Health Care for Expats in Spain and the Canary Islands - EHIC Card
Expats can be a strange lot! A great deal of time is often spent in selecting the right place to live, a new home, kitchen appliances and even thinking about a new job. However, I rarely find that expats give much consideration to that most important of subjects - healthcare. Indeed, along with "How do I get Brit TV?” one of the most popular questions that I am asked, often when it is too late, is "Can I get free healthcare in Spain?” Of course, the answer is a confusing yes, and … no.
When I worked as a reporter in the Costa Blanca, I remember interviewing a couple who had retired early and moved to Spain long before the statutory retirement age when the man would have been entitled to free healthcare within the Spanish health system for both he and his wife. They were unhappy that their Spanish doctor had refused them treatment and wanted the newspaper to publish a story condemning the “injustice”, as they saw it, when they were refused treatment. The couple were rather proud of the fact that they would travel back to the UK every six months to collect their 'free E111 health certificate, now replaced by the European Health Card (EHIC), which at that time would allow them to claim free emergency medical treatment in Spain. Whenever the couple visited the UK, they, mother in law and assorted family members would enjoy free NHS care in the UK, before continuing their treatment free within the Spanish health care system when they returned home.
Eventually, this state of affairs came to an abrupt end, when their Spanish doctor eventually realised what was going on and refused to treat them under the Spanish health care scheme, which was only ever intended to be reciprocal emergency cover for holidaymakers. The couple were not at all happy and after much complaining, reluctantly opted to take out rather expensive private health cover until he reached the statutory retirement age. I remember listening sympathetically to the story, but with no intention of publishing it. At a time of scarce health resources, I thought it was admirable of the doctor to spot abuse of the system, and to do something about it.
Clearly, this was simply abuse of an already overstretched system, and governments of both countries were right to put an end to it, although I am aware that some expats are still getting away with breaking the rules. In more recent years, the financial crisis faced by all countries in Europe have forced governments to reassess exactly who qualifies for free or subsidised treatment and who does not. Of course, many have fallen foul of the new rules, leaving some without any health cover at all, and often because they do not understand the newly enforced requirements.
In the case of Spain, the message is clear. If you are an expat over the statutory retirement age, you will be entitled to free healthcare, but always check your entitlement with the Department of Health in the UK before you move to Spain. If you are under the statutory retirement age and have a contract of employment, your employers will usually provide free healthcare under the Spanish system, but do check that this is the case. If neither is applicable, you have two options. The first is to purchase private health insurance. This can be expensive, dependent upon any pre-existing conditions and age. Although I have private health insurance, I would not wish to rely upon it for everything. It is reassuring to have it for emergency referrals and second opinions, but I am an admirer of both the UK and Spanish Health Services, which would always be my preferred choice in most circumstances.
If you are not entitled to free Spanish NHS cover, you can now purchase it within most of the autonomous regions of Spain. It is very good value with cover in the Canary Islands, for instance, now available for 60 euros per month. This does, however, exclude subsidised prescriptions, which have to be paid for in full, and the European Health Insurance Card (EHIC) if you wish to travel to other countries. However, as most expats quickly recognise, most generic drugs are exceptionally good value in Spain, and far cheaper than their equivalents in the UK.
In conclusion, if you are not retired, or in full time employment with a contract that includes health insurance, I recommend buying into the Spanish NHS scheme (Convenio Especial), as well as supplementing it with private insurance cover, if you can afford it. It is one of those things that may be irritating, boring and time consuming to arrange, but you will be very grateful for it should the time come to use it.
For further information about Spanish health care for expats and 'Convenio Especial', click here.