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Tarjeta sanitaria in Spain – how to get public healthcare and what your visa insurance must cover

Last updated 25 September 2026Rules checked every MondayOfficial sourcesSources & methodology →

Public healthcare in Spain takes two steps: the INSS recognises your right, then your region issues the tarjeta sanitaria. Here is who qualifies, how it works in Madrid, Catalonia and Andalusia, what visa insurance must cover, and which numbers to call.

Woman talking with a female doctor in a clinic office
Photo: fizkes/Adobe Stock

Getting the tarjeta sanitaria (health card) takes two steps in Spain. The INSS (National Social Security Institute) recognises your right to publicly funded care; your region's health service then issues the card. If you are still applying for a visa, sort out insurance first: each route words its rules differently, and some accept an S1 form (a certificate of cover from another country's health system) instead of a private policy.

Who is entitled to public healthcare in Spain?

Publicly funded care covers Spanish nationals and foreigners who have established their residence in Spain, plus people covered under EU rules or bilateral agreements. Under Ley 16/2003, as amended by Royal Decree-law 7/2018, foreigners with legal and habitual residence qualify if they are not obliged to prove cover another way. Your residence permit proves legal residence; your entry in the padrón (municipal register) proves habitual residence.

Your situationRoute to public care
Employee or self-employed, registered with the Seguridad Social (social security)Covered as an insured person
Contributory pensioner, or receiving a periodic Seguridad Social benefitCovered as an insured person
Spouse or registered partner, or child under 26 (or with a disability of 65% or more), of an insured person, living legally in SpainCovered as a beneficiary
Legally and habitually resident, not obliged to prove cover another wayCovered through residence
Not registered or authorised as a residentSame terms as Spaniards if you cannot export cover from your country and no third party is liable; the region recognises the right
Applicant for international protectionThe basic common portfolio of services while the application is pending
Family member of a returning Spanish national, with no other coverCovered; the INSS recognises the right

Source: Seguridad Social (INSS), read 23 September 2026.

For benefits that depend on living here, stays abroad of up to 90 days in a calendar year do not break your habitual residence.

How do you get the tarjeta sanitaria?

Start with the INSS. Foreigners apply with a TIE (foreigner identity card) or passport, proof of legal residence and a recent padrón certificate from the ayuntamiento (town hall); EU, EEA, Swiss and UK citizens also need a certificate that their home country does not export their health cover. INSS offices open Monday to Friday, 9:00–14:00, with a cita previa (appointment). Then take the INSS decision to your regional health service:

RegionCard and where to applyWhat to bring or know
Comunidad de MadridTarjeta sanitaria, at your assigned centro de salud (health centre), 8:30–20:30, or onlineDNI or valid TIE, a volante de empadronamiento (padrón document) issued in the last 90 days, and the INSS entitlement document. For foreigners the card lasts only as long as the TIE or EU registration certificate, so update it at each renewal
CataloniaTSI from CatSalut, online or at your CAP (primary care centre)You must be on the padrón of a Catalan municipality; there is no fee. Foreigners not registered with the INSS can still apply, under Ley 9/2017 on universal healthcare
AndalusiaHealth card of the Servicio Andaluz de Salud, at a primary care centreHabitual residence in Andalusia, cover recognised by the INSS, a DNI or NIE (foreigner identity number) if over 14, and a padrón certificate. The card does not expire

Source: Comunidad de Madrid, Generalitat de Catalunya (CatSalut) and Servicio Andaluz de Salud, read 23 September 2026.

In the city of Madrid, you can instead authorise the region to check your padrón entry. For questions about your entitlement, the INSS line is +34 91 542 11 76 or 901 16 65 65, Monday to Friday, 9:00–20:00; 901 numbers are usually not included in flat-rate plans. With the card, Madrid residents book medical appointments online, in the Cita Sanitaria Madrid app or by phoning their health centre.

What if you do not qualify? The convenio especial

If no route gives you public cover, you can buy into the public system through a convenio especial (special agreement) with your region. You need at least one year of continuous residence in Spain and an entry on the padrón of a municipality in that region; the agreement ends if you leave that padrón.

Royal Decree 576/2013 sets the fee at €60 a month under 65 and €157 a month from 65. Regions may charge more if they add services, and current regional fees were not available on the official pages we checked – ask your regional health service before you budget.

What health insurance do you need for a Spanish visa?

Until the INSS recognises your right, most routes into Spain require cover of your own. The wording differs by route:

RouteWhat the insurance must do
Non-lucrative residencePublic or private cover with an insurer authorised to operate in Spain, covering all risks of the public system; a registered S1 form is also accepted
Digital nomad (international telework)Public or private cover of all public-system risks; an S1 plus proof of registration with the Spanish Seguridad Social is accepted
StudentAll public-system risks with no co-payment, reimbursement or waiting period; any cover limit at least €30,000; travel insurance is not accepted. Students who work meet the requirement through their Seguridad Social registration
EU or EEA citizen not workingPublic or private cover in Spain equivalent to the public system. Pensioners can use a certificate of entitlement from the state paying their pension; students, a European Health Insurance Card valid for the whole stay
Family reunificationHealth insurance for the sponsor and every family member

Source: Spanish Consulate General in London, Ministry of Inclusion, Social Security and Migration, and BOE (Official State Gazette), read 23 September 2026.

The consular wording above comes from the Spanish consulate in London; other consulates may phrase it differently, so read your own consulate's page before you buy a policy.

The European Health Insurance Card is free and covers medically necessary care on temporary stays in the EU, Iceland, Liechtenstein, Norway, the UK and Switzerland – but not after you move your residence. Once insured in Spain, you order the Spanish card online; it is posted to your address within five days and never handed over in person.

Which emergency numbers should you call in Spain?

Save these before you need them. 112 is the general emergency number in Spain: calls are free and work from a locked phone or one without an active SIM. In the Comunidad de Madrid, 112 answers in Spanish and English, can bring in interpreters for other languages and passes health emergencies to SUMMA112, the regional medical emergency service; in Catalonia it answers in 50 languages.

NumberWhat forWhere
112Any emergency; freeAll of Spain
061Serious health emergencies where a life may be at riskAndalusia
061 Salut ResponUrgent health problems that are not life-threatening, health advice and TSI questions; 24 hours a dayCatalonia
024Suicide prevention; free, confidential, 24 hours a dayAll of Spain
016Violence against women; free and confidentialMinistry of Equality helpline

Source: Punto de Acceso General, Comunidad de Madrid, Generalitat de Catalunya, Servicio Andaluz de Salud, Ministry of Health and Ministry of Equality, read 23 September 2026.

One cost to note: outpatient prescriptions carry a user contribution, and people receiving the Ingreso Mínimo Vital (minimum income, see part 9) are exempt from it.

What to do now

StepWhatWhen
1Check what insurance your visa route requires and buy a compliant policyBefore you apply for the visa
2Register on the padrón at your ayuntamientoAs soon as you have an address
3Ask the INSS to recognise your right, with TIE or passport and a padrón certificateOnce you work, draw a pension or are legally resident
4Take the INSS document to your health centre for the tarjeta sanitariaIn Madrid, with a padrón document under 90 days old
5No public cover? Ask your region about the convenio especialAfter one year of residence, while on the padrón
6Save 112 and your region's health line in your phoneToday

Source: Seguridad Social and the regional health services, read 23 September 2026.

Official sources

The official pages this guide is based on, read 23 September 2026. Links open the authority’s own website.

Relocate in Europe provides general information, not legal or financial advice for your individual situation. Check with the authority named above before you act – rules change, and your case may differ.