If you’re paying for private health insurance in Spain, you might assume it gets you in everywhere. But that’s not quite how it works—especially when it comes to public hospitals.
So let’s clear it up.
Public and Private: Two Parallel Systems
Spain has two healthcare tracks:
- The public system (Seguridad Social), funded by taxes and free at point of care for residents and workers.
- The private system, used by those with private insurance or who choose to pay out-of-pocket.
These systems don’t always talk to each other. And unless you have a special type of policy, your private insurance won’t automatically get you into a public hospital.
The Short Answer
No, most standard private health insurance policies do not cover treatment in public hospitals.
If you show up to a public A&E and you’re not in the public system (i.e. contributing to Spanish social security), you’ll likely need to pay out-of-pocket.
Emergency care won’t be denied, but the bill might come later—and private insurers generally won’t reimburse it.
When Can You Use Public Hospitals with Private Insurance?
There are only a few specific cases where your private health insurance may interact with the public system:
- Coordinated Plans (Very Rare)
A handful of advanced (and usually corporate) plans may have reimbursement agreements with the public network. These are niche and not common for expats. - Public System Access Separately
If you’re working and contributing to social security, you can use the public system anyway—independently of your private insurance. Your private plan then becomes a top-up or alternative, not a passport into public hospitals. - Emergencies and Tourist Scenarios
If it’s an urgent life-threatening emergency, you’ll be treated regardless of insurance—but again, unless you’re in the public system, you’ll get a bill. Some private insurers offer reimbursement-only for emergency public hospital stays, but only after documentation and approval, and not all policies do. Always read the fine print.
Why It Matters for Expats and Visa Holders
Many expats in Spain—especially retirees, freelancers, or those on non-lucrative visas—aren’t automatically in the public system. That means your private insurance needs to be robust, since you can’t fall back on state care.
When applying for a Spanish visa, the required private insurance must be without copays and with full coverage in Spain—but this still doesn’t mean you can stroll into a public hospital and use it. It only guarantees private coverage.
So Where Can You Go with Private Insurance?
Your insurer will provide a network of affiliated clinics and private hospitals (called a cuadro médico). You can only use these unless your policy has reimbursement flexibility, which usually costs more.
If you go off-network—especially into the public system—you’ll either:
- Pay full cost out of pocket
- Submit a claim (with no guarantee of reimbursement)
- Or find yourself rejected for non-covered services
Final Thought
A lot of people move to Spain assuming healthcare is just… there. And it is—if you’re in the system. But private insurance is its own lane. If you’re relying on it, stick to private hospitals and clinics, and know where your nearest one is.
Public hospitals? Great reputation, but not where your private card gets you in.