Healthcare · Provider Overview
Private Health Insurance in Spain: Overview for Expats
Private health insurance in Spain splits into two distinct markets: Spanish insurers (Sanitas, Adeslas, DKV, Asisa) with strong local networks and lower premiums, and international insurers with multi-country coverage at higher cost. For most expats, the practical question isn't finding a policy—it's matching coverage level to your actual needs without overpaying for features you won't use.
Last reviewed: January 2026
Overview only. This is general information about a category of services, not a recommendation or endorsement. Individual providers vary significantly. Always verify current details directly with any provider you're considering.
Who this is for
This overview may help if you:
- Expats researching private insurance options before moving to Spain
- Those whose visas require private health insurance coverage
- People comparing private insurance to Spain's public healthcare system
- Anyone wanting to understand what factors affect insurance pricing and coverage
This may not be the right fit if you:
- Those looking for specific policy recommendations (we don't recommend providers)
- People needing current premium quotes (contact insurers directly)
- Those seeking medical advice about specific conditions or treatments
Key tradeoffs
Important considerations when evaluating this category of services.
Spanish insurers vs. international insurers
Spanish insurers (Sanitas, Adeslas, DKV) typically cost 30-50% less for equivalent coverage within Spain, with denser provider networks. International insurers (Cigna, Allianz, Bupa) cover multiple countries and often include home-country care—worth the premium if you travel frequently or aren't committed to staying in Spain. The decision usually comes down to: how often will you need care outside Spain?
Copay plans vs. full reimbursement
Copay plans run €40-80/month but charge €10-30 per visit. Full reimbursement plans cost €100-200/month but cover visits entirely. In practice, people who use healthcare frequently (chronic conditions, families with young children) often save money on full reimbursement. Healthy people who rarely see doctors do better with copay plans.
Coverage breadth vs. premium cost
Basic visa-compliant plans exclude dental, mental health, and maternity—adding these roughly doubles the premium. The practical question: are you buying insurance for visa compliance or actual expected care? Most people underestimate how much they'll want dental and specialist coverage once they start using the healthcare system.
Visa-compliant coverage often isn't enough
Minimum coverage to meet visa requirements (€30,000 coverage, no deductible for repatriation) leaves significant gaps. Common exclusions: pre-existing conditions, mental health, chronic disease management. Many expats maintain visa-compliant insurance for paperwork while carrying a separate policy for actual care.
What to verify
Before selecting any provider in this category, confirm these items.
- Confirm your visa's specific insurance requirements (coverage amounts, exclusions not allowed, validity periods). Learn more
- Check whether the insurer's network includes providers in your area.
- Verify how pre-existing conditions are handled and any waiting periods that apply.
- Confirm whether the policy provides the certificate format required for visa applications.
- Check age limits and how premiums change as you age.
- Verify cancellation terms and portability if you move.
Pricing: what varies
Cost structures differ between providers. These are common pricing factors to investigate.
| Category | What to check |
|---|---|
| Age factor | Age is the primary pricing variable. A 30-year-old pays €50-100/month; the same coverage for a 60-year-old runs €150-400/month. After 65, many Spanish insurers won't accept new applicants at all. |
| Coverage level | Basic visa-compliant: €40-80/month. Mid-tier with dental and specialists: €80-150/month. Comprehensive including mental health and maternity: €150-300/month. International policies with home-country coverage start around €200/month. |
| Deductibles/copays | Higher deductibles reduce premiums by 15-25%. Typical copays: €10-15 for GP visits, €20-30 for specialists, €50-100 for emergency room. Hospital stays often have daily copays of €50-150. |
| Geographic coverage | Spain-only is cheapest. Adding EU coverage adds 20-40% to premiums. Worldwide coverage (including US) can double the cost due to American healthcare pricing exposure. |
| Annual increases | Expect 3-8% annual increases, sometimes more. Some insurers are aggressive—a €100/month policy can become €150/month within five years. Ask for historical increase data before signing. |
Prices vary by provider, location, and individual circumstances. Always request current pricing directly.
Requirements: what varies
Eligibility and documentation requirements differ. These are common factors.
| Category | What to check |
|---|---|
| Medical questionnaire | Health declarations are standard and legally binding. Misrepresentation—even unintentional—can void your policy when you file a claim. If you have a condition, disclose it; the premium loading is cheaper than a denied claim. |
| Age limits | Most Spanish insurers stop accepting new applicants at 65-70. If you're approaching this threshold, secure coverage before you age out. Existing policyholders can typically renew indefinitely, so early enrollment matters. |
| Pre-existing conditions | Three approaches exist: exclusion (condition never covered), waiting period (covered after 6-24 months), or premium loading (covered immediately at higher cost). The same condition can be handled differently by different insurers—compare carefully. |
| Residency status | Spanish insurers generally require either Spanish residency or proof you're moving to Spain. International insurers are more flexible about residency but may have minimum commitment periods. |
| Payment method | Spanish insurers require SEPA direct debit (Spanish or EU bank account). International insurers often accept credit cards. This can be a factor during the initial period before your Spanish bank account is established. |
Operational notes
Day-to-day factors that affect the experience of using these services.
Provider network
Network density matters more than network size. In Barcelona and Madrid, most major insurers have extensive networks. In smaller cities or rural areas, check specific coverage before committing—some insurers have minimal presence outside major population centers.
Claims process
In-network care is typically paperless—show your card, receive treatment. Out-of-network claims require paying upfront, submitting receipts, and waiting 2-6 weeks for reimbursement. The practical difference is significant for ongoing care.
Language support
International insurers provide English support; Spanish insurers generally don't. For routine claims this doesn't matter, but for complex situations (prior authorizations, claim disputes) language barriers add friction.
Emergency coverage
All legitimate plans cover emergencies regardless of network, but definition of 'emergency' varies. What one insurer covers as emergency another may classify as urgent (lower coverage). Understand the distinction before you need it.
Specialist access
Direct specialist access (no GP referral required) is the norm for Spanish private insurance—a major difference from public healthcare. This means same-week specialist appointments are common, compared to weeks or months through the public system.
Alternatives: what differs
Other approaches or provider types that serve similar needs. No rankings—each has different tradeoffs.
Free for those contributing to Social Security or paying the convenio especial (~€60-160/month based on age). The coverage is comprehensive and quality is high—Spain ranks among the top healthcare systems in Europe. The limitation: wait times for non-urgent specialists can stretch to weeks or months, and not all visa categories grant access.
Makes sense if you travel more than 2-3 months per year outside Spain, or aren't certain you'll stay long-term. Premiums run 50-100% higher than Spanish policies for equivalent coverage, but you avoid the hassle of switching insurers if you relocate.
Adequate for the first 30-90 days while setting up permanent coverage. Does not meet visa requirements. Not a long-term solution—travel insurance excludes chronic conditions and typically caps payouts at levels insufficient for serious illness.
Common among long-term expats: register for public healthcare through Social Security contributions, keep private insurance for faster specialist access and English-speaking doctors. Total cost is higher, but you get the safety net of public coverage for expensive procedures while maintaining private convenience for routine care.
The right choice depends on your specific situation. Consider your priorities before narrowing options.
Next steps
Continue your research with these related guides.
Healthcare Hub
Overview of healthcare topics for expats.
How Healthcare Works in Spain
Understanding the Spanish healthcare system.
Spain Country Guide
Complete overview of setting up in Spain.
Living in Barcelona
City-specific healthcare context and resources.
Visas Hub
Visa requirements often specify insurance needs.
Sources & references
General References
- DGSFP (Insurance Regulator) – Spanish insurance supervision authority
- Individual insurer websites – Coverage details and pricing vary; verify directly
Note on Sources
- This is a category overview – Insurance products change frequently. Always verify current coverage, terms, and pricing directly with insurers.
Information gathered from these sources as of January 2026. Provider offerings, pricing, and requirements change frequently.