement visa application much easier.” Raquel Moreno, Spanish Immigration Lawyer

What the Spanish Authorities Require

To qualify for a Non-Lucrative Visa, the Spanish consulate typically requires:

• Full coverage health insurance with no co-payments OR
• Proof of public healthcare entitlement (like an S1)

By registering your S1 with INSS before applying (or shortly after arriving in Spain), you demonstrate that your home country is responsible for covering your healthcare. This solution can meet the NLV requirement without needing private insurance for residency in Spain.

Private Insurance vs. S1

For those not using an S1, private health insurance is a must and should cost between €1,500 and €2,500 per person per year, depending on age and health.

By contrast, if you’re eligible for the S1:

• You avoid those premiums
• You gain access to Spain’s world-class public healthcare system
• You have less paperwork during the visa process

We break this down in more detail in our guide to private health insurance for the NLV and other visas.

S1 as Proof in Your Visa Application

When applying for the Non-Lucrative Visa, you can submit a copy of your registered S1 or your INSS certificate as part of your supporting documents. Be sure to:

• Include a certified Spanish translation
• Provide proof of your state pension or qualifying benefit
• Show appointment or confirmation of S1 registration with INSS

Peace of Mind and Less Bureaucracy

Many of our clients have told us that using the S1 made their move less stressful. Not only did it save them money, but it also provided them with fast access to GPs, specialists, and prescriptions through Spain’s trusted public healthcare system.

In the next section, we’ll guide you step-by-step through the process of registering your S1 form with INSS and obtaining your health card (tarjeta sanitaria) in Spain.

How to Register the S1 Form in Spain

Once you’ve received your S1 form, whether from the UK’s NHS Overseas Healthcare Services or your EU home country’s social security office, you’ll need to register it in Spain to begin using the public healthcare system.

This registration process is essential for obtaining your tarjeta sanitaria (Spanish health card), which provides access to general practitioners, hospitals, prescriptions, and other public healthcare services.

Step-by-Step: Registering Your S1 with INSS

Step 1: Gather Your Documents

You’ll need:

• Your original S1 form
• A valid passport or national ID
• Residency documentation (NIE, TIE, or registration certificate)
• Spanish address proof (e.g., padrón)

Step 2: Book an Appointment at INSS (Seguridad Social)

Appointments are required for most offices. You can book online via the INSS official portal.

You can also try registering online if you have a digital certificate (certificado digital) or a Cl@ve system login.

Step 3: Submit Your S1 Form

At your appointment (or online), submit your documents. Once accepted, the INSS will issue a certificate confirming your right to healthcare.

Step 4: Take Your Certificate to the Local Health Centre

With your INSS certificate in hand:

• Visit your local centro de salud (health centre)
• Register as a patient in the Spanish healthcare system
• Request your tarjeta sanitaria (health card)

This card gives you access to public healthcare just like a Spanish citizen.

Tip from the NHS

“When your S1 has been issued, you’ll need to register it with the relevant authority in your country of residence. You’ll often need to do this before you can register for healthcare or obtain a medical card.” NHSBSA – Moving Abroad

What If You’re Not Eligible for an S1 Form?

Not everyone qualifies for an S1 form, and that’s perfectly okay. If you’re not yet receiving a state pension or are moving to Spain as a digital nomad, early retiree, or someone living off savings or private income, you’ll need private health insurance for your visa or residence permit.

Who Doesn’t Qualify for an S1 Form?

You won’t be eligible if:

• You haven’t started receiving a UK or EU state pension
• You’re a working-age mover without exportable benefits
• You’re a digital nomad or freelancer working remotely in Spain
• You’re relying on private pensions or investment income

In these cases, you’ll need to secure private health insurance that meets Spanish visa and residency requirements.

Option 1: Private Health Insurance

For most Non-Lucrative Visa and Digital Nomad Visa applicants, private insurance is mandatory if you don’t have an S1. Your policy must:

• Offer full coverage (without co-payments)
• Be valid throughout Spain
• Cover the duration of your visa stay (usually 12 months)

We explain this in detail in our guide:

Private Health Insurance in Spain – What You Need to Know

We also partner with vetted insurers who understand the Spanish immigration requirements and can provide compliant, affordable plans. Get your easy Spanish healthcare quote now.

Option 2: Transition to S1 Later

If you’re not eligible now but will be soon, you can:

1. Start with private insurance
2. Apply for the S1 once you start receiving your pension
3. Switch to public healthcare after registering your S1 with INSS

This phased approach is popular with early retirees who move to Spain in their late 50s or early 60s and become eligible for an S1 shortly after.

Real-Life Examples: Applying the S1 Form as a UK or EU Pensioner

Here are some real-world scenarios from individuals who have either qualified for the S1 form or found alternative healthcare solutions. These examples reflect the most common situations we see among our clients.

Margaret, 68 – UK State Pensioner Retiring to Málaga

Margaret started drawing her UK State Pension at 66. Now 68, she’s ready to enjoy retirement in the sun. Since she qualifies for the S1, she applied via NHS Overseas Healthcare Services and registered the form with the INSS in Spain.

Margaret now uses her Tarjeta Sanitaria for GP visits and prescriptions at her local health center – and pays very little out of pocket. She speaks fluent Spanish and is very happy using the public healthcare in Málaga.

John & Rachel – UK Pensioner with Dependent Spouse

John receives a UK pension and is moving to Valencia with his wife, Rachel, who is 61 and not yet retired. He applied for an S1 and used Form CA8454 to register Rachel as his dependent.

Rachel is now fully covered under John’s S1 – she doesn’t need private insurance in Spain.

Alex, 42 – Frontier Worker in Spain

Alex lives in Girona but works remotely for a UK company. As a frontier worker, he qualified for an S1 because he’s contributing to UK National Insurance.

He registered the S1 in Spain and avoided the cost of private cover. His fluent Spanish and the excellent facilities in Girona mean he’s happy to use the public system in Spain.

Emma, 58 – Early Retiree Without a State Pension

Emma moved to Spain at 58, living on rental income and savings. Since she wasn’t yet receiving a UK State Pension, she didn’t qualify for an S1 and had to purchase private health insurance in Spain.

She used our easy quote tool to find excellent healthcare in Spain.

4 Reasons Our Clients Still Choose Private Health Cover – Even with an S1 Form

Although the S1 form provides access to Spain’s excellent public healthcare, many of our clients opt to maintain or supplement their coverage with private health insurance in addition to their S1 entitlement. Here’s why:

Greater Choice and Flexibility

With private cover, you have the freedom to:

• Choose from a wide network of private hospitals and specialists
• Book appointments without referrals or delays
• Access alternative therapies or premium diagnostics not always covered publicly

This control over your healthcare journey is a top reason clients keep private insurance, even if they’re fully eligible for public care via the S1.

Language and Comfort

While many public doctors are excellent, not all speak English fluently, especially in rural areas. Private clinics, on the other hand, often:

• Offer services in English and other languages
• Provide a more familiar and reassuring experience
• Shorter wait times and more comfortable facilities

If you don’t yet speak fluent Spanish, this is a massive benefit. Even after ten years in Spain, I still prefer to have my serious medical appointments in my native language.

Relatively Low Cost for High Value

Private insurance in Spain is surprisingly affordable, especially compared to the US. Many of our clients find that plans:

• Start from €80–€150/month, depending on age and coverage
• Can include comprehensive extras, like dental, optical, and wellness checks
• Offer peace of mind at a reasonable price, even when paired with public coverage

Do you want to combine your S1 with a cost-effective private plan? We can help you compare providers and choose the best mix for your needs.

S1 Form Spain >> FAQs