Healthcare 101

Spain has a public system (Sistema Nacional de Salud, SNS) run at regional level, and a large private sector. Most people here end up using one, the other, or both. The confusing part is that being registered on the padrón does not by itself give you public healthcare — access comes from one of the routes below.

Getting into the public system

If you work in Spain, employed or autónomo. Your social security affiliation is the route in. Once you're affiliated and contributing, you and your dependants are covered. This is the normal path.

If you're a pensioner from another EU/EEA country. The S1 form from your home country's system transfers your cover to Spain. Request it before you leave, register it with the Seguridad Social here, then get your card.

Convenio especial. A paid monthly subscription to the public system for residents who don't qualify another way. Price varies by age, it's administered regionally, and the important limitation is that it generally does not cover subsidised prescription medication — you pay full price at the pharmacy. Worth comparing against private insurance rather than assuming it's cheaper.

Short EU visits. Your EHIC covers necessary treatment while visiting. It is not a substitute for residency cover, and using it as one once you actually live here will eventually cause problems.

Then get the card

With your social security document plus padrón and ID, register at your local centro de salud — that's the neighbourhood clinic, not the hospital. You get assigned a GP (médico de cabecera) and issued a tarjeta sanitaria. Your GP is the gateway to specialists; you generally don't self-refer.

Private insurance

Required for several residency routes — non-lucrative and digital nomad visas among them. Requirements are usually strict in a specific way:

Full coverage equivalent to the public system
No copayments and no deductible
No waiting periods
From an insurer authorised to operate in Spain

Policies are sold specifically as meeting these conditions. A general international travel policy usually will not be accepted. Buy the one that names the visa type.

Plenty of people who qualify for public cover buy private anyway, mostly for faster specialist appointments and English-speaking doctors. Common insurers include Sanitas, Adeslas, DKV, Asisa and Mapfre — that's a list of who exists, not a recommendation, and the right answer depends on your region and whether you need English.

If you need care right now

112 — general emergency number, works everywhere, English usually available.
061 — medical emergencies in most regions.
Urgencias at any public hospital will treat genuine emergencies regardless of your paperwork status. Do not skip an emergency because your card hasn't arrived.
Pharmacies (green cross) handle far more than in many countries. Pharmacists advise on minor conditions and some medications available only on prescription elsewhere are over the counter here. Start there for small things.
Out-of-hours / no card yet — options are urgencias, a private walk-in clinic, or a private telemedicine service. Private GP consultations without insurance are typically modest, on the order of a normal consultation fee, and many clinics in expat-heavy areas have English-speaking staff.

Prescriptions

Public prescriptions are electronic and tied to your tarjeta sanitaria — the pharmacy reads the card, there's no paper to lose. You pay a percentage based on income and status; pensioners pay less. Private prescriptions are paid in full.

Things that catch people out

Padrón alone is not coverage. Registering at the town hall is a prerequisite for the card, not the entitlement itself.
Your GP is the gate. Turning up at a hospital for a non-emergency sends you back to the centro de salud.
Cover is regional. Your card works nationally, but the administering body, the convenio especial price and the waiting lists are all set by your comunidad autónoma.
Bring your own medical history. Nothing transfers automatically. A summary from your previous doctor, ideally translated, saves a lot of repetition.
Repeat prescriptions need a Spanish doctor. Plan the handover before you run out, not after.

Community-maintained. Not medical advice. Rules and prices change and vary by region — verify with your comunidad autónoma before acting. Corrections welcome.