Thinking about moving to Spain—or already here—and want reliable access to the public healthcare system? Two common routes for non-insured residents are the Convenio Especial (a paid affiliation to Spain’s public system) and private health insurance. Here’s a clear, up-to-date comparison so you can pick the option that really works for your life, visa, and budget.
What is the Convenio Especial?
The Convenio Especial is a special agreement on healthcare provision that lets residents who aren’t otherwise entitled to public healthcare (not employed, not self-employed, no S1 or exportable rights) join the Spanish National Health System (SNS) by paying a monthly fee. Coverage is provided by your regional health service and grants you a public health card (tarjeta sanitaria) for care across Spain; for temporary travel within the EU/EEA/UK/Switzerland you can request a Provisional Replacement Certificate from the INSS.
Legal basis: Real Decreto 576/2013 sets national requirements; each region implements the process.
Who can apply?
Typically, legal residents who:
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Don’t qualify as insured/beneficiaries through work, exported rights, or mutualities.
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Reside effectively in Spain and can document their address/registration (regional details vary).
Practical note: This route is often used by non-EU residents on visas like the Non-Lucrative Visa who lack employment-based coverage.
Cost (2025)
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€60/month if you’re under 65
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€157/month if you’re 65 or over
These amounts are widely standardized across regions (some add admin nuances).
What the Convenio Especial Covers (and Doesn’t)
Coverage: Primary care, specialists, hospital care, surgeries, emergencies—the public network. Care is delivered within your regional health service and, when you travel within Spain, you’re attended in other regions’ public facilities. For short EU trips, you can request a temporary certificate (CPS) from INSS.
Common exclusions: Public system rules apply (e.g., co-payments for some prescriptions; dental is generally limited). Exact details are governed by the basic SNS portfolio and regional policies. Outpatient pharmaceutical services, outpatient orthopaedic services, dietary products and non-urgent medical transport are 100% paid for by the patient.
Private Health Insurance at a Glance
When it’s usually needed: Many visa/residency processes (e.g., student or non-lucrative visas) require private insurance with no copays, full Spain-wide coverage, and hospitalization. It’s immediate to contract and widely accepted by consulates.
Pros:
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Fast onboarding, broad national provider networks, often multilingual customer support.
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Add-ons (dental, travel, second opinions).
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Useful while you wait to become eligible for public care (or if you prefer shorter waiting lists).
Cons:
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Premiums rise with age and health profile; pre-existing conditions may be excluded or require waiting periods (policy-dependent).
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Not the public system; if your long-term goal is integration into the SNS, private insurance doesn’t itself grant a public health card.
Convenio Especial vs Private Insurance: Quick Decision Guide
Choose Convenio Especial if you:
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Are legally resident but not covered through work, S1, or mutualities.
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Want long-term public system access with predictable fees (€60/€157).
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Prefer your local centro de salud and public hospitals.
Choose Private Insurance if you:
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Need visa-compliant coverage now (often “sin copagos” + hospitalization).
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Prefer faster access to certain specialists or English-speaking networks.
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Want optional extras (dental, travel, international second opinions).
Hybrid strategy (common for new arrivals): Start with private insurance to satisfy visa/consulate requirements or to bridge waiting periods, then transition to Convenio Especial once eligible as a resident without other entitlements. (Expats commonly follow this path.)
Hospitals & Language
With the Convenio Especial, you use public hospitals/clinics of your region (and other regions during travel within Spain). Language availability varies by area; large cities and tourist regions tend to offer better English support.
Private insurers typically list English-speaking providers in major cities and coastal areas; check each insurer’s network directory before you buy.
Flexibility & Travel
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Within Spain (SNS): Your public card works across regions for necessary care; routine coordination happens through your home region.
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EU/EEA/UK/CH trips: Ask INSS for a Provisional Replacement Certificate covering necessary care during short stays.
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Private insurance: Check your policy’s travel clauses; many include emergency cover abroad or optional riders.
Step-by-Step: How to Apply for the Convenio Especial
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Confirm you’re not entitled to public healthcare via other means (employment, S1, mutualities). If you are entitled, request recognition through INSS/Sede Electrónica; if not, proceed to the Convenio.
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Prepare documents required by your regional health service (ID/NIE, proof of legal residence and effective residence such as padrón, etc.). Requirements vary by region (e.g., Valencia’s Conselleria de Sanitat page).
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File the application and set up payment of the monthly fee (€60 / €157). Regional portals (e.g., Madrid, Aragón) publish process and fees.
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Receive your public health card and primary-care assignment; then you can book appointments like any other SNS patient.
For a friendly expat-oriented walkthrough (including common scenarios like NLV retirees), see this guide.
Common Questions
Does the Convenio cover prescriptions?
You access public prescriptions, but co-payments apply per public rules; level depends on region/income/age.
Can I use the Convenio if I’m over 65?
Yes—the fee is €157/month.
What if I later become employed/autónomo?
Then you’d become entitled as an insured person through Social Security, and the Convenio would no longer be necessary.
Need tailored advice or someone to manage it end-to-end?
At Tax&Law Spain, we help you choose the best route and can handle the full Convenio Especial process for you—from checking eligibility to getting your certificado digital, submitting the application, and setting up SEPA so payments run smoothly. We also advise on private insurance for visa purposes and transitions to the public system later on.
Let’s talk:
Email: erica@taxandlawspain.com · Phone/WhatsApp: +49 1520 8381499 · Web: taxandlawspain.com
