Private Health Insurance in Spain: Costs, Providers \& What Expats Need (2026)

Spain has an excellent public health system, and expats who qualify for it through work, social security contributions, or long-term residency often find it more than adequate. But private health insurance isn’t just a lifestyle upgrade on the Costa del Sol — for many expats, it’s a legal requirement, a practical necessity during the gap before public system access, and increasingly a preference for faster access to English-speaking specialists.

This guide covers what private health insurance actually costs in Spain in 2026, which providers operate on the Costa del Sol, what the policies cover (and don’t), and how to navigate the purchase process.

Why Expats Need Private Health Insurance

Non-Lucrative Visa Requirement

If you’re applying for or renewing a non-lucrative visa, you need health insurance. What the policy has to look like depends on where you apply, and that is worth understanding before you buy.

The regulation itself is brief. RD 1155/2024, article 61.2.b, states the requirement in full as “contar con un seguro de enfermedad”. It sets no coverage standard, no minimum amount, and says nothing about copayments or waiting periods. The Ministerio de Inclusión’s own guidance adds that the insurer must be authorised to operate in Spain. Individual consulates then add their own conditions, and those differ between posts:

• Consulado General de España en Londres asks for “seguro público o privado de enfermedad concertado con una aseguradora autorizada para operar en España”, and accepts a receipt of S1 registration in place of a policy. Its published sheet sets no copayment or waiting-period condition. (Requirements sheet, Actualizado 11/02/2022.)
• Consulado General de España en Los Ángeles requires cover “with no deductible, no copayment, no waiting period or coverage limit”, covering 100% of medical, hospital and out-of-hospital expenses, and rejects travel insurance outright.

So the honest answer is that there is no single national rule to quote. Read your own consulate’s current requirements page, and if it demands sin copago cover, buy that; if it does not, a copayment policy can cost meaningfully less for the same underlying cover. The consulate or immigration office reviewing your application will read the policy document, not the certificate summary, so make sure the document itself says what you think it says.

Basic travel insurance or plans with significant copays won’t satisfy these requirements. The consulate or immigration office reviewing your renewal will scrutinise the policy document, not just the certificate.

Gap Before Public Health Access

EU/EEA citizens moving to Spain can register on the public system more easily, but non-EU nationals typically need to be working and contributing to Social Security, or have residency status with specific entitlements, before accessing public healthcare. During the period between arriving and qualifying — which can be 6 months to over a year — private insurance is your only option.

Preference for Speed and Language

Even expats fully entitled to public healthcare often maintain private insurance for specialist access (waiting times in the public system for non-urgent specialist appointments can run 2–6 months), English-speaking doctors, and access to private hospital networks like HC Marbella, Quirónsalud, and Vithas Xanit.

What Private Health Insurance Costs in Spain (2026)

Prices vary significantly by age, provider, coverage tier, and whether you choose a policy with or without copayment. These are realistic ranges for individuals on the Costa del Sol based on current market rates:

Under 40

€50–90/month for a standard policy without copay from Adeslas, ASISA, or Sanitas. With copay (€3–6 per GP visit, €12–20 per specialist), premiums drop to €35–65/month. For visa purposes, you need the no-copay version.

Age 40–50

€80–150/month without copay. Premiums start increasing meaningfully here as insurers price in higher actuarial risk. DKV and Caser tend to be competitive in this bracket.

Age 50–60

€150–250/month for comprehensive coverage without copay. This is where the Costa del Sol’s large expat retirement market becomes relevant — most providers have products aimed at this age group. Cigna International tends to be worth comparing here for expats who travel frequently.

Age 60–70

€250–400/month and rising sharply toward 70. Some providers stop accepting new applicants at 65; others cap at 68 or 70. Existing customers can usually renew beyond these ages but at substantially higher premiums. Shop carefully before 65 if you’re planning a move.

Age 70+

€350–600+/month for those who can get coverage at all. Most mainstream Spanish insurers won’t take new applicants over 65–70. Specialists like Cigna or Allianz Care may cover older applicants but at significant cost. The convenio especial (see below) becomes the more practical option for many people in this bracket.

Families

Family policies are usually priced per adult, with children under 18 sometimes added at low or no additional cost (varies by provider). A couple in their mid-50s can expect to pay €500–700/month combined for comprehensive no-copay coverage.

Autumn 2026: what changed, and what it means for a policy you already hold

Last verified: 7 September 2026.

Two things moved at the start of September. On 1 September the Council of Ministers approved the Estatuto Marco bill in second reading and sent it to the Congreso. On the morning of 2 September the doctors’ national strike committee responded with a preliminary agreement to call an indefinite strike in October. The format, the exact start date and the mobilisation calendar were not settled at that meeting, the unions still have to ratify it, and the committee is due to publish the definitive calendar at a press conference on 9 September. Andalucía is a particular case: the Sindicato Médico Andaluz signed a labour agreement with the Junta on 29 July and called off regional strikes, while also sitting on the national committee. Whether Andalusian doctors are called out in October is not something any source has yet answered.

Buying a policy now does not solve this autumn. The carencia periods set out above apply to a new contract, none for consultations at the insurers we have read, and six to ten months before non-emergency hospitalisation and surgery. A policy taken out in September is not a route around a public appointment already booked for October.

If you already hold a policy, the lever is the renewal window rather than the price. Article 22 of the Ley de Contrato de Seguro (Ley 50/1980) requires your insurer to notify any modification, including a premium increase, at least two months before your renewal date, and lets you oppose renewal in writing up to one month before it. Both dates run from the vencimiento in your own policy schedule, not from the calendar year. There is no cap on increases in the Insurance Contract Act, which is why the dates are the part that works in your favour. We covered the mechanics, the burofax route and the age ceilings in our July piece on the renewal letter.

On what the two systems currently deliver: the Ministry of Health’s own waiting-list tables put 853,509 people on surgical lists nationally with a 121-day average, and 102 days for a first outpatient consultation, on the cut to 31 December 2025. Andalucía’s surgical average on the same cut was 173 days, the longest of any region, and no newer official release has been published. The private sector’s own foundation, Fundación IDIS, reports an average of 15.6 days in its RESA 2025 study, down from 24.1. Read that figure carefully: it measures the gap between the pre-anaesthetic consultation and the operation, for scheduled surgery only, across 123 participating centres in 2024. It is not a waiting-list time and it does not start where the public clock starts, so it cannot be set against 173 days as a like-for-like comparison. The same study’s mammography figure, 12.1 days from request to test, went up rather than down.

Major Providers on the Costa del Sol

Sanitas

Spain’s largest private health insurer, with the broadest hospital network. Strong presence on the CdS through its affiliated clinics and the Sanitas La Zarzuela and Sanitas Virgen del Mar hospitals (Madrid-based, but network extends to Málaga province). Pricing is mid-to-premium range. Policies clearly labelled sin copago satisfy the strictest consulate requirements. English-language customer service available.

Adeslas

Adeslas (part of the SegurCaixa group) is typically the most cost-competitive of the major providers for younger applicants. Large network of affiliated professionals throughout Málaga and the CdS. Their Adeslas Completa range is popular with expats for visa purposes. The app is functional and allows easy appointment booking.

ASISA

Strong coverage network in Málaga and the western Costa del Sol (Marbella, Estepona, Benahavís). Competitive mid-range pricing. The ASISA Cuidarte and ASISA Más Salud plans cover most expat needs. Worth comparing for 40–60 age bracket where Adeslas sometimes becomes less competitive.

DKV

German-backed insurer with a reputation for customer service and straightforward claims. Slightly fewer affiliated specialists than Sanitas or Adeslas in rural areas, but strong in the main CdS towns. Popular with German and Northern European expats. Pricing typically competitive for under-55s.

Cigna International

International-focused policies designed for expats. More expensive than the domestic Spanish providers (€200–400+/month depending on age) but with broader international coverage — useful if you travel frequently between Spain and another country, or haven’t fully committed to Spain as your only base. Will cover new applicants slightly older than the Spanish-domestic insurers typically accept.

Caser

Part of the Helvetia group. Growing presence on the CdS. Competitive pricing, particularly for individuals in their 50s–60s where other providers’ premiums become steep. The Caser Medigest range is comprehensive and visa-compliant.

Copago vs. Sin Copago: What It Means

Many Spanish health insurance policies operate with a copago (copayment) — you pay a fixed amount per medical visit or service:

• GP visit: typically €3–6
• Specialist appointment: €10–20
• Urgent care: €15–30
• Hospitalisation: often covered in full even in copago plans

Policies sin copago (without copayment) cover all affiliated services with no out-of-pocket cost per visit. These cost €20–60/month more depending on age, but are required for non-lucrative visa compliance and are generally more practical if you have regular medical needs.

What’s Covered — and What Isn’t

Typically Covered

• GP consultations (unlimited with affiliated doctors)
• Specialist consultations (cardiology, dermatology, gynaecology, etc.)
• Diagnostic tests, blood work, X-rays
• Surgery (elective and emergency)
• Hospitalisation
• Emergency treatment
• Maternity (varies — often requires longer waiting period)
• Physiotherapy (often limited to a set number of sessions)

Commonly Excluded or Limited

• Dental: Basic policies typically exclude dental entirely. Dental is usually a separate add-on (€15–40/month extra) or a separate policy. Coverage is often limited to extractions and basic fillings — implants and orthodontics are rarely included even on enhanced dental plans.
• Mental health: Most standard policies include some psychiatric/psychological coverage but with significant limits — commonly 10–20 sessions per year, and inpatient psychiatric care is often excluded or capped.
• Pre-existing conditions: Spanish health insurers can and do exclude pre-existing conditions, particularly in the first 12–24 months of a policy. Some conditions are permanently excluded. Cigna International tends to be more flexible on pre-existing conditions than Spanish-domestic providers.
• Optical and hearing: Generally excluded unless on an enhanced plan or added as a rider.
• Cosmetic procedures: Excluded universally.

Carencia periods: what the policies actually say

A carencia (waiting period) is not set by law. The word appears nowhere in Spain’s Insurance Contract Act (Ley 50/1980), so every period below is contractual, written by each insurer into each product. The ranges here were read from the insurers’ own published general conditions in September 2026, not from comparison sites.

• Consultations and emergencies: no waiting period, across Sanitas, SegurCaixa Adeslas, Asisa, DKV and Cigna.
• Diagnostic imaging (MRI, CT): nothing to six months. Cigna Salud Plena lists none; Adeslas three; Asisa, DKV and Sanitas six.
• Ambulatory surgery: three to six months.
• Non-emergency hospitalisation and major surgery: six to ten months, and this is the clause that decides whether a policy helps you this year. Cigna’s base cover and DKV Residentes sit at six; Adeslas Plena Total, Asisa, DKV Top Health and Cigna Oncampus at eight; Sanitas Más Salud at ten.
• Childbirth: eight months across all five. Transplants run eight to twelve.
• Pre-existing conditions: not handled by a carencia at all. They run through the health questionnaire at underwriting, and a condition known but not declared can be excluded permanently rather than merely delayed.

Two things worth knowing before you compare products on this. The variation inside a single insurer is as wide as the variation between insurers: DKV runs hospitalisation at six months on one product and eight on another. And a short waiting-period list is not automatically the better deal. Sanitas Único carries almost none because its conditions exclude hospitalisation altogether, so there is less to wait for.

All five waive waiting periods for a urgencia vital, a life-threatening emergency arising after cover starts. That exemption covers the emergency itself; whether treatment or admission that follows is covered still depends on your policy’s terms, so it is not a general override.

For visa applications, confirm with your insurer that the carencia structure of your policy doesn’t leave you effectively uncovered — some consulates ask for a letter from the insurer confirming full coverage from the start date, which is only possible for the emergency/GP tier.

Age Cutoffs: Why Timing Matters

Most Spanish private health insurers apply strict age cutoffs for new applicants:

• Sanitas: maximum contracting age 75, no upper age limit to stay insured (Sanitas’s own terms, read September 2026)
• DKV: new applications up to 75 on most products; DKV Famedic Plus has no age limit (DKV’s own terms, read September 2026)
• Adeslas, ASISA, Cigna: product-specific; confirm the entry age for the exact product before cancelling an existing policy

The critical point: existing customers can usually continue renewing beyond these ages, even though new applicants can’t join. This means if you’re planning a move to Spain and you’re approaching 65, take out your policy before you move (or at least before you hit the cutoff), even if you won’t use it immediately. Getting locked out of the private market at 66 with no public health entitlement is a serious problem.

Cutoff ages, premiums, and convenio rates move year to year; the free WaypointSur Briefing tracks changes like these so a rule change does not catch you a year too late.

Visa-Compliant Policies vs. Basic Coverage

Not all policies sold in Spain satisfy non-lucrative visa requirements. The differences that matter:

Requirement	Visa-Compliant	Basic Travel/Limited
Copago	Sin copago (none)	Often has copago
Coverage limit	Typically unlimited or €300k+	Often €30k–€100k
Geographic scope	Spain only is sufficient	May be Spain + elsewhere
Annual renewal	Guaranteed renewal	Annual trip policies won’t qualify

When shopping, ask specifically: “Is this policy valid for a non-lucrative visa application?” Insurers who work with expats regularly will know what this means.

Private Hospitals on the Costa del Sol

Your policy’s value depends partly on which hospitals and specialists are in the network. The main private hospitals on the CdS that accept major insurers:

• HC Marbella International Hospital — Marbella’s main private hospital, accredited, English-speaking staff, strong surgical capacity. Accepts Sanitas, Adeslas, Cigna, DKV, ASISA.
• Quirónsalud Marbella / Quirónsalud Málaga — Part of Spain’s largest private hospital group. Excellent specialist depth. Strong cardiology and oncology departments. Widely accepted by all major insurers.
• Vithas Xanit International (Benalmádena) — Strong international patient focus, English and German-speaking staff, good emergency department. Convenient for the Fuengirola–Torremolinos corridor.
• Hospiten Estepona — Serves the western CdS. Good for residents in Estepona and Benahavís. Accepts major insurers.

Before committing to a policy, confirm your nearest preferred hospital is in-network — the affiliated hospital list varies between providers and even between product tiers within the same provider.

Using Private Alongside Public (SIP)

Many long-term expats on the CdS maintain both public health system access (via SIP card — see our healthcare Marbella guide) and private insurance. The logic: use the public system for chronic condition management, routine prescriptions (heavily subsidised), and anything where waiting time isn’t critical; use private for fast specialist access, diagnostics, and anything you want in English.

There’s no conflict or problem with doing this. Spanish law doesn’t prohibit dual use. Private insurers don’t reduce your premium because you have public system access, but the practical benefit of having both is meaningful.

Convenio Especial: Buying Into the Public System

The Convenio especial con la Seguridad Social allows people who are legally resident in Spain but not entitled to public healthcare (through employment or other entitlements) to pay a monthly contribution to access it. This is an alternative to private insurance, not a supplement.

Monthly costs (2026 rates):

• Under 65: €60/month
• 65 and over: €157/month

This gives access to the cartera común básica, the basic common portfolio of the public system, and it is not identical to the cover an insured worker or pensioner has. Ambulatory prescription medicines are excluded and are paid in full by the patient, as are orthoprosthetics, dietary products and non-urgent transport. It also requires a year of continuous prior residence in Spain, the EU, the EEA, Switzerland or the UK, plus empadronamiento. The €60 and €157 rates are national figures set by Real Decreto 576/2013 and unchanged since then. For retirees over 65 who can’t get private insurance at a reasonable price, or who have been rejected due to pre-existing conditions, convenio especial is often the most cost-effective route. It’s administered through the local INSS (Instituto Nacional de la Seguridad Social) office.

Note: convenio especial is not visa-compliant for non-lucrative visa purposes — Spanish immigration requires private insurance, not public system access via convenio especial.

How to Compare and Buy

The most practical approach for CdS expats:

1. Use a local English-speaking broker. Independent brokers who specialise in expat insurance (not tied to a single insurer) can compare across Sanitas, Adeslas, ASISA, DKV, and Caser simultaneously and know which products satisfy visa requirements. This costs nothing extra — brokers are paid by the insurer.
2. Get quotes directly from 2–3 insurers to benchmark the broker’s recommendation.
3. Read the policy document for exclusions before signing, not after. Specifically check: carencia periods for your age group, pre-existing condition exclusions, and dental coverage status.
4. Confirm visa compliance in writing if you need the policy for immigration purposes. Get the insurer to issue a letter or certificate explicitly confirming it meets non-lucrative visa requirements.
5. Set up direct debit from a Spanish bank account. Most policies require a Spanish bank account for the monthly premium. Open your account before shopping for insurance.

---

Frequently Asked Questions

Is private health insurance tax-deductible in Spain?

Premiums paid for private health insurance are not generally deductible for income tax (IRPF) purposes in Spain for employed individuals or retirees. There is an exception for self-employed individuals (autónomos) who can deduct premiums as a business expense up to €500/person/year (€1,500 for people with disabilities). If you’re filing as an autónomo, include insurance premiums in your deductible expenses.

Can I use my European Health Insurance Card (EHIC) instead?

The EHIC (or UK Global Health Insurance Card for British nationals) covers emergency and medically necessary treatment in Spain’s public health system — useful for tourists and short stays. It does not satisfy Spanish visa requirements, is not a substitute for private insurance, and doesn’t give you access to private hospitals. It also won’t cover ongoing management of pre-existing conditions. It’s a useful backup card to carry; it’s not a health insurance solution.

What happens to my insurance if I leave Spain temporarily?

Most Spanish private health insurance policies are Spain-only (or Spain + limited emergency EU coverage). If you leave Spain for an extended period, your coverage is suspended in most cases — you’re paying for access to Spanish-based healthcare. Some international policies (Cigna, Allianz Care) provide multi-country coverage that can continue while you travel, at higher premiums. If you travel frequently, specify this requirement when comparing policies.

Will insurers cover me if I have pre-existing conditions?

It depends on the condition and the insurer. Many conditions are excluded for the first 12–24 months (carencia for pre-existing conditions), then covered thereafter. More serious or chronic conditions (type 2 diabetes, heart disease, cancer history) may be permanently excluded or require premium loadings. Cigna International and some specialist brokers are better positioned to find coverage for complex health histories than going direct to domestic Spanish insurers. Always declare pre-existing conditions honestly — claims can be denied if undisclosed conditions come to light.

How do I make a claim or see a specialist?

With most Spanish private insurers, you don’t submit claims — you book directly with affiliated (in-network) providers. Find a specialist in your insurer’s app or directory, book an appointment confirming you’re using your policy, and attend. The insurer pays the provider directly. For out-of-network treatment, you’d pay upfront and submit a claim for reimbursement — but this is uncommon for planned care. Emergency treatment at any registered hospital is typically covered even if out-of-network, subject to policy terms.

Can my children be added to my policy?

Yes — most Spanish health insurers allow dependent children under 18 (sometimes under 23 if in full-time education) to be added to an adult policy. Pricing varies: some providers add children for €15–25/month each; others include the first child free on certain plans. Children born or adopted after the policy starts can typically be added within 30 days of birth without a carencia period. Check this specific condition when comparing policies if family coverage matters to you.

Related Guides

• How to Find a Good Gestor
• NIE Guide
• Healthcare Guide
• What Is a Gestoria?

Frequently Asked Questions

More on health cover in Spain

• Compare private health insurers
• What healthcare actually costs
• Cover during your first year in Spain
• Healthcare in Spain: the full guide
• Getting your SIP card (cita previa)