Let’s be honest. Buying PHI in Spain is usually straightforward… until you mention a medical condition. Diabetes? Heart issue? Even something mild like high cholesterol? Suddenly, the insurer who just said “¡Bienvenidos!” changes their tune.
So can you still get covered? And what are your actual options?
Do Spanish Private Insurers Accept Pre‑Existing Conditions?
Short answer: most don’t, at least not without caveats.
Most insurers require a health questionnaire during the application process. If you disclose a pre-existing condition, they’ll usually:
- Exclude that condition from coverage
- Raise your premium
- Or reject your application entirely
It depends on your age, condition severity, and the insurer’s risk appetite.
And if it’s one that slipped your mind that happened 40 years ago? They find out, they will deny cover and likely cancel your policy. This happened to us in 2025.
Commonly Excluded Conditions
Here are some of the most frequently flagged conditions in Spain:
- Type 1 or uncontrolled Type 2 diabetes
- Past cancer (especially within the last 5 years)
- Chronic heart conditions or history of stroke
- COPD, asthma requiring steroids
- Mental health diagnoses (bipolar, schizophrenia)
- Autoimmune disorders (lupus, Crohn’s, MS)
- Ongoing back pain or joint disease
Even mild or well-managed issues like hypothyroidism or high blood pressure may trigger exclusions or follow-ups. Or higher premiums.
Are There Insurers That Cover Pre-Existing Conditions?
Yes, but they’re few, and the terms vary.
- ASISA: One of the largest Spanish insurers. Some of their policies may allow certain pre-existing conditions if stable for several years, though exclusions still apply. Applications are handled on a case-by-case basis, especially for applicants over 65.
- Bupa Global: An international option that may cover long-standing, stable conditions, at a premium.
- Broker-only underwritten policies: Some specialist brokers work directly with underwriters to build customised quotes, particularly for older clients with/or complex histories.
But if you’re applying for a Spanish visa, watch out, any exclusions or co-payments will likely disqualify the policy.
See this guide to visa-compliant health insurance in Spain
If You’re Already a Resident: Consider the Convenio Especial
If you’re already living in Spain (with residency status) and have been here for over 12 months, the Convenio Especial could be a game-changer.
- No exclusions for pre-existing conditions
- No age limit
- Covers GP visits, specialist care, emergencies, and hospitalisation
- Costs around €157/month for over 65s
It’s a public system buy-in, not private insurance, so it’s not valid for visa applications. But it can be a strong option for long-term residents (ie after resisency) who’ve been declined elsewhere.
Also see: What health insurance is available for over 75s in Spain
Visa Applications: The Big Catch
If you’re applying for a Non-Lucrative Visa or Digital Nomad Visa, your policy must be:
- Comprehensive (no exclusions or co-pays)
- Without waiting periods
- From a Spanish provider licensed to operate nationally
This makes applying with pre-existing conditions extremely difficult. Most standard Spanish insurers won’t issue a visa-compliant policy if there’s any declared risk.
In some cases, underwriters may approve with a higher premium and no exclusions, but this usually requires direct negotiation via a broker, not a comparison site. It needs to be tailored.
What to Ask Before You Apply
Whether you’re buying online or through a broker, always ask:
- Will my condition be covered?
- Will it be excluded or surcharged?
- Are there any related medication restrictions? At all?
- Will you issue documentation clearly stating no exclusions (for visa purposes)? Really important.
If they’re vague walk away. If it’s not in writing, it won’t be in your policy.
Still Unsure?
If you’ve been turned down, excluded, or priced out, you’re not alone. Spain’s system isn’t very forgiving when it comes to health histories, especially after age 60.
But there are paths forward.
- Already in Spain? Read more about the Convenio Especial
- Applying for a visa? Check your options for visa-compliant insurance
- Over 75? Explore what health insurance is available in Spain for seniors
It’s not always easy, but it’s usually not impossible either, especially if you work with someone who understands this niche like a reputable broker.