Healthcare and Health Insurance for UK Citizens in Spain

Which route applies to you

Being British does not decide your healthcare in Spain. What you do and when you arrived does. Most people fall into one of these groups:

The rest of this page goes through each in turn.

The S1 for UK State Pensioners

If you live in Spain and receive a UK State Pension, the UK may remain responsible for your healthcare. The S1 is the form that transfers that responsibility so you can use the Spanish public system as a Spanish pensioner would (GOV.UK).

Who qualifies, according to the NHS:

• UK State Pensioners and their dependants who are lawfully resident in Spain.
• People receiving contribution-based Employment and Support Allowance, Maternity Allowance, or Widow's Benefit/Widowed Parent's Allowance.
• Posted workers, frontier workers and UK civil servants (through HMRC).
• Not people who also receive a state pension from Spain: Spain then becomes responsible. If you have paid into several countries' systems, the one where you paid longest is generally responsible.

How to get and register it:

1. Phone NHS Overseas Healthcare Services on +44 (0)191 218 1999 (Monday to Friday 8am to 6pm, Saturday 9am to 3pm) to request the application form. The Spanish Labour Ministry's UK office advises doing this at least 28 days before you move (Ministerio de Trabajo).
2. Once you arrive, register as a resident and on the padrón (municipal register) at your town hall, which GOV.UK lists as required steps (GOV.UK: Living in Spain).
3. Register the S1 at your local INSS office or through the INSS online portal.
4. The INSS posts you a Spanish social security number. Take it to your local centro de salud (health centre) to get your health card.

Our step-by-step guide to registering an S1 and the S1 checklist cover the documents in more detail.

A dependant covered on a pensioner's S1 loses that cover once they start claiming their own UK State Pension; a new S1 is then issued in their own name and must be registered again.

Timing and the State Pension age rise

The UK State Pension age is rising from 66 to 67 between April 2026 and April 2028, affecting people born from 6 April 1960 to 5 March 1961; those born from 6 March 1961 qualify at 67 (Which?). If you plan your move around the date you will qualify for an S1, check your exact State Pension date first, because it may now be a few months later than you expected.

What the GHIC does and does not do

The UK Global Health Insurance Card (GHIC) is free and valid for up to five years. It covers medically necessary state healthcare, including emergency treatment, ongoing treatment for existing conditions and routine maternity care, on the same terms as a local resident (NHS).

It does not cover:

• private clinics or hospitals;
• medical repatriation to the UK;
• mountain or ski rescue;
• co-payments a local resident would pay, such as part of the cost of prescriptions.

GOV.UK describes the GHIC as a card for temporary stays and "not a substitute" for registering in Spain. If you move to Spain, it is not your healthcare route and it will not satisfy a residence or visa application. S1 holders living in Spain can get a UK-issued GHIC for trips to other EU countries, and those who have lived in the EU since before 1 January 2021 on an S1 may be eligible for a UK EHIC instead. See EHIC, GHIC and residence healthcare for the detail.

If you lived in Spain before 1 January 2021

UK nationals legally resident in Spain before the end of the Brexit transition period are covered by the Withdrawal Agreement. The TIE (Tarjeta de Identidad de Extranjero) is the only residency document listed for this group (GOV.UK: Living in Spain).

Healthcare points for this group:

• If you already had an S1 based on Disability Living Allowance, PIP, Carer's Allowance or Attendance Allowance before 1 January 2021, you keep that entitlement while you keep receiving the benefit. These benefits no longer create S1 entitlement for people who did not already hold one (NHS).
• After five or more years of residence you can apply for permanent residency, which gives access to state healthcare like a Spanish citizen. You will need a "legislation letter" confirming the UK is not responsible for your healthcare (GOV.UK).

If you moved after Brexit

UK citizens arriving since 2021 are third-country nationals for immigration purposes. GOV.UK states that you must show proof of healthcare cover when applying for a visa or registering as a resident, usually through work contributions, private insurance or the convenio especial.

For the non-lucrative visa (NLV), Real Decreto 1155/2024 requires public or private health insurance with an insurer authorised to operate in Spain (Ministerio de Inclusión). The Spanish consulate in London adds that the policy "must cover all the risks insured by Spain's public health system", and that "a receipt of registration of S1 form on the web of Social Security is also accepted" (Consulate in London). So a UK State Pensioner with an S1 may not need a private policy for the visa at all.

If you are not yet drawing a State Pension, you will need a private policy from an insurer authorised to operate in Spain. London's page does not mention co-payments, but a policy without co-payments (sin copago) meets every consulate's version of the rule. You also need income of 400% of IPREM, which at €600 a month in 2026 means €2,400 a month for the main applicant (OCU). Our NLV health insurance guide covers what the policy must include. When you're ready, here's how to get comparable quotes, direct from insurers or through a registered broker.

If you work in Spain

Employment or self-employment registered with Spanish Social Security gives you and your registered dependants access to the Spanish public system. You still need to register with your regional health service to get a health card. See public healthcare for workers and autónomos.

UK employees sent to Spain temporarily can stay in the UK system as posted (detached) workers. HMRC's National Insurance enquiries line confirms whether you qualify and issues the paperwork.

The convenio especial

The convenio especial is a pay-in scheme for the Spanish public health system for residents with no other public entitlement. Under Real Decreto 576/2013 you need one continuous year of residence and a current padrón registration, and you pay €60 a month under 65 or €157 from 65 (Ministerio de Sanidad; BOE).

Two limits for UK citizens: you cannot join if the UK already pays for your healthcare through an S1, and you pay the full cost of outpatient prescriptions, orthopaedic products and non-urgent transport. Full detail is on our convenio especial page.

By comparison, residents in the public system pay between 10% and 60% of prescription costs, depending on income and whether they are a pensioner, under the bands in force since 14 May 2026 (see prescriptions and pharmacy costs).

Using the NHS once you live in Spain

The NHS is residence-based, so moving abroad permanently can mean you lose free NHS treatment in the UK. If the NHS funds your Spanish healthcare through an S1 and you later return to live in the UK, contact NHS Overseas Healthcare Services to cancel the S1 (GOV.UK: Living in Spain).