US citizen getting Health Insurance
and Healthcare in Spain
EKG chart with heart symbol



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 facility can be:

  • NHS.
  • NHS but run by a private company.
  • Private.
  • Half and half: some areas private, some NHS.





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 "Serveis Socials - Dependencia i autonomia personal"
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"



Public patients in residence homes, relevant to my family:

+/-
  • If someone is a Spanish citizen with NO pension and no savings, and they go into a residence home as a public-paid patient, do they have to pay anything ? What if their children have salaries or savings, do the children have to pay ?

  • If someone is on NHS but NOT a Spanish citizen and they have savings, and they go into a residence home as a public-paid patient, what do they have to pay ?

  • At what point can one apply to get on the waiting-list for a residence home as a public-paid patient ? Do they have to be a certain age ? Do they have to need to move in right away ? What happens if they apply now, a room becomes available, and they decide not to move in, they want to stay on the list until later ?

  • Can a couple apply together, to live in a room together ?

  • Does one apply and get on a waiting-list for a specific facility, or do you apply and get on a waiting list for anywhere in a whole city or province ?

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:






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.

5/2020 someone told me: "the system is nationwide, so no matter where you register your DVA, any doctor that could need to see this information will have access to it, in any part of the country. This is because even if each Comunidad Autonoma has their own Registry, they all end up sending this information to a Central Registry."

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 "Registro de Voluntades Vitales Anticipadas"
Catalunya's "Registro de voluntades anticipadas"





Funeral


Spanish News Today's "Understanding The Funeral Process In Spain"



Golden Leaves
Iberian
Santalucia
Avalon's "European Plans - FAQs"
Adeslas

Maybe there are 4 choices:
  • Funeral plan: big-upfront payment, but at death they handle everything.

  • Funeral insurance: covers expenses at time of death. Funeral director or crematorium staff handle arrangements.

  • Your own savings account to cover death expenses. Funeral director or crematorium staff handle arrangements.

  • Do nothing: let your family deal with it after you die.


What happens if you die with no plan, no assets, no one claims the body/ashes ? I don't want any funeral etc. But my heirs back in USA would need to get a death certificate.



Apparently cheap cardboard or wicker coffin for cremation is illegal in Spain; any coffin must be hermetically sealed.

From various people on "Expats in Spain" Facebook group:
+/-
My wife died 15 months ago. The funeral directors took care of everything. No need of a funeral plan as a cremation here is very cheap, and as I said the funeral directors took care of everything.

...

My husband died suddenly at home. The doctor telephoned the funeral directors who are based and own the crematorium local to where I live. After that it was seamless. They took care of everything there is no need for a funeral plan. The insurance companies just call the funeral directors who then take over. They spoke English asked me what I wanted and that was that. When I hear how much people pay for these funeral plans this is the reason I speak out. There is no need for them. Go to your local crematorium. They have offices there and they will answer all your questions.

...

I'm not sure that I would recommend giving 4000+ Euros to a company who promise to pay for your funeral one day in the future. Google some of these funeral companies like Avelon before you do anything. Better put your money into your own savings account. Check out local funeral directors and see what they suggest. Funerals or cremations usually take place within a couple of days of death unless a PM is needed.

...

My husband died 6 months ago went to local funeral directors they asked me what I wanted done even flowers funeral 2 days later then cremation had his ashes in a week they were really good company

...

In most areas on the Costa Blanca a funeral plan is not necessary. If the person dies in hospital the administrative staff liase directly with a funeral director. If the person dies at home unexpectedly a call to the Guardia Civil is made to confirm death and they will liaise with a funeral director. Cremation is the easiest to arrange. The crematorium staff speak most European Languages and can arrange all types of religious and humanist services including flowers, equivalent of lying in chapel of rest and urn for ashes. They arrange issue of death certificates and give advice on what needs to be done. If placing the body in a niche at a cemetery is preferred following a religious service the funeral director will arrange this. However, a niche should be reserved in advance through the local town hall. Funerals usually take place within 24 - 36 hours after death but for foreigners it is allowable to request up to 5 days delay to allow family and friends to make travel arrangements. It is easy to arrange a funeral. However, one needs to be aware that bank accounts can be frozen or partially frozen if a joint account. Ask your bank what their process is. Also investigate how death duties / taxes will be applied to the estate.

I would be stressed with or without a so-called funeral plan in this situation! The crematoriums are happy to provide quotes for their range of services so its easy to get a ballpark figure. I would prefer to keep the amount in my savings account and hand over my credit card at the time rather than have a third party profit from it. But that is my personal preference.

...

My partner died in Andalusia very suddenly, he died on the Sunday afternoon, we had no funeral plan, the morgue in the hospital phoned Collfer a local funeral in hurcal overa he was cremated on the Tuesday and his ashes and all the paperwork completed on the Wednesday, total cost €2500.

...

My condolences, I had the same and paid more, but yes just hide the money away because the bank will freeze the money as soon as you give the death certificate.

...

You can get a plan from the tanatorio itself cheaper it's basic but it's cheaper

...

Funeral plans in my experience are expensive in the long run whereas shopping around the better funeral directors is often much cheaper. Certainly a lot cheaper than UK. My wife passed away 3 years ago and the final costs were much cheaper than the original funeral plan we had cancelled earlier and had to pay a huge penalty for 'admin' costs.

...

they have crematoriums and usually a body has to be buried within 72 hours unless you pay for storage. usually the undertaker wants the cost of the funeral before the burial ...

...

My elderly neighbour passed suddenly leaving his wife behind ... they had no funeral plans ... because he died at home the ambulance took his body to the hospital to confirm his death and release his death certificate and within 4 hours his body was transferred to the crematorium. I took his wife to the crematorium who were so very helpful, we literally there and then chose the basic coffin and urn and booked the time, which was just about 24 hours later from appointment. She paid €3200 which had to be part cash part card, we attended the service the very next day and within 24 hours of his cremation to which we didn't attend we were able to return to collect his ashes. It was done very quickly but the crematorium were very professional and very good to his late wife.

I did ask this question for interest, you can store the said person at a cost of €300 a day to allow family to arrive and suspend the service till later.



Repatriating a body from Spain to home country:
+/-
Repatriation Help
Anubis

7/2018: Quote through Repatriation Help for funeral director services plus transport of body from Barcelona to Lima Peru, not including mortuary or hospital charges: about €6200.



Our family member, a Spanish citizen, died 2/2021:
+/-
They died from COVID in a public hospital in Barcelona, with no insurance. Procedures may vary elsewhere.

Because of COVID, no public viewing or funeral.

If you have insurance (seguro de decesos) you need to contact that company and they will take care of all, asking you about your preferences. But we had no insurance.

Finding a funeral home:
Cofune (but nothing for cremation in Barcelona)

Apparently Barcelona has only two funeral homes in 2021. A law was proposed in 2017 to create a municipal service, but it was defeated.

We went to the hospital (Vall D'Hebron). There are two funeral-home offices on the grounds, right next to each other. Went into one and they quoted us €3500 for the simplest cremation. Went into the other and they quoted €1800, so we went with that one. I think the second was including fewer extras, and the real difference in the basic service part was €1800 versus €2100.

No chance for a viewing at the hospital, since this is a COVID case.

We were able to reclaim our relative's clothing right away, but the Security office held the only valuable thing (mobile phone) until we came back another day with a document showing power of attorney.

Two days later we went to the mortuary at Montjuic cemetery, and were able to view the closed coffin with the body inside. The cremation took place after that, probably very soon.

Not sure when we'll get the actual urn with the ashes. Funeral home is supposed to be arranging the death certificate, but that could take a couple of months.





Miscellaneous


Diseased people in waiting room will infect you
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"



There is a "Tarjeta Social Universal", but I don't know how to get it or what it does. Maybe it's only for those receiving pension benefits ?
Tarjeta Social Digital




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 ? Maybe just for non-medicines, such as supplements or beauty supplies.

It seems impossible to get any Spanish pharmacy to order a medicine that is approved in EU and prescribed by a Spanish doctor, but not on the official list of Spanish medicines. For example, 8/2020 the vaccine Shingrix is approved in EU but not listed in the Spanish system, so no pharmacy can order it from anywhere no matter how much I'm willing to pay. As far as they're concerned, it doesn't exist.

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.
Medicare.gov's "Part B late enrollment penalty"

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.

When you start collecting US SS benefits, make sure they don't take Medicare payments out of them ?

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"

Insurance while traveling in USA:
Sanitas may cover you.
IM Global (but may not cover COVID-19)
United Healthcare

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.

2/2020: One thing that drives me crazy (with both NHS and private system) is vaccinations. If you are between ages 5 and 80, it's just about impossible to get vaccinations. They assume you had them as a child or don't need them until you're ancient. We live with someone who is on the edge of lung failure, and I'm afraid that if one of us gets the flu, she will catch it from us and get pneumonia and die. Yet none of us can get flu vaccinations for love or money, through NHS or private or pharmacies, this year, except for the one of us who is 85 years old. He got a free flu shot through the NHS.

Psychiatric treatment: Apparently the NHS does cover it, but the process of getting coverage is slow. Get a referral from family doctor to psychologist, then get a referral from psychologist to psychiatrist, then start treatment.



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: February 2021.