The two systems, in one paragraph
Spain runs a public system (Sanidad, funded through social security) and a large private sector that runs alongside it. Most residents end up using both: public for anything serious (surgery, oncology, A&E), private for speed on GP visits, specialists and diagnostics. If you work and pay into social security — as an employee or as autónomo — public healthcare is included. If you don't yet, you'll need private insurance to get residency and to get seen quickly.
Who gets public healthcare
- Employees on a Spanish contract — automatic through social security.
- Autónomos paying the monthly cuota — automatic, from day one of registration.
- Registered unemployed after having contributed — usually covered.
- Non-EU residents on non-lucrative or digital nomad visas — usually NOT covered initially; you'll need private cover, then can switch or add public once you're in the system.
- EU citizens short-term — EHIC covers emergencies; register locally for full access.
- Convenio Especial — a paid opt-in to the public system (~€60–160/month) after 1 year of padrón, if you're not otherwise covered.
Private insurance: what most expats actually buy
For visa purposes (non-lucrative, digital nomad), you need a policy with no copays, no waiting periods and full coverage in Spain. The four names you'll see everywhere: Sanitas, Adeslas, DKV, Asisa. Expect roughly €50–110/month for a healthy 30-something, more with age. Cheaper 'seguro de salud básico' policies (~€30) exist but usually don't meet visa requirements.
- Sanitas — biggest English-speaking network, easy app, slightly pricier.
- Adeslas — largest overall network, best value if you want lots of specialists.
- DKV — good app, strong in mental health add-ons.
- Asisa — cheaper, smaller network, fine for basics.
Your first month: what to actually do
- Get your NIE / TIE and empadronamiento first — nothing else works without them.
- If working: your employer registers you with Seguridad Social; ask for your número de afiliación.
- Book an appointment at your local centro de salud to get assigned a GP (médico de cabecera) and receive your tarjeta sanitaria.
- If not working: buy private insurance that matches visa requirements before you need it.
- Download your regional health app (in Madrid: Tarjeta Sanitaria Virtual / Cita Sanitaria Madrid) — this is how you book everything.
Prescriptions, pharmacies and out-of-pocket costs
Pharmacies (farmacias, green cross) are everywhere and staffed by actual pharmacists who'll sort minor stuff without a GP. Prescriptions on the public system are heavily subsidised (typically 40–60% off, less for pensioners). Antibiotics require a prescription; contraception, allergy meds and most standard things are cheap over-the-counter. A private GP visit is €40–80; a specialist €70–150 if you pay cash.