Why Health Insurance is important for British Expats in Spain

Spain has long been one of the most popular destinations for British people of all ages looking for a warmer and more relaxed way of life. It is estimated that around 750,000 British people are now permanently resident in Spain, and recent surveys have found that many are unaware of how to access state medical care, or are not properly covered with their own medical insurance.

State System

In many areas of Spain, the state provision is excellent, especially in the emergency medicine sector. Care can be offered free of charge to British people who are permanently resident in Spain as long as they have registered with the local authorities and have a “tarjeta sanitaria” or Health Card (also known in the UK as the European Health Insurance Card,  EHIC). The main barrier to being able to get this card is a linguistic one as all of the forms will have to be completed in Spanish, and many expats simply do not get round to completing the process. This card gives you the same rights as a Spanish citizen but not the same rights as with the NHS; you will have to pay for things like prescriptions which you may get for free in the UK.

Longer Term Care

The main way in which the State medical system in Spain differs from the UK system is in longer term care. The concept of the extended family in Spain still holds strong, and elderly people with complex conditions such as Alzheimer’s are more likely to be cared for by family than in the UK. There are not as many nursing homes or care homes, and services such as home helps or home carers just do not exist. These issues may mainly affect the elderly, but also can affect people recuperating from a major operation or with any other long-term condition. Also, many routine, non-emergency procedures such as hip replacement or cataract removal may not be covered under the Spanish state system.


Having private medical insurance in Spain gives you far more choice over where you are treated, who you are treated by and which services you can access. Private patients can choose to see a doctor who speaks English fluently, or to be treated in a hospital of their choosing rather than going to the nearest one. Misdiagnosis due to language barriers has been identified as a growing issue in the British expat community, so it is of critical importance that expats can access doctors who they can communicate easily with.


If health deteriorates to the stage where the expat wishes to return home to be closer to family for care, travel is not covered in any state system. As with travel insurance, private medical insurance can be used to cover the costs of an air ambulance back to the UK, or for other ongoing care such as carers or physiotherapy until the expat is well enough to travel home alone.