Health Care for Expats in Spain – ‘Convenio Especial’
Brexit continues to create anxiety for many expats planning to move to Spain and other European countries. One of the regular issues that people write to me about is health care, and particularly for those under state retirement age. Although I don't have any more information about what will happen to health care in Spain after Brexit, I am concerned that many expats moving to Spain are being coerced into purchasing private health insurance when there really is no need.
It is not unreasonable for Spain to ensure that newly arrived expats have the means to support themselves when living in the country, and this requirement includes health care. Indeed, evidence of a health insurance policy, as well as a number of other criteria are now sensibly required before newly arrived expats are given residential status. However, it appears that many banks are now using this requirement as an opportunity to sell expensive health cover to their clients, instead of advising them of the cheaper alternatives that are available. Expat websites, magazines, estate agents, lawyers and other information sources for expats are also guilty of pushing private health insurance, simply because they receive a hefty commission for each sign up. Even some furniture stores, that are popular with expats, are now interrogating their customers about their health care provision.
Whilst I have nothing against private health insurance, apart from clarity about premium increases and cover, as we get older, it is not the best option for everyone, and certainly not for those with existing medical conditions. My preference is to go with Spain's National Health Service that is, in most cases, excellent. On occasions, when we have required a second opinion or prompt, non-emergency treatment, I have to admit to using a private hospital, but that is always a second choice. I do, however, object to expats being coerced into a situation when they are led to believe that private health insurance is their only way of settling in the country.
As many readers will already be aware, despite various assurances, gifts and special offers when they take out a new health insurance policy, matters quickly change a few years later as they become older, and premiums are suddenly increased. In most cases, insurance companies know that we will pay up and shut up, simply because the older we get the more difficult it is to transfer to another, and possibly cheaper company. Some of the most worrying correspondence that I have received recently from expats relates to older expats who have found themselves priced out of the Spanish private insurance market as they reach the age of 70.
There is an alternative, and that is to purchase health cover from the Spanish health service. In most cases, following the age of retirement, most British expats of pension age will be entitled to free health cover anyway, so this issue will not be of concern to them. However, if you have retired early or do not qualify in the usual way, the following information may be useful.
Spanish regional health authorities offer a pay-in scheme for health care services. This is called ‘Convenio Especial’ and should be available from a local social security office. This is a public health care insurance scheme that is available throughout Spain to enable expats to access state-run health care. The scheme is managed by each autonomous region, so there may be some variations between them.
Most importantly, and unlike private health insurance, the scheme is offered regardless of pre-existing conditions. Children are already protected under Spanish law, as are pregnant women, and so there is no need to take out Convenio Especial for them, as they are entitled to free health care anyway. As far as I am aware, the only downsides are that if you wish to travel out of Spain, you do not have the right to claim a European Health card, and would need to take out private travel insurance for the period that you are away from home. In addition, expats are responsible for the full cost of prescriptions under this scheme. Do also be aware that patients are expected to have sufficient understanding of Spanish, since unlike most private hospitals, interpreters are not provided and it is a matter of luck whether or not your doctor or consultant speaks English.
Under the Convenio Especial scheme, expats pay a monthly fee of 60 euros per month for the under 65s, and 157 euros for those aged 65 and above, which compares very favourably with premiums charged by most private health insurance companies (not including special offers, or premiums merely designed to tempt you into signing up).
Some argue that those who can afford private health treatment should do so, since it puts less strain upon the National Health Service. Despite this, it is important for expats to have genuine and transparent choices when it comes to deciding upon important issues, such as health care. Much will depend upon affordability, but from my own limited research and contact with expats, it appears that many new expats are left unaware of Spain’s NHS options that are available to them, and are instead being needlessly driven into the potentially exploitative arms of private health insurance companies.
© Barrie Mahoney
How Do I Purchase the 'Convenio Especial'?
This scheme is managed by each autonomous region of Spain, so application rules may vary from region to region. In most cases, applications may be made at your local Social Security Office. Before you can apply, applicants will need to be resident in Spain for at least one year and not be in receipt of any UK health cover. If you need written proof that you are not covered by the UK, request a 'Legislation Letter' from the Overseas Healthcare Team on (+44) 191 218 1999.
Several readers have told me that they have experienced difficulty in communicating their requirements to local officials, who have been less than helpful. Whether or not this is a reaction following Brexit, I suggest that unless you have reasonable Spanish, you take a fluent Spanish speaker to the office with you. Alternatively, using a gestor to help may be a reliable and good value alternative.
The scheme is currently available in the following regions; please click on the appropriate link:
Castilla y León
© Barrie Mahoney