The difference between private health insurance and public health insurance in Spain

The Difference Between Private and Public Health Insurance in Spain

When it comes to health insurance, the choice is between private or public coverage. It might seem that private insurance is far superior and more reliable than public insurance, but is that really the case? In today’s article, we’ll try to clarify this.

Public Insurance: Compulsory Health Insurance Policy (Tarjeta Sanitaria del SNS)

Anyone (regardless of residency status in Spain) who has a local residence permit and pays contributions to the Spanish Social Security Fund (Seguridad Social) can obtain a compulsory health insurance policy. Family members can also use the services of compulsory health insurance (linked to the primary applicant’s profile). To register in the social security system, you first need to request a social security number (NUSS, in Spanish). You can do this on the Social Security website (using a digital signature).

— How do you get the compulsory health insurance policy? (For example, in Catalonia):

You need to bring your passport, TIE, and proof of residence to your nearest local medical clinic and apply for the Tarjeta Sanitaria (TSI). The policy is issued within about 2 weeks, and you can pick it up at the local clinic. There’s no charge for issuing the card. Learn more: at this link.

If you are not a resident of Spain, you will need to bring your passport, recent proof of residence, and an “archived registration” (Padrón Histórico), which shows that you have been registered in Catalonia for more than 3 months, thus qualifying for a minimum set of free medical services in Catalonia. To obtain the TSI certificate in Spain, you must pay social security contributions.
(Yes, in Catalonia even undocumented immigrants who don’t pay social security can access free medical care).

— What services are included in basic compulsory health insurance?

Primary care, general practitioner visits, specialist consultations, vaccinations, prescription discounts, etc.

— What drawbacks might compulsory health insurance have?

In Spain, healthcare is managed by autonomous regions rather than the central government. Therefore, the range of services and access to compulsory health insurance can vary depending on the autonomous region.

For example, in Catalonia, due to a shortage of doctors, there are long waiting times for some doctors/procedures. This is partly because doctors in Catalonia must know Catalan at a C1 level, limiting the hiring of doctors from other regions of Spain.

Private Insurance

Both residents and non-residents can obtain private insurance in Spain. It is issued quickly, within just a week. It includes more services, virtually no waiting times, and access to a wide range of tests.

One of the main benefits is that you don’t have to wait weeks or months for a doctor’s appointment or examination because you can visit any accredited private clinic. Many specialists are available to you in various clinics, not just the hospital you’re assigned to. The key is that the center has a contract with your insurance company. Major well-known insurance companies such as Sanitas, DKV, and Adeslas partner with the most prestigious medical centers and have their own medical centers. For example, in Barcelona, these include hospitals like Quirón or Teknon.

There are 3 main categories of private insurance:

Insurance without co-payments and restrictions (Cuadro médico sin copago y sin carencias) includes all services, including hospitalization. This insurance is the most expensive but is necessary for obtaining various types of residency in Spain. (About 70 euros per month, depending on the applicant’s age).

Medical examinations without hospitalization (Cuadro médico sin hospitalation) allow you to see a general practitioner and get referrals for basic tests. Hospitalization is paid separately.

Insurance with co-payments (Cuadro médico con copago) is suitable if you rarely get sick: the insurance itself is inexpensive (about 20 euros/month), but you’ll need to pay extra for some doctor visits and tests. You can pay for the insurance policy either in full for the year or monthly from a European bank account.

Key Differences

Aside from booking appointments, you need to consider how to treat serious illnesses. If you only have an individual health card (TSI), treatment will be completely free, and the clinic will do everything possible to cure you. On the other hand, a private insurance company has the right to refuse to work with you or not renew the contract when it expires. If you become ill and the insurance covers it, your contract will be terminated, and no other insurance company will work with you.

If you had previous illnesses that you informed the insurance company about, the insurance contract might include a so-called waiting period for visits related to this issue (Carencias). This can range from one month to six months.

Also, compulsory health insurance is required for vaccinations (e.g., seasonal flu or COVID-19 vaccinations), as private clinics do not operate within this system.

So, Which Insurance Should You Choose?

Spaniards prefer to have both types of insurance, as they can be useful at different times. Additionally, private insurance is affordable, starting at 15-20 euros per month and up.

We recommend following the example of the Spaniards and getting additional private insurance. Moreover, if you are applying as a student or under the Non-Lucrative Visa program, you need to include this document when applying for or renewing your residency. And we can help you with this — we work with someone who can help you get health insurance on favorable terms!

Please contact us via private messages with any questions, and we’ll write the next article. See you soon!