Question
I’d like to hear your experience in Spain using the public and private healthcare in Spain.
I still live in the US for now, and every other week, I spend an entire day just organizing and managing my doctors appointments, resolving medical bills, and contacting the insurance company about claims and why they are not covering some of the services.
It’s ridiculous how our healthcare system requires this much of my energy and time. And this does not even guarantee I get quality care. In the last 4 years, I’ve been to 5 optometrists, 3 neurologists and 2 ophthalmologists just for my eyesight and they still can’t get me the right prescriptions.
Answers
These are the answers of Spainguru’s Facebook group members:
“We live in Valencia and have private health insurance, so far using only the private healthcare system. Like you, we were very frustrated with the U.S. healthcare system, which is primarily profit-driven. As a result of a hospitalization here last year, admitted via Urgencias (ER), I have finally been diagnosed with conditions that should have been diagnosed long ago in the U.S. It was 3 days into my hospitalization before there was any contact needed with the insurance company.
Besides my GP, I see 6 or 7 specialties here. Scheduling appointments and obtaining insurance authorizations when needed can still be challenging and time-consuming. It can sometimes take a few weeks to get an appointment.
However, I almost always feel like I’m making progress, and a huge difference is we almost never see any medical bills or get involved in any claims, other than medications at the farmacia (which I pay out of our U.S. HSA).”
“If you require a visa to move to Spain, you will most likely be required to purchase qualifying private health insurance. It is my understanding that Tricare does not fulfill the requirement.
The required private health insurance must be with a Spanish insurance company and have no deductibles, no copays and no limits. In spite of this, private health insurance in Spain costs a fraction of what it does for less coverage in the U.S.”
“Private dental insurance is a thing in Spain and works similarly to that in the U.S. It is included in some private health insurance policies as an add-on option to others, as well as stand-alone dental insurance.”
“We are in our 70s and have private health insurance here in Spain, no co-pays and no deductibles. Costs us around €300 a month. Prescriptions are a small fraction of what they cost in America. I recently had a full hip replacement and paid zero.”
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“Much better than the US. It’s hard to go into details, but I’ve had major surgery twice in intensive care unit. I never even hear about how much it cost. My insurance pays it and I don’t hear anything.”
“Private insurance plans typically do not cover pre-existing conditions. I just got hit due to asthma exclusion. A 4-day stay in the hospital was about 1100 euros. Better than US but something to be aware of.”
“I had very negative experiences with the public system in Barcelona. I now stick to private care for most issues and use public only for things like vaccinations.”
“Waiting times for specialists in public healthcare have increased. You must see a GP for a referral, and then it’s a waiting game. Private healthcare allows you to book specialists directly. Policies can have a 6-month waiting period before covering treatments. The system is becoming strained due to demand and demographics.”
“If you’re moving to Spain with many pre-existing conditions, the private system may be expensive out of pocket for the first year until you qualify for public healthcare.”
“If you can, get both public and private health insurance. Public care is great in emergencies, but private is easier for scheduling and regular appointments.”
“Spain’s healthcare is robust. I had two surgeries in 5 years with minimal wait. It’s nowhere near the cost of US healthcare.”
“In private care, you’re more proactive. When you go to the doctor, there’s no nurse or vitals, you walk in and the doctor says, ‘tell me.’ But the care has been outstanding.”
“I had a baby in a private hospital and paid nothing. Routine diagnostics are covered. The only issue was with extreme sport injury exclusions, which required extra calls.”
“For fertility treatments like IVF, the system in Spain is more transparent, significantly cheaper, and the experience is more personalized than in the U.S.”
“The hardest part about Spanish healthcare is overcoming PTSD from the U.S. system. Once you do, the quality of life and care is much better.”
“You may wait months for some public system appointments. Private insurance speeds that up significantly, and apps make booking easy.”
“Spain’s system ranks among the best in the world. It’s not perfect, but the blend of public and private options gives you flexibility and affordability.”
“I have both government and private and I find them both very good.”
Conclusion
The overwhelming consensus from expats is that both public and private healthcare in Spain provide a higher quality of care at a significantly lower cost than the U.S. system.
Private insurance is especially praised for its affordability and ease of use, offering rapid access to specialists, zero co-pays, and full coverage for most procedures. However, it often excludes pre-existing conditions.
Public healthcare, while generally reliable and free for residents, involves longer wait times for specialist appointments and requires navigating through GP referrals. Many expats recommend having both private and public coverage to balance access and peace of mind.
For those coming from the U.S., adapting to Spain’s healthcare system may require a mindset shift, but the lower financial stress and quality of care make it worth the transition.
Public vs Private Healthcare in Spain at a Glance
| Category | Public Healthcare (SNS) | Private Healthcare |
|---|---|---|
| Eligibility | Available after 1 year via convenio especial or through employment/self-employment or S1 Form | Required for visa holders (e.g. NLV, Digital Nomad Visa); can be purchased at any time; UK reitrees may use S1 instead |
| Cost | Low monthly fee (e.g. €60–€157/month under convenio), no co-pays | Varies by age and provider (€50–€300/month), typically no co-pays or deductibles |
| Pre-existing Conditions | Covered | Usually not covered; exclusions common (e.g., asthma, migraines, etc.) |
| Wait Times | Often long, especially for specialists and surgeries | Shorter for most appointments, diagnostics, and surgeries |
| Specialist Access | Must go through a GP for referral | Can book directly with specialists, depending on policy |
| Emergency Care | High quality and free | High quality and typically fully covered by insurance |
| Language Accessibility | Limited English, varies by region | Many English-speaking doctors and staff, especially in expat-popular areas |
| Administrative Hassle | Scheduling and navigating system can be challenging; long waits for approvals | Easier scheduling via apps/websites; fast reimbursements; usually minimal paperwork |
| Medication Coverage | Subsidized prescriptions based on income / Not included with Convenio Especial | Not usually included; meds paid out-of-pocket unless policy includes a pharmacy add-on |
| Overall Experience | High-quality care but requires patience and adaptation | More convenient and faster, but limitations with pre-existing conditions and some exclusions |
