Question
What happens (in terms of payment) if you have an NIE, social security, but do not have an empadronamiento and visit a public hospital emergency in Spain?
Answers
These are the answers of Spainguru’s Facebook group members:
“Based on personal experience, you’ll be treated with the best of care, and they will send you the bill if you don’t have insurance.”
“The bill will depend on the treatment received. It can be low or high. For example, my bill for a four-day hospital stay was €4,000.”
“I’ve heard of someone receiving an ER bill of about €200 during a trip. That’s significantly cheaper than what we’re used to in the U.S.”
“It’s confusing. By NIE, do you mean just a number or a residency card (TIE)? For social security, you need a residency card. Without private or public medical insurance, you’ll pay on your own. Normally, bills are mailed, but without an empadronamiento, you might have to pay immediately.”
“If you have travel insurance, you might be able to submit the bill for compensation.”
“Employers often provide private medical insurance for work visa holders. While it’s not mandatory, it’s a common practice. Private insurance should cover emergencies, even if certain procedures are excluded initially.”
“Even if you don’t pay immediately, the hospital will send the bill to your address. For example, I was told to expect my bill in 10 days.”
“For tourists, emergency care is accessible, but there’s usually a charge. Urgencias visits cost around €150 per visit, and the care level is outstanding.”
“Some emergencies might be treated for free. In one case, a public hospital said, ‘This will be free because it’s an unforeseen event and an emergency.'”
“Emergency care is a right for everyone in Spain. However, you may be billed for certain services like ambulance transport if used.”
“If you’re not paying into social security and don’t have insurance, you will have to pay for treatment, but the costs are typically much lower than in the U.S. You can pay online or in person.”
Conclusion
In Spain, visiting a public hospital without an empadronamiento or private insurance usually results in a bill, but the costs vary widely based on the treatment and circumstances.
Emergency care is accessible to all, though payment is often required unless covered by private insurance, public healthcare, or reciprocal agreements.
Some members have reported surprisingly low bills for ER visits (e.g., €200), while others have faced higher charges (€4,000 for a multi-day hospital stay). Tourists and those without empadronamiento may need to pay immediately, though travel or private insurance can sometimes offset these costs.
It’s important to clarify your healthcare coverage and rights, whether through private insurance, social security contributions, or emergency care entitlements, before needing medical assistance in Spain.
