Health Insurance in Spain vs. the U.S.: Key Differences for Expats
Moving to Spain from the U.S. comes with many lifestyle changes, and one of the most significant is healthcare. In Spain, the health insurance system is substantially different to the US, with regards to accessibility, cost and coverage. Here’s what expats need to know when considering health insurance in Spain.
1. Public vs. Private Healthcare in Spain for expats
Spain: Universal Public Healthcare with Private Options
Spain has a universal public healthcare system (Sistema Nacional de Salud - SNS), funded through taxes. It provides free or low-cost healthcare for residents, including foreigners with legal status. While public healthcare is excellent, many expats opt for private health insurance in Spain for faster access to specialists and private hospitals.
U.S.: Private Insurance is Essential
Unlike Spain, the U.S. does not have universal healthcare. Most Americans rely on private insurance, often through their employer. Government-funded programs like Medicare and Medicaid exist, but they are limited to specific groups (seniors, low-income individuals, etc.). Without private insurance, medical care in the U.S. is extremely expensive.
2. Cost Comparison
Spain: Affordable Healthcare
- Public healthcare is free or requires only small co-payments.
- Private health insurance in Spain is much cheaper than in the U.S., averaging €100-€200 per month, depending on coverage and age.
U.S.: High Costs
- Private health insurance is expensive, with individual premiums averaging $500-$800 per month and family plans exceeding $1,500 per month.
- Even insured individuals face high deductibles, co-pays, and out-of-pocket expenses.
3. Coverage and Access to Healthcare in Spain
Spain: Broad Coverage with Some Waiting Times
- Public healthcare covers primary care, hospital visits, specialists, and emergency services.
- Some waiting times exist in the public system, especially for non-urgent treatments.
- Private insurance provides faster appointments and access to private hospitals.
U.S.: Limited by Insurance Type
- Coverage varies widely depending on the insurance plan. Some plans exclude essential services like mental health care, maternity, or dental.
- Out-of-network care can be extremely expensive.
- Without insurance, medical bills can lead to significant debt.
4. Pre-Existing Conditions
Spain: No Restrictions in Public Healthcare
- Public healthcare in Spain covers all conditions, including pre-existing ones.
- Some private insurers may have restrictions, but generally, coverage is more accessible than in the U.S.
U.S.: Some Restrictions Apply
- ACA-compliant plans cover pre-existing conditions, but private non-ACA plans may exclude or charge extra for them.
5. Role of Employers in Health Insurance
Spain: Optional Employer Insurance
- Employers are not required to provide private health insurance, as public healthcare is widely available.
- Some companies offer private insurance as a benefit.
U.S.: Employer-Dependent Coverage
- Most working Americans rely on employer-sponsored health insurance.
- Employees still pay a portion of the premium, deductibles, and co-pays.
6. Prescription Medication Costs
Spain: Subsidized and Affordable
- Public healthcare in Spain subsidizes most prescription drugs, with patients paying 10-50% of the cost depending on income.
- Medications are generally much cheaper than in the U.S.
U.S.: Expensive and Unsubsidized
- Drug prices are significantly higher, and insurance co-pays and deductibles affect costs.
- Many Americans struggle to afford essential medications without insurance.
7. Expats & Foreigners: What You Need to Know
Spain:
- Expats who become legal residents can access public healthcare in Spain.
- Golden Visa, Non-Lucrative Visa, and Digital Nomad Visa applicants need private health cover in Spain to meet visa requirements.
- Non-residents can also enroll in the Convenio Especial (a public healthcare pay-in scheme).
U.S.:
- Foreigners must purchase private health insurance.
- Without coverage, even basic medical treatment can be extremely expensive.
Which System is Better for Expats?
For those relocating from the U.S. to Spain, the lower healthcare costs, universal access, and high-quality medical services make Spain an excellent option. While private insurance is recommended for faster care, the public system offers comprehensive and affordable medical treatment.
At Landcross Partners, we help U.S. expats navigate health insurance options in Spain. Whether you need private coverage for visa applications or guidance on the public system, our partners are here to assist you.
