Do expats need private health insurance in Spain?

It depends on your situation. (1) EU citizens who contribute to Spanish Social Security (work, self-employment) can access the public healthcare system (Seguridad Social). (2) EU retirees receiving a pension may qualify for the S1 form, giving access to public healthcare. (3) Non-EU nationals applying for the Non-Lucrative Visa MUST have private health insurance (mandatory requirement). (4) Anyone outside the above categories will need private insurance for full healthcare coverage. Even for those with public healthcare access, private insurance is popular for faster specialist access, English-speaking doctors and dental cover.

What health insurance is accepted for the Non-Lucrative Visa?

The NLV requires comprehensive private health insurance with: full medical coverage (hospitalisation, outpatient, emergency), NO copayments (franquicias or copagos), NO coverage exclusions for pre-existing conditions (or explicit inclusion), valid in Spain for the full duration of the visa, and documentation in Spanish or with certified translation. Accepted insurers include Sanitas, Adeslas, AXA, Cigna, DKV, Allianz, and Generali. International policies (Cigna Global, GeoBlue, Bupa International) are also accepted if they meet the above criteria.

How much does private health insurance cost in Spain for expats?

Costs vary significantly by age, insurer and coverage level. Approximate monthly premiums for a single adult: Ages 30–40: €60–90/month (basic); €90–130/month (comprehensive). Ages 45–55: €90–130/month (basic); €130–180/month (comprehensive). Ages 55–65: €130–200/month (basic); €180–250/month (comprehensive). Ages 65+: €180–300+/month. Dental cover adds approximately €20–40/month. Spanish insurers (Sanitas, Adeslas) are generally cheaper than international insurers (Cigna Global, Bupa) but may have more restrictions.

Which health insurer has the most English-speaking doctors on Costa del Sol?

Sanitas has the widest network of English-speaking doctors on Costa del Sol, with dedicated international patient services at Sanitas La Moraleja and affiliated clinics in Marbella, Fuengirola and Málaga. AXA also has a strong English-speaking network. For American expats specifically, Cigna Global has the best network of US-trained or English-speaking specialists. Hospital Quirón Marbella and USP Hospital Costa del Sol (Marbella) both have comprehensive international patient departments with translators and English-speaking staff.

Can I keep my UK, US or German health insurance when moving to Spain?

UK NHS entitlement ends when you permanently leave the UK. You may be able to use EHIC/GHIC for temporary visits to Spain, but it does not cover you as a Spanish resident. US health insurance (employer-provided or Marketplace plans) generally does not cover care outside the US. German statutory insurance (gesetzliche Krankenversicherung) can sometimes be maintained for the first year abroad, but typically you must arrange Spanish insurance. The safest approach is to purchase Spanish or international expat health insurance upon arrival and cancel any non-applicable home country coverage.

Private Health Insurance Spain for Expats [2026]

Healthcare is one of the most important practical considerations when moving to Spain. Spain has an excellent public healthcare system — ranked by the WHO among the top 10 in the world — but access for expats depends on your immigration status. Private health insurance bridges the gap and is mandatory for many visa types.

Who needs private health insurance?

Expat situation	Healthcare access	Private insurance needed?
EU citizen working in Spain	Public (Seguridad Social)	Optional but recommended
EU retiree with S1 form	Public (via S1 form)	Optional
EU retiree without S1	None from public system	Required
Non-EU (NLV holder)	None from public system	Required (NLV condition)
Non-EU (Golden Visa)	None from public system	Required (application)
Digital Nomad Visa	Depends on employment	Required if not contributing to SS
Tourist / under 90 days	EHIC for emergency only	Strongly recommended

The main private health insurers in Spain

Sanitas — Best for expats on Costa del Sol

Sanitas is Spain's largest private health insurer and arguably the most expat-friendly:

Feature	Details
Network	1,000+ clinics, 40,000+ doctors nationwide
English service	Dedicated international patient service
Costa del Sol	Clinics in Marbella, Fuengirola, Málaga, Benalmádena
NLV compatibility	✅ Fully accepted by consulates
Dental	Available as add-on (~€20/month)
Monthly cost (approx.)	€80–200 (age 30–60)

Best for: Expats who want a Spanish insurer with a large local network and English-speaking doctors.

Adeslas (SegurCaixa Adeslas) — Best value

Adeslas is Spain's second largest health insurer, part of the CaixaBank group:

Feature	Details
Network	800+ clinics, 35,000+ doctors
English service	Limited — Spanish-language focused
NLV compatibility	✅ Accepted by consulates
Monthly cost (approx.)	€60–160 (age 30–60)

Best for: Expats who speak Spanish and want lower premiums with good local coverage.

AXA Spain — Best for international coverage

AXA Spain offers a balance between Spanish local coverage and international network:

Feature	Details
Network	Spain + international network
English service	Good — international insurer support
NLV compatibility	✅ Accepted
Monthly cost (approx.)	€90–220 (age 30–60)

Best for: Expats who travel frequently or want coverage when visiting their home country.

Cigna Global / Cigna Spain — Best for US expats

Cigna has two products relevant to expats:

✓Cigna Spain — local Spanish product
✓Cigna Global — international product accepted worldwide

Feature	Details
Network	Spain + 90+ countries
English service	Excellent — 24/7 English helpline
NLV compatibility	✅ (check specific policy covers Spain fully)
Monthly cost (approx.)	€150–350 (age 30–60)

Best for: American expats, those frequently visiting multiple countries, high-net-worth individuals wanting premium global cover.

DKV — Best for German speakers

DKV is a German-backed insurer popular with German and Austrian expats in Spain:

Feature	Details
Network	Strong Spain + Europe coverage
Languages	Spanish, German, English
NLV compatibility	✅ Accepted
Monthly cost (approx.)	€80–200 (age 30–60)

Best for: German, Austrian and Swiss expats who want German-language customer service.

Premium comparison table (2026 estimates)

Insurer	Age 35	Age 45	Age 55	Age 65
Sanitas	€90/mo	€120/mo	€160/mo	€220/mo
Adeslas	€70/mo	€100/mo	€140/mo	€190/mo
AXA Spain	€100/mo	€135/mo	€175/mo	€240/mo
Cigna Spain	€90/mo	€120/mo	€160/mo	€220/mo
Cigna Global	€180/mo	€220/mo	€280/mo	€350/mo+
DKV	€85/mo	€115/mo	€155/mo	€210/mo

Estimates for a healthy non-smoker with comprehensive cover. Dental cover adds ~€20–40/month.

What to look for when choosing a policy

NLV-specific requirements

If the policy is for a Non-Lucrative Visa application:

✓✅ No copayments (franquicias or copagos)
✓✅ No coverage sublimits for specific conditions
✓✅ Pre-existing conditions covered (or covered after waiting period)
✓✅ Hospitalisation fully covered
✓✅ Emergency coverage 24/7
✓✅ Valid from day 1 of policy (no initial exclusion period)
✓✅ Documentation available in Spanish

General expat considerations

✓English-speaking doctors: Ask insurer for a list of English-speaking medics in your area
✓Hospital access: Check which hospitals are in-network (Hospital Quirón, USP are top-tier)
✓Waiting periods: Some policies have 6–12 month waiting periods for certain treatments
✓Dental: Most base policies exclude dental — add separately if needed
✓Optical: Usually excluded — check if relevant

Hospitals on Costa del Sol

Marbella

✓Hospital Quirón Marbella — Premier private hospital, full international patient service
✓Hospital USP Costa del Sol — Excellent general hospital, English-speaking staff
✓Hospital Ochoa — Well-regarded private hospital, multilingual

Fuengirola

✓Hospital Vithas Xanit International — Leading in Benalmádena, very expat-friendly
✓Clínica Ochoa Fuengirola — Good outpatient facilities

Málaga city

✓Hospital Quirón Málaga — Major city hospital, specialist centre
✓Hospital Vithas Málaga — Modern private hospital, good specialist coverage

Health insurance for the S1 form (EU pension holders)

If you receive a state pension from an EU country, request the S1 form from your home country's pension authority:

✓UK: Contact DWP (Department for Work and Pensions) — request S1 form
✓Germany: Contact Deutsche Rentenversicherung
✓Netherlands: Contact SVB
✓Sweden: Contact Försäkringskassan
✓Norway: Contact NAV

The S1 form entitles you to free Spanish public healthcare. However, private insurance is still recommended for faster specialist access and English-speaking practitioners.

Practical tips for expats on Costa del Sol

1. Get quotes from multiple insurers — prices vary widely

2. Ask about expat-specific plans — Sanitas and AXA have dedicated products

3. Check your nearest hospital is in-network before signing

4. Register with a local GP (médico de cabecera) even with private insurance

5. Keep a copy of your policy in Spanish for any claims or NLV renewals

6. Consider group policies if multiple family members — significant discount

Costa Expat can help you navigate health insurance options as part of your residency setup on Costa del Sol.

Private Health Insurance Spain for Expats [2026] — Sanitas vs Adeslas vs Cigna Compared