Who is entitled to public healthcare
Being an employed worker in Spain gives access to healthcare from the very day of registration with Social Security. The company registers the employee when hiring them, and this covers both the employee and their recognised beneficiaries.
Self-employed workers are also entitled through their contributions to the Special Scheme for Self-Employed Workers. And foreigners with legal residence and municipal registration can apply for the health card even if they do not pay contributions. Emergencies, in any case, are always treated.
The health card and municipal registration
Coverage takes the form of the health card of your autonomous community: the SIP in the Valencian Community, the individual health card in other regions. It is applied for at the health centre or the municipal health office, where you choose a family doctor.
To apply for it as a foreigner you need the NIE and the municipal registration certificate from the town hall. The European Health Insurance Card, which covers temporary stays in other EU countries, is issued by the INSS and can be requested online or at its offices.
The pharmaceutical co-payment since May 2026
Royal Decree-Law 11/2026 reformed the contribution for prescription medicines, in force since 14 May 2026. Active workers contribute between 40% and 60% of the price depending on their annual income, with new monthly caps for lower incomes.
Key points
- Under €9,000: 40%, with a cap of €8.23 per month
- From €9,000 to €17,999: 40%, with a cap of €18.52 per month
- From €18,000 to €34,999: 45%, with a cap of €61.75 per month
- From €35,000 to €99,999: 45% or 50% depending on the bracket, with no monthly cap
- Over €100,000: 60%, with no monthly cap
Private insurance: when it is worth it
Pensioners contribute 10% with caps ranging from 8.23 to 61.75 euros per month, and those receiving minimum top-ups are exempt. The reform added these monthly limits so that chronic treatment does not become a financial barrier.
Private insurance does not replace public healthcare, it complements it. Sanitas, Adeslas, Mapfre or Asisa offer medical panels with prices starting at around 30 euros per month for a young adult on basic plans, and rise with age and coverage. The strong point is specialities without waiting lists and dentistry depending on the plan.
If the company finances it, the premium paid for each worker is exempt from personal income tax up to 500 euros per year. Many companies use it as a cheap and highly valued benefit in kind: it costs little, does not add to withholding within the limit and improves the subsidiary's perception.
