US citizen getting Health Insurance and Healthcare in Spain

Payment section                     (Home / Travel / Moving to Spain / Healthcare in Spain)
Care section
Nursing home / residencial long-term care section
Health-care directive section
Miscellaneous section
 




Ways to pay: national system, or private insurance, or cash.
Get care at: state providers, or private providers.





Payment





I believe there are prescription discounts for low-income people, and they are applied to citizens and residents alike, and some are same for NHS or non-NHS. Sanitas's "Co-Payment Prescription Charges In Spain"
ExpatFocus's "Spain - Prescriptions and Medications"
Richelle de Wit's "What Percentage Should I Pay For Prescription Medicines Through NHS"
But "Update June 2018: The new PSOE government has announced the cancellation of the co payments for prescription meds, but not specified a specific date when this will come into effect. Financing has to be found from other sources first."
from Richelle de Wit's "Co-Payment Prescription Meds - Maximum"









Care



A little confusing; a facility can be:





Nursing home / residencial long-term care / Retirement Home / care home / hospice



General question: Is there a standard name for these nursing homes or care homes or whatever, in Spain ? What is the official term ? Maybe "residencia de ancianos" ? "Residencia para personas mayores" ? "Residencia para geriatricas" ?

One related term is "Ley de Dependencia". For web pages for the state-run programs, the key word to search for is "dependencia".

It seems the state doesn't own any nursing/residence homes; they're all privately-owned. But some accept both private and public patients, others private only.



ExpatFocus's "Spain - Elderly Care"
Sarah Coles' "Care homes abroad: your options and the cost in Spain, Portugal, France and Australia"
The Telegraph's "Retiring to Spain: what you should know about health care"



From ExpatFocus's "Spain - Elderly Care":
Care homes that are already in existence can normally cater for relatively large numbers of people, with some having facilities for more than 100. These usually offer single rooms to residents, with communal lounges and dining rooms. However, waiting lists are often long due to the demand. It is estimated that there is less than half the recommended amount of care home places that are needed to cope with the aging population in Spain.

...

Those who are prepared to wait for a place at a state-funded care home will need to pay the equivalent of 80% of their pension to cover the costs. Private residential care can be anything from €1700 to €3500 each month per person. These fees are out of the reach of most Spanish elderly as the average monthly pension is in the region of €700. Spanish nationals are often given priority for places at state run establishments.



Public assistance:
Lares CV's "Ley de Dependencia: ¿como se inicia la solicitud?"
Ayuntament de Barcelona's "Servicios Sociales de Atencion en la Dependencia"
Generalitat de Catalunya's "Reconocimiento de la situacion de dependencia"

IMSERSO (Instituto de Mayores y Servicios Sociales) and SAAD (El Sistema para la Autonoma y Atencion a la Dependencia)
Wikipedia's "Ley de dependencia"

My wife, who is a family doctor in Barcelona, says the usual process for public help is:
  1. The person gets to the point where they can no longer do some tasks of daily life (cooking, walking, bathing, whatever), and they have no family or the family has reached the limit of helping them.

  2. The person goes to their family doctor, who evaluates and writes up a list of their maladies.

  3. The person takes/sends the list to a social worker.

  4. The social worker does a home visit and evaluation.

  5. The social worker sends recommendations to ??? or starts the person on home care or some other program.


Richelle de Wit's "How to Apply for Home Help for the Elderly and Disabled"



Questions about public patients in residence homes, relevant to my family:

Some responses from people:
Each region or district tends to have different requirements.
You can get moved up the waiting list for health reasons.
Usually you have to be at least 65 years old.
Not everyone (with a pension) pays the same; it depends on several things and the residents have the right to retain a small part (20% ?) of their pension for living expenses.
Another response:
Variable by Region. I'm a UK qualified social worker in Alicante/Murcia. All statutory services start with social work assessment which at the moment is around 18 to 24 months waiting time for assessment. Services are means-tested with most services being excluded if you have more than 800 euros income. All Care homes are private provision with reduced cost if you are responsible of region. Murcia/Alicante/Valencia have social services web pages [ Murcia, Alicante, Valencia ].

Also see "Caring Costa Blanca" Facebook group

6/2018: My wife, who is a family doctor in Barcelona, says the wait for a woman who wants to move into a residence home as a public-paid patient in Barcelona is 5 years.

6/2018: I looked up (on Consorci de Serveis Socials de Barcelona's "Persones amb Dependencia i Gent gran") the residence home right next to our apartment building in Barcelona. They have 88 public residents, 0 private residents, and a waiting-list of 422.



Private facilities:

Domus Vi
Ballesol
Orpea Residencias (they acquired Sanyres)
Casaverde
Angels Nursing Group
Residencia Rojales (in Alicante)

SmartExpat's "Retirement Care in Andalusia"
Plusesmas's "Residencias de ancianos"

Pensium's "Precios de las residencias de tercera edad en España"





Health-care directive



Called Documento de Voluntades Anticipadas (DVA), or (maybe in Andalucia only) La Declaracion de Voluntad Vital Anticipada.

Local health center in Andalucia doesn't have any info or forms about this. Have to go to central administration ?

Your document might have to be notarized, and registered with the govt ? Not sure if this is done on a provincial, regional or national basis.

Notaria F. Javier Ramos's "Guia Practica Documento de Voluntades Anticipadas" (PDF)
Alzheimer Europe's "Advance directives" (PDF) 5/2005
AECC's "Voluntades Anticipadas"
Andalucia's "A Guide to Making an Advance Health Care Directive" (PDF) 2013
Andalucia's "Registro de Voluntades Vitales Anticipadas"





Miscellaneous





justlanded!BCN's "Healthcare in Spain"
Spanish Visa's "Get Private Medical Insurance in Spain"
Jose Marc Castro's "Retiring to Spain"
Expats in Spain's "Health Care in Spain" (PDF)
NIE Barcelona's "Health Insurance"
Myra Cecilia Azzopardi's "Free Healthcare The Facts"
Seguridad Social's "Medical Assistance"


From Practical Spain's "Health Care, Hospital, Emergencies, Prescriptions":
It is sensible to have a resume of your medical history translated into Spanish, in particular detailing any specific illnesses, drugs required, or allergies. It is most sensible to have the basic bilingual details in writing always carried with you.

Practical Spain's "Bilingual SOS Form"

...

When going to see a doctor, take a medical phrase-book with you or write out the paragraph that describes your problem before you see your doctor.
My suggestions:
Write everything down ahead of time, run it through Google Translate, print it out, maybe show it to some Spanish friends to make sure it's right. Symptoms, questions, your medical history, allergies, medications, etc. Print English next to Spanish for each sentence. Print it all out and take it with you.

If at the end of the appointment they're giving you some instructions you don't understand, get them to write it down in Spanish, so you can take that home and translate it there.

Tell the Doctor booklet (€6.50)

Expats in Spain's "Emergencies,Crisis Lines and Medical Help" (PDF) (emergency numbers and a few medical terms)
"Spain Emergency Phone Numbers" image

There are translators and interpreters who specialize in medical documents and hospital visits. Probably expensive.

Spanish pharmacies will not accept a prescription from another country.

There are price and service differences among pharmacies; shop around.

Site that shows which medicines are allowed under the NHS: Bot Plus (log in as "INVITADO")

Surprisingly, the NHS here is not really "national", in that each autonomous community has a separate computer system, and they don't connect to each other. So if you move from one community to another, request a copy of your medical records and take them with you.

In Andalucia at least, if you don't keep your padron "renewed" (every 2 years ?), the health service may "annul" your health card, and you'd have to go update the padron and then get the health card reinstated.

Surgery service: Operarme.es

Hearing aids:
Hear-it's "Information about hearing loss and hearing aids in Spain"
t-oigo (for children only ?)
Otoclinic Foundation

Medicare:

Medicare, with a few exceptions, does not cover expenses outside the USA. And if you stop paying for Medicare part B while outside USA, and later go back to USA and resume Medicare part B, your premiums will be higher because of the gap.

From someone on "Expats in Spain" Facebook group:
I am a contract analyst for the largest medical insurance company in the US. What I might suggest is at the very least getting a Medicare Advantage plan rather than straight Medicare when you retire. Medicare does not cover out of the country, but many of the Advantage plans will cover for any kind of emergency while you are out of the US. You do not want to give up or waive your Medicare benefits (even though they cost you) because if you come back to the US there are large penalties and a waiting period to get Medicare started for you. The penalties get bigger and bigger every year for Medicare.

... I have noticed that when retirees get a lot older and need added care, they move back to the US, and then Medicare gives them a ton of trouble trying to get their benefits back.

I'm told USA medicare online system will not let you log in from an IP address outside of the USA; use a VPN.

Elder Law's "Getting Medicare While Traveling or Living Overseas"

Surviving Yucatan's "ACA - Obamacare's Effects on American Expats Living Abroad"
Go Curry Cracker's "Obamacare, Expats, and Limitations on Visits Home"

Americans of a certain age may want to get a measles vaccination before coming to Europe:
Meredith Wadman's "Traveling Abroad? Born Before 1989? You May Need a New Measles Vaccination."
In Spain, even though I'm in the NHS, the local Centro Salud refused to do it for me, saying they do it only for babies. So I went to the regional Vaccination Center for International Travelers, and they prescribed it. But then my local health center wouldn't supply ANY vaccinations for me, even a tetanus booster. They WILL inject a vaccine you buy at a pharmacy, but the nearest pharmacy had almost none of the vaccines I wanted, not even a tetanus booster. Eventually found the "Medical Prevention" department at a regional govt hospital that was willing to vaccinate me for free.



From Dave Barry's "Only Travel Guide You'll Ever Need":
Medical care in Europe is excellent, and you may rest assured that if God forbid anything were to happen to you, the hospital personnel will use only the highest-quality stainless-steel drill to bore a hole in your skull to let out the Evil Spirits.

Ha ha ! We are just joshing, of course. There is really nothing at all primitive about European medical care except that in some countries they practice it in foreign languages, meaning you run the risk of entering the hospital complaining of an inflamed appendix and coming out as a member of a completely different gender. That is why many smart travelers take the precaution of having the international symbol for "No Sex-Change Operation, Thank You" tattooed on or near their private parts. ...







This page updated: November 2018.



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