Whether you rent a villa in Spain for a few weeks of holidays or you are considering settling there permanently and building your house in Roses, one question often arises: is health coverage different in Spain? The answer depends on your legal status and especially on how long your stay is. Here is what you need to help you choose the health protection suited to your situation, whether temporary or permanent.

Some notions about the Spanish health system

Spain has a public health system, the Sistema Nacional de Salud (SNS), founded on universal access but conditioned by legal residence and subject to contributions. Care is generally of good quality, but the type of coverage depends on your status on site. In the private sector, you can only rely on yourself… or rather on a good health insurance in Spain (whether local or international).
For any tourist or temporary stay, European citizens, including the French, can use their European Health Insurance Card (EHIC). It guarantees coverage of “necessary” medical care during the stay, according to the rules of the SNS. Note: this does not mean all care will be free: out-of-pocket expenses are common in Spain, especially for medicines. Also, the EHIC does not cover private care, medical repatriation, or expenses related to cancellation of stay for medical reasons. If you incur costs without EHIC, the French Social Security may possibly reimburse necessary care, but according to French rates, which are sometimes lower than those charged in Spain. The out-of-pocket expense may then be significant.

Duration of stay: the key to understanding your health coverage in Spain

For a temporary stay up to 12 months, it is often recommended to take out travel insurance that covers 100% in case of hospitalization (including private), emergency medical costs, and repatriation. Some bank cards also provide this kind of coverage, but with often limited caps, and conditions modeled on French Social Security rules. It should be noted that for any stay of more than 3 months, you must apply for a Certificado de Registro de Ciudadanos Miembros de la Unión, to register as an EU citizen in temporary residence in Spain.

When the stay is in the logic of long�??term residence in Spain, whether for a permanent settlement or an annual presence of more than six months (183 days), the situation changes. Fiscal status shifts, and with it the obligation to comply with local rules. French Social Security then stops covering you, and affiliation to the SNS becomes unavoidable. That involves obtaining beforehand the NIE (foreigner identification number), essential for any administrative procedure in Spain, including registration with the local social security (INSS).

Procedures for SNS affiliation depending on your status (employee, self�??employed, retiree)

If you work as an employee with a Spanish contract, affiliation to the SNS is automatic.

As a self�??employed worker, you must register with the RETA (Autónomos) scheme.

If you are a retiree with a French pension, you can transfer your rights to Spain using the S1 form.

For people without professional activity or who do not meet the affiliation criteria, joining the SNS is not mandatory, but can be done through a voluntary contribution scheme, such as the Convenio Especial.

Finally, any long�??term installation of more than 3 months requires registration at the local town hall, called empadronamiento, to formalize your residence there.

Local or international private health insurance: an asset given the limits of the SNS

Even if you are affiliated with the SNS, this public health insurance does not cover all medical needs. Many services are excluded or poorly reimbursed, notably optics, dental care, comfort services or certain specialized treatments. Moreover, waiting times for seeing certain specialists in the public sector can be discouraging. For these reasons, many residents choose private health insurance, local or international, to benefit from direct access to private sector and better care.

For expatriates in Spain, international health insurance policies offer notable advantages. They provide cross�??border coverage (Spain + country of origin), flexible guarantees depending on needs, and real freedom in choosing health care providers/facilities. Such contracts are suitable both for permanent settlement, as well as for owners of second homes who divide their time between countries, or hybrid profiles like digital nomads or people without formal activity. An expatriate mutual insurance gives access to private Spanish clinics, known for their quality and responsiveness, while ensuring reimbursement of routine medical expenses, hospitalisations or optics and dental, at the rates applied; often higher than those in France.

Given the potential cost of care and significant out�??of�??pocket expenses, planning an appropriate health coverage for Spain is never superfluous. Proper anticipation and the right choice of coverage allow you to live your experience in place without risking medical or financial hardship. Health should never be a variable to adjust in an emigration or travel project, even within another European country.