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Understanding Spanish Health Insurance for Expats
- watersidesales
- Sep 4
- 4 min read
Updated: Oct 11
Navigating the Confusion Around Spanish Health Insurance
Confusion seems to be rife when it comes to expats and Spanish health insurance. Every week, we speak to people who have arranged a Spanish medical policy but have no idea how the policy works in practice. Some individuals we speak to have had the policy for years and still do not understand how to arrange their regular check-ups or preventative screenings.
This article aims to provide clear information to help you decide what type of Spanish healthcare plan will suit your needs.
The Spanish Network Medical Insurance: Affordable Coverage
THE SPANISH NETWORK MEDICAL INSURANCE is a type of insurance that offers affordable Spain-only coverage.
With a network medical policy, you can access a list of doctors that the insurance company has contracted and registered in their network. The doctor agrees on a cost rate per consultation and treatment, while the insurer settles the cost directly with the doctor, clinic, or hospital. This means that the customer never has to pay for medical care and treatment.
It is crucial to understand that it is not the clinic or hospital that contracts with the insurance company's network. Instead, it is the individual doctors who contract. Some may contract with every insurer, while others may only choose to contract with one or two insurers. The insurance companies do not recommend the listed doctors; they simply offer you a choice. Any doctor registered and qualified to practice in Spain can add themselves to an insurer's network.
Important Considerations for Your Policy
Once you have a policy, it is essential to know that if you attend a doctor who writes a medical report mentioning historical aches, pains, or medical issues that predate the policy and have not been declared, you will not be covered. In Spain, most pre-existing conditions will be excluded.
The insurance company will offer different levels of their network medical policy. When obtaining prices and information, always ask these questions:
Are there doctors in your area? Where is the nearest A&E in the network?
If for a visa, which level of the insurer's policy meets all nine criteria boxes for a visa or residency?
If not for residency/visa, what are the copayment costs if I volunteer to copay for a lower price?
What is the treatment cost limit annually and over the lifetime of the policy?
What are the exclusions in the small print?
In the event of serious illness, such as cancer, does your policy provide advanced treatment options?
Be aware that lower-cost medical insurance may have various clauses that could end up costing you more. Many offer low-cost coverage but provide limited access to the best cancer care, even requiring patients to pay for ongoing chemotherapy drugs. Additionally, many insurers may require you to pay for prosthetic parts, donor organs, skin, ligaments, etc.
Reimbursement Type Medical Policy: Freedom to Choose Doctors
This type of policy usually includes all the coverage provided in the Medical Network of the insurer explained above, but with the added advantage of the freedom to choose doctors and specialists. With the right policy level, you can access some of the top doctors and specialists in the world.
For many, this is the more well-known type of policy. A medical policy where you can choose the doctor or specialist you want to attend. With this type of policy, you can visit any local clinic or hospital, or even see the very top specialists in their field of medicine. Perhaps you know of a friend or relative who spent their family savings to ensure their loved one received the best treatment from a top specialist.
In Spain, the policy that allows you this freedom often has several levels to choose from. Most reimbursement policies still let you use the insurance company's medical network. When you do, there is no upfront payment and no reimbursement claim.
Key Questions to Ask About Reimbursement Policies
If you want to pay extra for the best coverage, check a few things based on where you may need to use the policy.
Note: Most insurances providing worldwide medical coverage will include a clause stating that you need to become a registered resident of the country where you take up the insurance.
When I moved from the UK to Spain (as an EU citizen then), BUPA informed me that if I were to be formally domiciled in Spain as a registered resident or visa holder, I could not continue the coverage with them. The terms of the policy stated that you had to be residing the majority of the year in the UK. Spanish worldwide policies tend to have the same restriction.
Here are some questions to consider when looking at this type of medical policy:
What are the levels of worldwide coverage you offer?
Does the level you offered provide sufficient coverage for the USA, Germany, and the UK, where medical costs are high?
Does your policy give me access to a national medical network in all Spanish provinces? This is a visa requirement (networks must have no upfront payment, no copay).
What percentage can I claim back for medical care outside the network? (80%, 90%, 100%).
If for a visa, can you clearly outline why this policy meets visa criteria?
Conclusion: Making Informed Choices
This article is designed to encourage you to think about the details of the policy you need. Tailor Made Healthcare is here to answer any questions or concerns you may have. We want our prospective customers to have a reasonable understanding of the coverage they are signing up for.
Once you take a policy with our agency, we are here to provide help and support. Most of our customers prefer to contact us by email or phone for any questions or concerns. We are dedicated to providing excellent personal service.
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Francis Payne
Tailor Made Healthcare Spain.
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