Healthcare is the topic that causes more anxiety among British people planning a move to Spain than almost anything else. The NHS is the one thing most people worry about leaving behind. The good news is that Spain has one of the best public healthcare systems in Europe, consistently ranked among the top ten in the world. You can access high-quality medical care in Spain without it becoming a financial burden. But your route into that system depends entirely on your visa type, your age, and your employment status, and getting it wrong can leave you either uninsured or paying for coverage you didn't need to pay for. 

Once you establish legal residency in Spain and are no longer ordinarily resident in the UK, you lose your entitlement to free NHS treatment. You can still access the NHS if you return to the UK for a visit, for urgent or emergency treatment, but you cannot continue using the NHS as your primary healthcare provider while living abroad. This is a point that confuses people, particularly those who assume they can simply fly back to the UK for GP appointments or planned treatments. HMRC and the NHS use residency status to determine entitlement, and once Spain is your primary residence, UK-based routine healthcare is no longer yours to use freely.

Spain's public health system, the Sistema Nacional de Salud (SNS), is funded through social security contributions and general taxation. Access for British expats depends on how you arrived in Spain and what your current status is.

If you are working in Spain under any work-authorised visa - employed by a Spanish company, registered as an autonomo, or working under a Digital Nomad Visa while paying into Spanish social security, you are entitled to full SNS access in the same way a Spanish citizen would be. Your social security contributions fund your healthcare, and you register with a local GP at your nearest health centre, using your TIE card and Padron certificate. 

If you hold a Non-Lucrative Visa, the situation is different. The NLV explicitly prohibits work, which means you are not paying into social security, which means SNS access is not automatic. This is why private health insurance is a mandatory requirement for the NLV, it is your healthcare safety net for as long as you remain on that visa. Some NLV holders do eventually gain SNS access over time, particularly if they transition to a different visa type or reach retirement age, but it should not be assumed or relied upon in the early years. 

The S1 form is one of the most valuable documents available to British retirees moving to Spain, and if you qualify for it, obtaining it before you leave the UK should be near the top of your to-do list.

S1 is issued by NHS Overseas Healthcare Services (part of the NHS Business Services Authority) and certifies that the UK government will cover the cost of your healthcare in Spain. This means you can register with the Spanish public health system - accessing GPs, specialists, hospitals, and prescriptions through the SNS with the UK paying Spain for those costs rather than you paying out of pocket or through insurance. It is available to UK state pensioners, people receiving certain UK benefits, and in some cases people who have taken early retirement and are still within the age bracket where UK social security covers them. 

To apply for an S1, contact the NHS Overseas Healthcare Services team before you leave the UK. Once in Spain, you register the S1 at your local INSS (Social Security) office, and from that point you are entitled to SNS healthcare. For retirees who qualify, the S1 effectively eliminates the need for comprehensive private health insurance.

Whether it is mandatory for your visa or simply your preferred route to healthcare, private health insurance in Spain is a well-developed market with strong options at reasonable prices by UK standards. For Non-Lucrative Visa applicants especially, the policy must meet specific requirements - no excess, no co-payments, full coverage in Spain including hospitalisation and repatriation, and issued by a provider authorised to operate in Spain.

The main providers used by British expats in Spain are Sanitas, Adeslas, Asisa, AXA Spain, Cigna Global, and Allianz Care. Sanitas and Adeslas tend to have the most extensive networks of hospitals and clinics across Spain, which matters if you are living outside a major city. Cigna Global and Allianz Care are popular with people who want international coverage that works both in Spain and when travelling or spending time back in the UK.

The cost of private health insurance in Spain varies by age, health history, and the level of coverage you choose. A healthy person in their thirties or forties can expect to pay between £50 and £100 per month. Someone in their fifties will typically pay £100 to £200 per month, and those in their sixties and beyond should budget £200 to £400 per month or more, depending on pre-existing conditions and the insurer. 

The Global Health Insurance Card (GHIC) replaced the European Health Insurance Card (EHIC) for UK citizens after Brexit. If you have an old EHIC, it remains valid until its expiry date, after which you apply for a GHIC as its replacement. Both cards entitle you to access state-provided healthcare in Spain at the same cost as a Spanish resident which for most treatment means free but only during temporary stays. Once you are a legal resident in Spain, the GHIC no longer applies to your situation. It is a card for visitors and travellers, not residents. Some people moving to Spain assume they can use the GHIC as a substitute for private health insurance or SNS registration but they cannot. It will not be accepted as proof of coverage for a visa application, and it does not cover ongoing or planned treatment for residents.