Confused about health insurance for people over 75

As EU citizens, you and your 78-year-old father have the legal right to live anywhere in Spain. For stays longer than three months, your father needs comprehensive health coverage—which he can secure via an S1 form (if he receives a state pension from another EU country), private health insurance, or by registering into the Spanish public system through residency.

1. Empadronamiento: Register your address at your local Madrid municipal office (Ayuntamiento) to get your census certificate.

1. EU Registration (Green NIE): Apply for the Certificado de Registro de Ciudadano de la Unión at a designated National Police/Immigration office in Madrid within three months of arrival.

1. Take your Green NIE and padrón to your local public health center (centro de salud) to obtain your individual health card (tarjeta sanitaria).

As EU citizens, you and your 78-year-old father have the legal right to live anywhere in Spain. For stays longer than three months, your father needs comprehensive health coverage—which he can secure via an S1 form (if he receives a state pension from another EU country), private health insurance, or by registering into the Spanish public system through residency. - @SimCityAT

@SimCityAT is correct, of course, but I'd clarify:

For stays of more than 3 months you should do the EU Citizen Registration process (which requires proof of health insurance).

Given the American connection, my guess is that you are unlikely to have an EU pension (and hence S1), but if you do this is the cheapest option. Access to the public system is not easy for a 78 year old man, unless you're sending him out to work (or he previously had it in another EU country). Typically, the public access for retirees (without an EU pension/S1) is via the Convenio Especial (officially Convenio Especial de Asistencia Sanitaria) and I believe you need at least one year of legal residence before you qualify. Most likely, therefore, is a Spanish private health insurance policy (ASISA, Adeslas, etc.). This will typically be rather expensive for a 78 year old, especially if he has pre-existing conditions. After a year (or whatever the magic number is in Madrid) you can swap to the Convenio Especial which should be cheaper. This covers pre-existing conditions and has fixed rates based on age: under 65s pay 60 euros pm, 65 and overs pay roughly 160 euros pm.

@sjavierb The convenio especial is where your father will probably land, and two details about it usually get reported wrong.

What it asks for is a year of actual residence in Spain before you apply, plus being on the padrón of the town where you sign it. Not a year of holding a residence card. The padrón histórico is normally what proves it. The price is set by age, 157 a month from 65 up, and your region can charge more if it puts extra services in.

The part that catches people out is medicines. It buys the basic care package, so GP, hospital, tests and emergencies, but prescriptions sit outside it and he would pay them in full. At 78 that can be the biggest number on the page, so price it before deciding.

And if he draws a state pension from an EU country, none of that applies. The S1 puts him in the public system for free, and it also shuts the convenio off, because you cannot sign it when you already have cover through the EU rules.