One of the main concerns for anyone coming to live in another country must be ‘how will I obtain the healthcare I need?’. This is particularly the case where you are perhaps a little older in years and know that more, rather than less, health care is on the horizon.
The situation has been precarious for those moving to Spain as their country of choice. State health care in Spain is generally considered to be good. It deserves this reputation and most people who have had direct experience of it speak highly of the care they have received.
However, it comes at a cost. Like many countries, Spain has become concerned that the Spanish health service is being taken for granted. Amid fears of ‘health tourism’ it was announced in August 2012 that foreigners in Spain without residency or work permits would no longer receive free Spanish health care. This would exclude children and pregnant women and emergency services would still be free.
At the same time residency became more difficult to obtain. Not only did you need the necessary passport and NIE documentation but to prove that you would have some form of health care when you arrived in Spain.
Regional governments protested and organisations such as ‘Yo Si Sanidad Universal’ have grown to advise those no longer eligible. It’s claimed that the new, more restrictive approach, is saving money and clarifies the situation for everyone. But what could you do if you weren’t eligible?
The state insurance scheme
To compensate a little for the crackdown it was announced that there would be a state-run insurance scheme (convenio especial) that would be available to everyone, at a price.
This national scheme would require a monthly subscription in order to guarantee access to the Spanish health service. It would not, however, cover the cost of medicine or health transport services.
The scheme is managed by each autonomous region and accepts people with pre-existing conditions. The basic monthly fee is 60€ for those under 65 and 157€ for those aged 65 and over. Of course, most people aged over 65 will be in receipt of a state pension and so entitled to state health care anyway.
El País reports that only 300 people have taken out the insurance so far. This was particularly surprising as something similar had already been operating in the Valencian region with a good degree of success.
Perhaps its lack of success could partly be attributed to the fact that many expats discovered that they were already eligible for state health care in Spain, without knowing it.
Resident before 2012
Although the requirements for healthcare were tightening up for some, they were relaxing for others.
Those early retirees resident in Spain before 2012 discovered that they could access Spanish national healthcare for free provided:
· they didn’t have an income of more than €100,000 annually
· they could produce a letter to indicate they weren’t eligible for health care elsewhere
There must have been mixed feelings for those who were already paying into private health insurance or the Valencian health insurance scheme.
Resident after 2012
So, what health care can you access if you are considering moving to Spain and will not be eligible through employment?
If you are receiving a state pension or are on long term sickness benefit, then you are entitled to health care and should obtain an S1 form (previously E121) from the international Pension Centre on 0044 191 218 7777. Once it has been issued you should register the S1 form with your local INSS office.
There are two alternatives:
Option 1 – you can take out private health insurance.
Option 2 – the convenio especial - state-run insurance scheme
For those people with a pre-existing condition, the convenio especial may be the only option in the future. The residual S1 (formerly residual E 106) previously provided temporary healthcare for early retirees. From July 2014, its issue has been withdrawn by the UK government.
It is a little ironic that the very measures that were taken to restrict health care access in Spain actually opened the door for many expats who had thought themselves ineligible. An outcome that those devising this policy had probably not foreseen.
If you were registered as a resident in Spain prior to 24th April 2012 and have an annual income less than €100,000 then you should speak to your local INSS office to register for healthcare in Spain as a resident.
El Pais in English: http://elpais.com/elpais/2014/04/28/inenglish/1398692445_765520.html?rel=rosEP
Gov.uk – Healthcare in Spain
NHS choices – Update – residual S1 forms for early retirees: