When we moved to Spain in 2023, health insurance was one of the first jobs on the list, and not because we went looking for it. Before Spain would register us as residents, we had to prove we were covered. We had no Spanish income yet, so that meant a private policy.
Three years later, we have both: SIP cards for the public system, and private insurance on top. So when people ask about health insurance in Spain, the honest answer is that it depends on whether you’re entitled to public healthcare yet. And even once you are, a private policy can save you a lot of time in waiting rooms.
Public or private health insurance in Spain: what decides it
Spain has a public health system that residents reach through a regional health card, and a big private market alongside it. Which one you can lean on comes down to one question: are you entitled to public healthcare yet?
The Valencian health service’s SIP card FAQ (opens in new tab) lists who can get a card. It starts with people registered with Seguridad Social (social security) and their beneficiaries, and goes on to a few more specific groups. If you’re registered with social security, or a beneficiary of someone who is, private insurance is a choice. The same FAQ also lists foreigners with private insurance as a group that can get a SIP number, so holding a card doesn’t by itself mean you have public cover.
If you’re not - you’ve just arrived, you don’t work for a Spanish employer, there’s no Spanish income - you have a gap. For an EU citizen registering as a resident, that gap is exactly what the paperwork checks. Royal Decree 240/2007 (opens in new tab), article 7, says someone who isn’t working in Spain needs sufficient resources for themselves and their family, as well as a seguro de enfermedad que cubra todos los riesgos en España: health insurance that covers all risks in Spain.
Why we had to buy private insurance first
That was us in 2023. We’d already let our Dutch health insurance go, and we had no Spanish income. Private insurance was a hard requirement for our residency paperwork - the green NIE certificate for me and our son, and the TIE (residence card) for my wife.
It also had to be a policy without copago. Asisa’s page on policies without copayments or waiting periods (opens in new tab) describes a copago as the amount you may pay when you use certain medical services. For our registration, a plan with copayments wasn’t an option.
So all three of us went onto a DKV policy with no copago. It wasn’t a decision we agonized over. It was a box on a checklist, and we ticked it.
An hour in one waiting room, twenty minutes in the other
Two moments sum up public versus private healthcare in Spain for us.
The first came after our car crash. We went to the emergency department of a public hospital and waited an hour without being seen.
The second was a couple of months later. Our son’s hand was swollen and painful, so we drove to the emergency entrance of our usual private provider. A doctor saw him within five minutes. He arranged an x-ray, which took another two. About twenty minutes after walking in, we were walking out again.
That’s two visits, not a study. But it’s the comparison that settled things for us, and it’s why we’ve kept private cover even with SIP cards in our wallets. Many of the specialists at our private provider speak English, too, which helps when you’re describing a child’s symptoms and your Spanish runs out halfway through a sentence.
Getting a SIP card in Valencia: how it went for us
Having private insurance doesn’t stop you getting a SIP card, and we have ours now as well. What changed for us is that we now pay into Seguridad Social: my wife through her job, and me as an autónomo (self-employed). Which route gets you a card depends on your situation, and the FAQ lists them.
SIP stands for Sistema de Información Poblacional. The Valencian health service’s FAQ (opens in new tab) describes the SIP card as the document that identifies you to the public health services and gives you access to them. It’s a regional card: if you live elsewhere in Spain, your region issues its own and the steps may differ.
This is how it went for us:
- I registered online first. The FAQ says the online route needs a digital certificate or Cl@ve (the government’s online login) - our digital certificate post covers getting one. Without either, you go straight to your nearest health center instead.
- We got an appointment at our local centro de salud (public health center).
- They checked that we were on the padrón in Torrent, the town register we’d signed up to through our empadronamiento.
- We showed our documents: my wife’s TIE, our passports and our NIEs.
- Our SIP cards were done.
Before you go, the same FAQ recommends bringing a certificado de empadronamiento that’s still in force (six months), and, if you’re registered with social security, the INSS document showing your right to healthcare.
What private health insurance in Spain costs us
Today the family is split across two insurers. My wife is still on the original DKV policy from our residency application. Our son and I moved to Asisa, and we pay about €86 a month for the two of us.
We’ve stayed on plans without copayments ever since. We never needed to change, and it takes a worry away: when someone needs a doctor, we go, without adding up what each visit will cost.
Your quote will depend on the insurer, the plan and the ages of the people on it, so treat our number as one data point rather than a price list.
Waiting periods (carencias) and switching insurers
Private policies can come with a carencia (waiting period): the time between the policy starting and certain cover kicking in. Asisa’s FAQ on waiting periods (opens in new tab) gives six months as its general carencia, and eight months for hospitalization for any reason, childbirth included. Other insurers set their own.
The useful part for us: when we moved from DKV to Asisa, the waiting periods were dropped, because we were transferring from one Spanish insurer to another. Asisa’s page on insurance without waiting periods (opens in new tab) says it removes them if you already have a similar policy with another company, and asks for your old policy’s condiciones particulares (the policy schedule) and your latest receipt. The same would apply to my wife if she moved over.
That page also notes that in an urgencia vital (a life-threatening emergency), Spain’s 1980 insurance contract law requires insurers to waive waiting periods.
Other ways to get health cover in Spain
Not everyone needs what we needed.
Visiting from another EU country. The European Health Insurance Card covers necessary care during a temporary stay, with the same rights as people insured in the country you’re visiting, according to administracion.gob.es (opens in new tab). You may pay a fixed amount or a percentage, just as locals do. It stops being the answer once you move here: the Ministry of Health (opens in new tab) says it isn’t valid for establishing residence in Spain.
The public pay-in option. The convenio especial (special agreement) lets economically inactive foreign residents pay into the public system. The Ministry of Health’s page (opens in new tab) asks for at least one continuous year of residence immediately before you apply - and says time lived in another EU or EEA country, Switzerland or the UK counts toward it - plus registration on a padrón and no other route into public healthcare. It costs €60 a month under 65 and €157 at 65 or older, with no copayments or waiting periods, though prescriptions you collect at the pharmacy are paid in full. We went private, so I can’t tell you how this one goes in practice, but it’s worth a look before you sign up for a premium.
Working in Spain. Being registered with social security is the first group on the Valencian list of people entitled to a SIP card, so private insurance becomes a choice rather than a requirement. That’s where we ended up, with a job on one side of the family and autónomo registration on the other.
What I’d do again
- Work out first whether you’re entitled to public healthcare. If you’re not, your residency application will need cover the office accepts, which for us meant private insurance.
- If you’re registering without Spanish income, buy a policy without copago. It was a hard requirement for us, and your extranjería (immigration) office can confirm what it accepts.
- Get on the padrón early. The SIP card and the residency paperwork both lean on it.
- Apply for the SIP card too - online if you have a digital certificate or Cl@ve, then the appointment at the health center with your NIE or TIE, passport and a recent certificado de empadronamiento.
- Keep the private policy if the budget allows. Twenty minutes versus an hour unseen is the whole argument.
- If you switch insurers, ask the new one to remove your waiting periods, and have the old policy’s conditions and last receipt ready.
We use both systems now. The SIP card lives in the wallet for the public side of life, and when our son turns up with another swollen something, we already know where we’re driving. In a first year that had plenty to worry about, being properly covered was one thing we could stop thinking about.
