Health insurance is complicated everywhere, but in Spain even more so, because as an expat you can choose between the public and the private system. This guide helps you make the right decision.
The Spanish healthcare system at a glance
Spain's healthcare system is two-tiered:
- Public system: Seguridad Social (social security) - free or very cheap
- Private system: various insurers - costs money, but is often faster
A brief background: After the transition to democracy in 1978, Spain established a public healthcare system similar to Germany's. Today it has been partly privatised, but basic care remains public and free.
Key point: In the public system you pay nothing directly as an employee. Your employer pays. If you register as an autonomo (self-employed), you pay around 250 EUR/month into the Seguridad Social. That amount covers healthcare too.
Public system - Seguridad Social
The Seguridad Social is Spain's public healthcare system. Services are free or very cheap.
How it works:
- You register as an employee or self-employed person
- You receive a Tarjeta Sanitaria (health card)
- With this card you go to a GP (Medico de Cabecera)
- Your GP can refer you to specialists
- All treatments are free (or with very small co-payments)
Services (what is included):
- General medicine and internal medicine
- Emergency department (Urgencias)
- Operations and hospital stays
- Prescription medications (partially, 30-60% discount)
- Pregnancy and birth
- Dental treatment NOT included (except emergencies)
- Optometry/glasses NOT included
- Psychotherapy very limited
- Cosmetic treatments NOT included
Costs:
- Employees: free (employer pays)
- Self-employed (Autonomos): approx. 250 EUR/month (as part of social security)
- Unemployed: free
- Pensioners: free
- Students: free or very cheap
Pros:
- Free for employees
- Comprehensive for general medicine
- Emergencies fully covered
- High quality
Cons:
- Waiting times (2-4 weeks for non-urgent procedures)
- Dental care not included
- Administration can be slow
- You need a fixed GP
- Small co-payments for medications
Tip
If you are an employee, the public system is invaluable. You pay nothing extra and the care is good. Use it! You can always add supplementary insurance later.
Private health insurance
Private insurers in Spain offer faster appointments and broader cover, but they cost money.
The largest private insurers on Mallorca:
-
Sanitas - Spain's largest private insurer
- Cost: 60-130 EUR/month (depending on plan)
- Network: 4,000+ doctors, many private clinics
- Note: well structured, good app
- Website: sanitas.es
-
Adeslas - main competitor to Sanitas
- Cost: 50-140 EUR/month
- Network: 3,000+ doctors
- Note: cheaper options, good dental cover
- Website: adeslas.es
-
Asisa - third-largest provider, regionally present
- Cost: 55-125 EUR/month
- Network: 2,500+ doctors
- Note: good for self-employed
- Website: asisa.es
-
MAPFRE - large insurer
- Cost: 50-120 EUR/month
- Network: large network
- Website: mapfre.es
What private insurance typically covers:
- Free choice of doctor (not just your GP)
- Fast appointments (24-48 hours instead of 2 weeks)
- Dental treatment (up to 1,000 EUR/year)
- Optometry/glasses
- Psychology/psychotherapy
- Alternative medicine (acupuncture, homeopathy)
- Treatment abroad (in some countries)
- Hospital treatment at private clinics (faster, more comfortable)
Private insurance costs:
Prices depend on:
- Age: 25-year-old: 40-60 EUR/month; 50-year-old: 100-150 EUR/month
- Plan: basic (essentials only): 40-60 EUR; premium (everything): 120-200 EUR
- Add-ons: dental supplement +15 EUR, psychology +10 EUR, etc.
- Health status: with a pre-existing condition often 10-20% surcharge
Example prices (March 2026):
- Young healthy person: 50-70 EUR/month
- Middle-aged couple (40s): 120-160 EUR/month together
- Older insured person (60+): 150-250 EUR/month
How to choose the right private insurance:
-
Use comparison websites:
- ilunion.com
- sanitas.es
- adeslas.es
- Enter: age, postcode, desired cover
-
Ask questions:
- "Are my current doctors in the network?" (important!)
- "How long does it take to get a specialist appointment?"
- "Is dental cover included?"
- "Can I cancel monthly or only annually?"
-
Fill in the health questionnaire
- Answer honestly
- Declare pre-existing conditions (if you do not, the insurer can cancel)
-
Compare and test
- There is often a 30-day trial period
- Use it to see whether the policy works for you
Warning
Private insurers often exclude pre-existing conditions. If you already have a condition (for example high blood pressure), it can be excluded for 1-3 years. Be honest on the questionnaire
- if you lie and complications arise later, the insurer will not pay.
EHIC for the transition period
The EHIC (European Health Insurance Card) is a bridging solution when you have just moved to Spain.
What the EHIC is:
- The blue insurance card you receive from your German health insurer
- It is valid in all EU countries
- It entitles you to public emergency care
- Free, as long as you are insured in your home country
How long it is valid:
- Usually 5 years
- Important: you must still be insured in your home country
- If you are working and paying social security contributions in Spain, you no longer need the EHIC
When you need it:
- You have just arrived and are not yet registered
- You do not yet have a Tarjeta Sanitaria
- You are travelling from Spain to another country
What it covers in Spain:
- Public clinics and hospitals
- Emergencies
- Accident treatment
- Routine doctors (if you need it)
- Private treatment NOT covered
- Dental care NOT covered
Tip: Try to get your Tarjeta Sanitaria within the first 3 months. Then you no longer need the EHIC and you have full access to the Spanish system.
Supplementary insurance and dental cover
The Spanish public system is good, but it has gaps. Supplementary insurance can fill them.
Dental insurance:
- Public: not included (except emergencies)
- Private: 15-30 EUR/month for a basic dental plan
- Covers: check-ups, cleaning, fillings, partly implants
- Limit: usually 500-1,500 EUR/year
Psychology/psychotherapy:
- Public: very limited
- Private: 10-20 EUR/month
- Covers: 15-30 sessions per year
- Benefit: therapist of your choice
Optometry:
- Public: not included
- Private: 5-10 EUR/month
- Covers: eye tests and contact lenses
Why supplementary insurance:
- You have basic public cover (safe)
- Supplementary cover fills the gaps (dental, faster appointments)
- Together cheaper than private only
- Best of both worlds
Example combination:
- Public insurance (free as an employee)
- Dental supplement (20 EUR/month)
- Psychology supplement (15 EUR/month)
- Total: 35 EUR/month for basics plus extras
vs.
- Private comprehensive insurance only: 100-150 EUR/month
The supplementary option is cheaper and more flexible.
Insuring your children
In Germany, children are automatically included in the family insurance at no extra cost. In Spain something similar exists, but not automatically: you must actively register your children as beneficiarios (dependants) with the Seguridad Social.
How to proceed:
- Fill in form TA.1 (application for beneficiario status)
- Make an appointment at the TGSS in Palma or online via sede.seg-social.gob.es
- Documents: birth certificate (Libro de Familia), the child's NIE (if available), your own social security card
- Apply for the Tarjeta Sanitaria at the Centro de Salud and choose a paediatrician (Pediatra)
Newborns: First register at the Registro Civil (within 8 days of birth), then apply for beneficiario status. Allow 2 to 4 weeks until the card arrives.
What children receive in the public system:
- Paediatrician (Pediatra) up to age 14
- Free vaccinations following the Balearic vaccination schedule
- Well-child check-ups (Revisiones del nino sano)
- PADI programme: free dental preventive care for children aged 6 to 15 (check-ups, fillings, sealants). Participating dentists can be found at the Centro de Salud or at ibsalut.es.
- Emergency care and hospital stays
Children in private insurance:
A separate premium per child (usually 30 to 60 EUR/month), often with a family discount from the second child onwards. Benefits: shorter waiting times at the paediatrician, specialists within a few days, often extended dental cover beyond PADI (for example orthodontics).
Warning
Waiting periods apply to children too. For pregnancies, plan 10 to 12 months in advance. Congenital conditions can be excluded if the child is not added to the policy immediately after birth.
Comparison: public vs. private
| Criterion | Public (Seguridad Social) | Private (Sanitas/Adeslas) |
|---|---|---|
| Cost | Free (employees) | 50-150 EUR/month |
| Specialist waiting time | 2-4 weeks | 24-48 hours |
| Dental cover | Not included | Included (partly) |
| Free choice of doctor | GP only | Yes, free choice |
| Psychotherapy | Limited | Included |
| Quality of care | Good | Very good |
| Bureaucracy | Somewhat complex | Simpler |
| Invoices | Free | Direct billing |
| Best for | Employees | Self-employed, urgent needs |
How to choose your insurance
If you are an employee:
- Public system (free) + optional dental supplement (20 EUR/month)
- Cost-effective and sufficient
If you are self-employed:
- Public system is expensive (250 EUR/month)
- Private insurance is cheaper (100-150 EUR/month for better cover)
- Or: public + affordable supplements
If you visit the dentist often:
- Private insurance with dental cover
- Or: public + dental supplement (20 EUR/month)
If you need fast appointments:
- Private insurance
- Or: public + specific supplements for specialists
If you do not have much money:
- Public system as an employee (free!)
- Ask your employer to register you
Your first steps:
- Register at the Ayuntamiento (empadronamiento)
- Apply for the Tarjeta Sanitaria (health card)
- Find a GP (Medico de Cabecera)
- Decide on supplements based on your life situation
- Optional: compare private insurance (if self-employed)
Summary: Spain's healthcare system works well. Use the public option when you can. It is free and sufficient. You can always add supplements or private cover later.