Questions about health care for expats in Spain

Hello SilverGrizzly,

Welcome to Expat.com

Please note that this new topic has been created on the Spain forum with your post as it deserves a stand-alone thread.

It won't be long before our members read it and provide the insights you need.

Good luck & best wishes for the new year.

Diksha
Expat.com team

Good luck with your new life in Spain!

Medical care in Spain is very good, and significantly cheaper than USA.

There is free public health care, together with private health care comparable to the US.

Like everywhere, the cost of private health care cover depends on your age, pre-existing conditions, the level of care/cover (Gold, Platinum, VIP, etc.) you want, the deductible - and whether you are covered in the public health system.

Unlike the US, where companies often have sneaky exclusion periods, your Spanish coverage should start immediately. Similarly, I think you'll find the Spanish options don't have the sneaky cover exceptions and small print that you have to be so careful of over there!

As a foreigner, you haven't contributed to the Spanish social security system, hence you won't qualify for the free healthcare option. However, once you are a resident, you can choose to contribute to the social security system by being self-employed, taking a job (full-time or part-time) as an employee, starting a company, or registering as unemployed. So, later, you could qualify.

I'm also resident in Bulgaria (another EU country), so I pay monthly social security as unemployed, it's only 15 euros per month. This qualifies me for free state healthcare in Bulgaria. My private health policy is substantially cheaper as a result, as they know I'm covered by the state system. They also issue me with an EHIC (European Health Insurance Card) for use when I'm in Spain or elsewhere in the EU. It will, of course, be more expensive for you (or me) to do this in Spain, but the principle is the same.

That means that to start you should have a private health insurance policy. However, this is a requirement for any residence permit / long term visa issued by immigration. For immigration purposes, it specifies a zero deductible, which is obviously more expensive. Once you are a resident, you can renew in future years with a larger deductible to reduce the annual cost (if you want to).

My partner's policy at ASISA was 400 euros annually. When I had one for immigration it was nearly 1,000 euros. I'd say that yours is likely to be 1,000 to 2,000 euros.

Usually, they are very good at explaining the cover. The level of cover is very good, and I don't think you need to worry about getting good quality care, should you need it.

ASISA has a good website and you can get a quote online, and they explain the cost, coverage, and deductible. We had ASISA policies and it's a good company. But there are many other options too, most have websites with direct purchase.

Two popular comparison engines in Spain are RASTREATOR and ACIERTO. They have options for house insurance, car insurance, and private health insurance ("seguros de salud"). Give your age and info (phone/address, etc.) and they'll show you prices for all the major companies. Getting cover is pretty straightforward, we did it all online.

I did a quick check on ASISA.ES they have a 20% off new year offer. If you are 70+ you have to get a quote from their office, but I entered a 69 age OK. The quote for the annual premium was 1,447 euros for a policy "sin copago" (no deductible) for Asisa Activa Plus.

All these companies provide national coverage wherever you are in Spain. You don't need to worry about regional issues or availability of doctors/hospitals. For example, ASISA's coverage says:

"So that you have the best of private healthcare. Being with ASISA means having a great team willing to do everything you need for your health:

- The largest medical group of free choice among 40,000 health professionals.
- The largest private national hospital network with 17 own hospitals and more than 1,000 subsidized centers.
- More than 600 free authorization tests and with the possibility of managing 8 out of 10 authorizations via the Web.

Do I have coverage throughout Spain?
ASISA has the largest national assistance network with more than 100 insured care offices, 17 own hospitals and more than 1,000 hospitals and subsidized centers spread throughout the national territory, to guarantee you the widest coverage.

And abroad?
With ASISA, you will also have international health coverage when traveling abroad and for a maximum period of three months. If you plan to travel abroad, call +34 91 514 36 11.

Does it cover assistance during pregnancy?
If what you are looking for is coverage for pregnancy and childbirth, count on it too. Because ASISA offers you all the care and attention you need, including preparation for childbirth.

Does my health care insurance have any dental coverage?
Yes, extractions, emergency and infection cures, an annual cleaning, diagnostic tests for these reasons, treatment of oral cavity diseases and fluoridations for children under 6 years of age are covered. In addition, ASISA has created a dental policy for comprehensive care of your oral health.

Since when can I benefit from my health insurance?
From the first day of contracting your policy, you will be able to make use of the services provided by your medical assistance, except for those benefits that have a grace period.

Can I choose a doctor?
Yes, you can freely choose between 40,000 health, medical and ATS professionals that we currently have."

Gwynj:

Wow! Thanks for the info.

We are also contemplating retiring to Spain (later this year) and your information on the companies and the comparison sites was extremely useful to us. Thanks again.

SilverGrizzly, you mentioned not taking the different waves as an omen. I wouldn't either. My plans got scuttled a few times this year. Once I finally got to Spain (Sept-Oct),  I felt way, way safer than in the U.S.

My husband and I (Americans) have been living in Spain for almost 4 years on a non-lucrative visa. You need private health insurance to obtain your residency card. We signed up with a plan through our bank - Banco Sabadell. We also went to the local health agency and got on the government/national health plan. So we have both. We have never used the private insurance. Once we got on the national plan, that is all we use. It's great.

GWYNJ:
Thanks for such a quick and through response.

I got a quote from Asisa by saying I am 69.

The rates seem to be a little bit cheaper in Asturias, 1,360 € without copay down to 850 € for a policy with a “slightly higher” copay.  Both quotes per annum. 

The web page did not get any more specific about the copay.
And there was no mention if prescription drugs were included.

My current Spanish retirement phantasy is to spend this coming Spring in Asturias on a 90 day tourist visa to see how much of the expat dream survives it's encounter with expat reality. 

One of the things on my to do list will be to gather details and experience about the local health care scene in Asturias as well as other aspects of the expat reality like money transfers and taxes.  I plan to get a 90 day travel medical insurance policy and then book a couple of physician appointments while I am there.

The on-line research I have done about Spanish health care has been very positive.  And all the Covid statistics I have seen are better than those in the USofA.

If it does I will return to California and liquidate my USofA existence while applying for a non-lucrative visa.  And become a jubilado in the Fall

The copay isn't usually much.

My experience of USA healthcare plans was high premiums, high copay to get the premiums down a bit, and sneaky small print to reduce your treatment options and create grounds for denial. :-)

This is unpleasant, but kinda makes sense in the country with the world's highest cost of medical treatment. So, of course, you're worried. But EU countries don't work like this, and it's all done in a very common sense way. EU healthcare, in general, is very good.  Spain is an excellent location from many perspectives, including its healthcare system.

You can visit Spain 90 days visa-free as an American. But the no lucrativa is pretty easy and inexpensive (apart from the healthcare policy) to get, so there's no real reason to wait. I, personally, would certainly get the visa (and my new home in Spain) before liquidating my life in USA. You might want to divide your time between the two, although this tends to be a bit expensive.

Spain is not the cheapest country in the EU, but it's significantly cheaper than California. Unless you live in some desert hellhole near the Salton Sea. :-)

Here's a quick comparison between a CA city and a Spanish coastal city:
https://www.numbeo.com/cost-of-living/c … ty2=Malaga

Thank you for the info.  Is DKV a good health insurance for Torrevieja community?

My wife has just moved to DVK from Sanitas.  It appears the coverage is the same.  The annual renewal with sanitas was 1,350€.   With DKV it's 735€

Time will tell if we got it right !

Thank You for the info we are going to try for a non profit visa to live in Spain for a year. Going back to Florida on Friday after visiting relatives on vacation for six weeks

For the sake of clarity :   It s a non lucrative visa, not non profit visa

My impression is that there are a bunch of major healthcare companies in Spain, and the plans look fairly similar... so it just comes down to price.

As mentioned elsewhere, most of the banks offer plans too as part of their "portfolio of client services", but these tend to be slightly more expensive. (And I'd guess they're just re-badged from a specialist anyway.)

I think you can look at Aegon, DKV, Asisa, Adeslas, Sanitas... and many more.

I strongly recommend the comparison engines (Rastreator, Acierto) as they'll give you a good long list with the expected premiums (and the main terms/cover)... and you can take it from there.

For us, Asisa was one of the cheapest, and the cover seemed good. It was a positive experience, so we renewed a couple of times (but for subsequent years with a copago, we only did the zero for immigration).

How many useful hints! I will happily follow them further!

wrote:

How many useful hints! I will happily follow them further!

I thought about moving here, but so many difficult measures that I have found in this article. Indeed, it is written amazingly, like https://ejemplius.com/muestras-de-ensay … -politica/ does. But when I start to think about the ways to realize all of the above mentioned, I start to get worried about the result. And, therefore, to doubt if it worth doing at all.

StacieStaples:
I am working through similar issues.  I think I am pretty good at solving problems but recognize that I have limited existing skills at being an expat.  There is a whole lot of new skills to learn:  money & finances, health care, housing, visas, language, Spanish bureaucracy &c.

And I am pretty sure there are skills I will need to learn that right now I don't even know I need to learn.

But skills are learnable.

My strategy will be to move to Spain in March on a three month tourist visa with a goal of comparing and contrasting the expat phantasy with expat reality.  At the end of that stay I should know pretty much if my needs can be met in Spain, the big problems that will occur during my first year of expatriation will be and how difficult it will be to learn the skills I will need.

Given my prior experiences visiting Spain I am pretty sure it will be where I want to retire.  But I figure an extended stay of three months will give me enough learning experiences to make an intelligent decision about living there.

I worked in Saudi Arabia for 4 years and know that living in a foreign country is different than living.

I would be interesting in hearing from long-term expats in Spain about what were the biggest problems (both expected and unexpected) they encountered during their first expat year.  And what was the most important unexpected skill(s) they had to learn during their first year.

SilverGrizzly wrote:

I am Barry, norteamericano and new to this forum and site.

I have been semi-retired for the past 15 years, working with a medical staffing agency that has allowed me to travel 2 to 3 months every year.  I have used those travels to to scout retirement locations.

In November 2019 I spent a month in Asturias and said, “This is it.”  I gave notice to my agency and booked a flight for April 2020.

And then the Plague hit.  Cancelled that flight four days before I was supposed to leave.  Waited through the first wave of the virus, got vaccinated and made plans to Fly out again in April of this year.

Only to have Delta emerge.  Cancelled that flight a week before take off. 

Good thing I don't believe in omens.

I am now vaxe'd and booster'd.  Current phantasy is to fly out the first week in March 2022, spend 3 months living the Spanish reality to be sure this is what I want to do.

However, all of this has got me thinking about the reality of health care for expats in Spain.

Everything I have researched says that Spain has a first rate national health care service.  I also understand that since I will have a non-lucrative visa I will not be eligible for that and will have to have a private insurance policy through a Spanish insurance agency.

First question:  Is that information reasonably correct?

Second question:  I would like to hear form other expats in a similar situation about their subjective/qualitative experiences using private health insurance to access health care in Spain.

Third question:   My current health insurance consists of (USA) Medicar and a ”Platinum” supplemental plan that covers things like co-pay, out of pocket expenses and prescriptions.  The premiums for these plans is paid for by my pension.  I will lose these plans if I relocate to Spain. 

So my third question is a ‘two-fer':  Are there Spanish health insurance plans that are this comprehensive? 

And what can I expect to pay?  The Spanish health insurance plans I have contacted have given me monthly rates ranging from USD $ 100 to 600.  With no indication as to what they do and don't cover.

Fourth question:  Any personal experiences with outrageously good Spanish health insurance companies?

Thanks in advance for your help.  I suspect there is probably a health care forum somewhere in this blog.  I will try to locate it.

Without dough it effects more than you. There needs to be help. Looks like there is more than one in the same boat.

I have my residence permits in Spain and Bulgaria. And I'm still trying for my permit in Cyprus, based on the Brexit Withdrawal Agreement. I've had no problems at all, and I've not had to learn any new skills or coping strategies (at least in relation to living in them). On the contrary, it's all very relaxing. All three are lovely countries, and I'm happy to recommend any/all of them.

I suppose it depends on what you want to do, and how much you want to integrate. Everywhere has high-speed internet, Netflix, and access to the news/folks back home. And if you're going to be hanging out near a Mediterranean beach it's hard to imagine that it'll be a stressful experience. :-)

First of all, I wish you good luck!