
Public healthcare for foreigners in Spain: Who is entitled?
4 Agosto, 2025
In Spain, the right to public healthcare is generally linked to being insured under Social Security (through work and contributions) or being a beneficiary of someone who is. But what about foreigners who hold initial residence permits without employment activity (such as non-lucrative residences, students, or family members) or those who are in an irregular administrative situation?
National legal framework: universal healthcare since 2018
The Royal Decree-Law 7/2018 of 27 July, on universal access to the National Health System, restored the principle of universal healthcare, recognizing the right to health protection for all people residing in Spain, provided they do not already have mandatory coverage through another means (such as private insurance required for a visa) or the possibility of exporting healthcare coverage from their country of origin.
This framework allows foreign nationals with initial permits or even those in an irregular situation to access public healthcare under certain circumstances. However, healthcare management is decentralized, and each autonomous community applies this right according to its own criteria and procedures.
Autonomous communities with broader access regulations or practices
Catalonia (Barcelona)
Catalonia is a clear example of local universal healthcare coverage. Its regional regulations guarantee medical care to all residents, regardless of their employment or administrative status.
In practice, many people holding initial residence permits (such as non-lucrative ones) and even those in an irregular situation have been able to obtain the Individual Health Card (TSI) simply by providing:
- Municipal registration (empadronamiento)
- Identification (NIE or passport)
- A certificate proving the absence of other mandatory coverage
Thanks to this policy, foreigners who theoretically should only use their private insurance have obtained free access to the Catalan public healthcare network.
Valencian Community
The Valencian Community was one of the first to adopt universal healthcare measures after the healthcare exclusion of 2012. Since 2015, its regional government has committed to treating all people, with or without papers, by removing requirements such as minimum registration periods.
After the 2018 national reform, this approach has remained, and today there are still cases of initial residents without contributions who have been able to access public healthcare.
Andalusia and Asturias
Both regions did not implement healthcare restrictions even during the 2012-2018 period, maintaining a practically universal assistance model. This means their administrative culture is more open to healthcare access for uninsured groups, including foreigners holding initial permits without contributions and people in an irregular situation.
Aragon, Balearic Islands and Cantabria
These communities also developed their own healthcare coverage measures for uninsured individuals to avoid exclusion. This especially benefited migrants in irregular situations, but also legal residents who did not contribute and, in some cases, could access the public network through local procedures.
Basque Country
The Basque Country implemented a specific system for people without ordinary healthcare rights, granting a Basque Individual Health Card (TIS). However, it established stricter requirements, such as one year of registration in the municipal register and income below certain limits. For this reason, an initial resident with sufficient economic means (such as non-lucrative permits) generally did not meet these conditions, except in special cases.
Regions with stricter application
In other communities, such as Madrid, Murcia, Castilla-La Mancha, Canary Islands, Extremadura or La Rioja, the national regulation was applied strictly. In these cases, the main way for a non-contributing foreigner to access public healthcare remains the Special Agreement with Social Security (with monthly payment) or the use of private insurance required for the visa.
Universal access, but with consequences?
Universal access to public healthcare in Spain is an important social achievement, ensuring that no one is left without medical care due to lack of resources or administrative status. However, it also has a direct effect on the system’s capacity: more patients with the right of access means greater strain on services. This, in many regions, translates into longer waiting lists for specialist consultations, diagnostic tests, or surgical procedures.
This is where private healthcare comes in, an alternative in Spain that has a very well-developed sector and leading hospital groups such as Quirón, Vithas or HLA. Private medical insurance also has a relatively low cost compared to other European countries. Companies such as Adeslas, Asisa, Sanitas or DKV offer policies that provide quick access to a wide network of hospitals and specialists, reducing waiting times and offering a more personalized service.
This raises an inevitable question:
Is it really worth relying solely on public healthcare?
Is saving the cost of private insurance more important, or is speed and more personalized care worth it?
The answer depends on each person’s financial situation and what they value most: saving money or having faster and more direct service.
What has been your experience?
What has been your experience with public and private healthcare in Spain?
What would you recommend to others in the same situation?
Click on the icons and share your experience directly on Facebook, LinkedIn or X.