Healthcare in Spain for Britons: GHIC, Public Access and Private Cover

Healthcare in Spain for Britons changed with Brexit: the card you used on holidays does not follow you when you move, and the public system has its own entry rules. The UK GHIC (Global Health Insurance Card) is meant for visits, Spain’s visa rules ask for health insurance, and public access depends on how and where you live. This guide is for Britons who are not UK State Pension S1 holders; if you are, read the S1 and State Pension guide first. This article is for informational purposes only and is not medical or legal advice; verify current requirements with the relevant Spanish authority or a licensed professional.

Will you be covered on day one in Spain?

Not by the UK card, and possibly not by the Spanish system either, depending on your situation.

• The GHIC is a visitor’s card. The NHS says you are entitled to one if you are ordinarily and legally resident in the UK and have no healthcare cover provided by an EEA country or Switzerland. It adds that you must be entitled at the time of treatment, and that using the card without entitlement can make you liable for the full cost or lead to prosecution.
• Spain’s public system is tied to residence. The consolidated RDL 7/2018 gives the right to health protection to foreigners who have established residence in Spain. One route to public funding, article 3.2.c, requires a foreigner to have legal and habitual residence and no obligation to prove mandatory cover another way.
• The gap is our reading, not a quoted rule. No official page read states in one place that a Briton who arrives now, does not work and holds no S1 has no public right at the start. We infer it from that RDL 7/2018 condition, from the visa’s insurance requirement and from the routes the UK government lists below. Check your own case with the regional health service.

Until you have a route in the table, treat yourself as needing private cover from the day you land.

Which route fits your situation?

The UK government’s guidance for UK nationals living in Spain, last updated July 27, 2022, lists how people usually reach the Spanish system. The table sets those routes beside what the official pages say; amounts and rules carry their own links.

On the permanent residence row, the UK page says people with 5 years of residence can apply for permanent residency, then register at the INSS (Instituto Nacional de la Seguridad Social, Spain’s social security institute) with a letter, a “documento de no exportación”, stating the UK does not cover them. The Ministry of Health page states the 5 year rule only for EU and EEA nationals and does not mention UK nationals. We found no page confirming the result for a Briton who arrived after 2020, so do not plan on it.

What the GHIC covers, and where it stops

The GHIC is useful for visits and for the first weeks of a house hunt, as long as you still live in the UK.

• What it covers. The NHS lists emergency treatment, care for long-term or pre-existing conditions and routine maternity care, when the care cannot reasonably wait until you return to the UK. The provider in the country you visit decides whether treatment is medically necessary.
• Where it works in Spain. The UK government’s visitor guidance, last updated September 2, 2021, says to show the card at any state hospital or doctor and that you cannot use it for private healthcare.
• What it does not cover. The NHS names medical repatriation, private facilities and ski or mountain rescue, and says it will not cover costs a local resident has to pay. You may have to pay part or all of a bill up front and claim a refund. It is free, lasts up to 5 years and is not a replacement for travel insurance.
• The NHS at home. The UK guidance says UK nationals who move to the EU should not expect free NHS care when visiting the UK unless an exemption applies. The NHS says moving abroad permanently ends automatic entitlement under normal NHS rules.

These NHS pages were last reviewed in 2023 and the GOV.UK Spain pages date from 2021 and 2022, so read them as the UK government’s description of Spain, and prefer the Spanish sources below for Spanish rules.

Public access in Spain and the convenio especial

What the law gives residents

RDL 7/2018 sets who holds the right to care. It also says that people entitled under the EU coordination rules or bilateral agreements can use the system, and that someone without a public right under its second paragraph may obtain care by paying a convenio especial. The UK government’s guidance adds that registered residents get basic state services free, with a share of prescription costs: residents usually pay 10 to 60 percent. Foreigners who are not registered or authorized residents pay 40 percent of the retail price of medicines.

How the convenio especial works

The Ministry of Health describes the convenio especial as a pay-in agreement that affiliates you to the national health system, aimed at economically inactive foreigners who need health insurance to reside in Spain. It is not the Social Security convenio that fills pension contribution gaps.

1. Meet three conditions. Under RD 576/2013 article 3: one year of continuous effective residence in Spain immediately before applying, registration on the padrón (the municipal register, see the empadronamiento guide) when you apply, and no other access to public health protection. The Ministry of Health page (undated) goes further and says periods of residence in the EU, the EEA, Switzerland or the UK meet the requirement; the regulation’s own text says in Spain, so ask your regional health service which reading it applies. The UK government page says one year on the padrón, so follow the Spanish text.
2. Gather documents. The Ministry lists proof of residence, such as a padrón certificate or a police residence certificate, and, for people from countries covered by the EU regulations or the EU-UK Trade and Cooperation Agreement, a sworn declaration or a no-export certificate from the home authority showing no public cover.
3. Apply to the regional health service of the municipality where you are registered, or INGESA in Ceuta and Melilla. The authority must give a reasoned decision within 30 days of receiving the application.
4. Pay the monthly fee. 60 euros if you are under 65 and 157 euros at 65 or over. Communities may raise it when they add services, and the pages read show only these 2013 amounts, so check the regional figure.

The Ministry says the convenio gives the common basic portfolio with no co-payments or waiting periods, plus a health card. Outpatient medicines, orthopaedic items, dietary products and non-urgent transport are paid 100 percent by the patient. The UK guidance notes that most people use private dentists, since only some basic dental treatment is in the state system.

Private insurance and the visa

Private cover is the first-year default for most Britons arriving now, and the visa makes it a legal condition.

• The law. RD 1155/2024 article 61 requires enough funds and a health insurance for the initial non-lucrative residence authorization. Renewal, under article 64, requires having kept the insurance and continuing it. Student applicants, under article 35, must hold a policy from an insurer authorized in Spain with benefits similar to the common basic portfolio, valid for the planned stay.
• The London consulate. Its non-lucrative visa page asks for the original and one copy of a public or private health insurance certificate from an insurer authorized in Spain, covering all risks the Spanish public system covers.
• Older wording. A February 2022 London consulate PDF accepted the S1 registration receipt as insurance. The current page does not mention it. S1 holders should ask the consulate.
• Open question. The UK government’s guidance lists the convenio especial, beside private insurance, as a usual proof of cover for a visa, but the convenio needs padrón registration and a residence year first, and no Spanish page read confirms that a consulate accepts it for a first visa, so ask the consulate before relying on it.

No official page read gives a price for private insurance. For the visa documents around the policy, see the visa dossier guide and the overview of visa routes.

Withdrawal Agreement holders and posted workers

The UK government says the Withdrawal Agreement covers UK nationals living in an EU country by December 31, 2020 who are workers or self-employed, students or self-sufficient with full sickness insurance, or already have permanent residence. They keep equal treatment with nationals and can continue to use reciprocal healthcare such as the S1, S2 and EHIC. The Ministry of Health says access for people with NHS-funded cover is guaranteed by the Agreement until December 31, 2020 and by the social security protocol from January 1, 2021. Residence cards for this group are in the Withdrawal Agreement card guide.

The UK staff guide ties full social security coordination to people in a cross-border situation on December 31, 2020 who continue in it. We read that as leaving a Briton who moves now outside the Agreement, but no page states it for new arrivals.

Posted workers are a separate case. The Ministry says a worker posted by a UK employer stays in UK social security for two years, with healthcare rights unchanged, and the UK pages send questions on posted worker status to HMRC. People who live in Spain and work in Gibraltar and are not covered by the Agreement have, per the UK guidance, had no reciprocal state healthcare in Spain since July 1, 2022.

Your next step: pick a route before you fly

List your date of arrival, your work status and your age, then match them to one row of the table. A Briton who is moving now and not working can buy a qualifying private policy and apply for the visa without help. After arrival, register on the padrón, keep the policy running and check the regional health service for the convenio once the residence year is met.

Get help from a gestor or adviser if you mix work and residence, if you are near 65 and the fee changes, if you hold a Withdrawal Agreement document, or if your regional health service does not recognize the UK residence years. For the visa step, see the guide to applying from the UK.

The Spain Navigator puts every step of your move to Spain in order, from the visa to settling in.