Retiring to Spain: Healthcare Guide for Pensioners
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 5 November 2026
Retiring to Spain?
You don't have to figure this out alone
Dr. Pedro Yelamo Vera is an independent, bilingual GP licensed in Spain. Book a 15-minute video consultation in English or Spanish for €50, with a private electronic prescription issued under Spanish law when clinically appropriate.
Retiring to Spain, your healthcare depends on where your pension comes from. EU, EEA, Swiss and UK state pensioners usually register an S1 form and join the public system. Retirees from the US, Canada and other non-EU countries need private health insurance for the visa. After a year, some can pay into the public system.
- With a state pension from the UK, the EU, the EEA or Switzerland, you ask that country for an S1 form and register it in Spain.
- The S1 gives you a Spanish health card and public care on the same terms as people insured here.
- Pensioners in the Spanish system pay 10% of the price of most prescribed medicines, with a monthly cap that depends on income.
- Non-EU retirees on the non-lucrative visa need private insurance with an insurer authorised in Spain.
- After one year of residence, the convenio especial costs €157 a month from age 65. It does not include prescriptions.
- Before you buy a policy over 65, check age limits, pre-existing conditions, rising premiums and renewal rules.
Dr. Pedro Yelamo Vera is a GP licensed in Spain (Colegiado No. 484814280).
For a medical emergency, call 112 or go to the nearest local emergency department. Do not wait for a video consultation or an online reply.
How does healthcare work when you retire to Spain?
Spain's public health system (SNS) covers people who are insured here or whose care another country pays for. As a retiree you usually join it in one of three ways:
- S1 form: for people who receive a state pension from the UK, an EU or EEA country or Switzerland. The pension country pays for your care in Spain.
- Private insurance: for most non-EU retirees, at least at first. It is a condition of the non-lucrative residence visa.
- Convenio especial: a monthly fee to join the public system after one year of residence, if you have no other right to it.
Our side-by-side guide to health cover in Spain compares every option.
What is the S1 form, and who gives it to you?
The S1 is an EU form that proves another country pays for your healthcare. The European Commission says you ask the country that pays your pension for it. You then use it to register with the health service where you live. After that you are treated like a person insured there.
Who issues it depends on the country:
- UK: the NHS Business Services Authority (Overseas Healthcare Services). You must already receive your UK State Pension to apply. You can apply online or through its helpdesk.
- France: CLEISS says you ask your basic pension fund, not your CPAM. For most private-sector retirees that is the Assurance retraite (CNAV).
- Germany: an EU leaflet in German says you apply to the health insurer where you are insured.
- Other EU or EEA countries and Switzerland: ask the body that pays your pension or your health insurer at home.
How do you register the S1 and get a Spanish health card?
You register the S1 with Spain's Social Security office (INSS). Then you sign up at your local health centre. GOV.UK describes the steps for UK pensioners, and they work much the same for others:
- Register your S1 at your local INSS office or through the INSS online portal.
- The INSS sends you a Spanish social security number by post.
- Take it to your local health centre (centro de salud) to register.
- You are given a medical card to use at the doctor, the hospital and the pharmacy.
UK pensioners: the NHS says to stop using your old UK GHIC or EHIC once your S1 is issued, then apply for a new UK-issued card after you register in Spain. If you need urgent care before registration is done, GOV.UK says to call Overseas Healthcare Services on 0044 191 218 1999.
Retiring to Spain from the UK: what is different after Brexit?
If you receive the UK State Pension, you can still apply for an S1: the NHSBSA bases eligibility on receiving it. What changed is residence: GOV.UK tells UK nationals to check which visa or permit they need. Early retirees below State Pension age cannot get an S1 as pensioners. They follow the non-EU path below: private insurance first, then possibly the convenio especial.
What do pensioners pay for prescriptions in Spain?
Pensioners in the Spanish public system pay 10% of the price of most prescribed medicines. A monthly cap limits what you pay. Royal Decree-law 11/2026, published in the BOE on 13 May 2026, sets these caps by yearly income. It came into force on 14 May 2026, and Congress validated it on 28 May:
| Yearly income | Your share | Monthly cap |
|---|---|---|
| Under €18,000 | 10% | €8.23 |
| €18,000 to under €60,000 | 10% | €13.37 |
| €60,000 to under €100,000 | 10% | €18.52 |
| €100,000 or more | 60% | €61.75 |
Pensioners who receive the top-up for pensions below the minimum pay nothing. If you pay more than your cap, your region refunds it at least every six months.
The Comunidad de Madrid says the previous rates and caps still apply for now. The INSS must first load updated tax data, which it usually does once a year between October and December. Your pharmacy, your health centre or your region's health app can show your own rate. People on the convenio especial pay the full cost of medicines, says GOV.UK.
What if you retire to Spain from the US, Canada or another non-EU country?
Most non-EU retirees come on the non-lucrative residence visa. Spain's Ministry of Inclusion says you need public or private health insurance with an insurer authorised to work in Spain. The rules are in Royal Decree 1155/2024. The first permit lasts one year.
Consulates add detail. The Spanish consulate in San Francisco, for example, wants a certificate in Spanish from an insurer working in Spain. The policy must cover 100% of medical, hospital and outpatient costs, with no copayments, no pre-existing exclusions and no coverage limit. Travel insurance is not accepted. Rules vary, so check with your consulate.
US retirees should know that Medicare usually does not cover care outside the US. After one year of continuous residence, you may apply for the convenio especial, as long as you are on the padrón and have no other public cover. It costs €60 a month under 65 and €157 a month from 65, under Royal Decree 576/2013. Read our convenio especial guide for the details.
Which health insurance covers expats over 65 in Spain?
Policies for people over 65 differ a lot, and we do not recommend brands. Compare the policy wording on these points before you sign:
- Age limit for new customers. Ask whether there is a maximum age to join.
- Pre-existing conditions. Check what is excluded and for how long. A visa policy must not exclude them.
- Premiums with age. Ask how the price changes as you get older.
- Renewal. Spain's insurance contract law lets either side refuse to renew, with written notice (two months for the insurer). Ask in writing whether the policy offers a lifetime renewal guarantee.
- Network and limits. Check that hospitals are near your home, and look for limits on medicines, dental care and physiotherapy.
Which region of Spain is best for retirees, from a healthcare point of view?
No region is best for everyone. Healthcare is run by each region, so look at the place, not just the climate. Before you choose a town, check:
- How far it is to the nearest public hospital with an emergency department.
- Where your health centre and the nearest pharmacy are.
- Waiting times in that region. Our guide to waiting times by region uses the official data.
- Whether help in your language is nearby, from family, carers or a private doctor.
What should you bring, and which vaccines are offered to older adults?
Bring copies of your medical records and recent test results. Make a list of every medicine you take, by generic name and strength. A Spanish pharmacy should dispense a valid prescription from another EU country if it has all the required details and the medicine is sold here. In practice, some pharmacies still ask for a Spanish one. UK prescriptions are accepted only at the pharmacist's discretion, and NHS e-prescriptions cannot be used. US and other non-EU prescriptions are not valid. A prescription from a doctor licensed in Spain is the reliable route. See our guide to UK and US prescriptions in Spain.
Spain's 2026 vaccine calendar, agreed by the national health council, offers older adults:
- A flu vaccine each season from age 60.
- A COVID-19 vaccine for older adults. The starting age is set each season (70 in 2025–2026).
- Pneumococcal vaccine from age 65.
- Shingles vaccine at 65, with older age groups up to 80 being added over time.
- A tetanus and diphtheria booster around age 65, if you had all five doses as a child and teenager.
Ask at your health centre once you are registered. Regions set their own campaign dates.
How do you keep long-term conditions under control after the move?
Gaps happen in the first months, before you have a Spanish GP. Plan for them:
- Bring enough medicine to last until you are registered.
- Ask your doctor at home for a short letter with your diagnoses, medicines and recent results.
- Book a first visit with your new GP once you have your health card.
- Public visits may be in Spanish only. A carer, a relative or a translation app can help with the basics.
Our guide to chronic condition follow-up explains how to keep your records together.
Talking it through with a doctor by video
Dr. Yelamo is a GP licensed in Spain. He sees adults, children and pregnant patients by video, every day from 07:30 to 20:30 (Spain time). It can help while you wait for your health card, or alongside public care. In the visit he will:
- Review your medicine list and your records from home.
- Talk through new symptoms that are urgent but not an emergency.
- Tell you when you need a test, an in-person exam or the public system.
He does not promise any test or prescription before the visit. Where clinically appropriate, following a genuine evaluation. Treatment and prescriptions are issued solely at the doctor's discretion based on evidence-based clinical guidelines.
A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
See how the Urgent Care video visit works. It lasts 15 minutes and costs €50.
This guide is general information. It does not replace a consultation with your doctor.
Frequently asked questions
Do UK pensioners get free healthcare in Spain?
If you receive the UK State Pension, you can ask the NHS for an S1 form and register it with the INSS. You then get public care in Spain on the same terms as people insured here, paid for by the UK. You still pay a share of prescription costs.
I am a German or French pensioner moving to Spain. Who gives me the S1?
In Germany, you apply to the health insurer where you are insured. In France, CLEISS says you ask your basic pension fund, such as the Assurance retraite, not your CPAM. In both cases you then register the S1 in Spain.
Can I join the convenio especial if I have an S1?
No. GOV.UK says that if the UK pays for your care through an S1, you cannot join the convenio especial. It is for residents of at least one year with no other right to public care.
Does Medicare cover me if I retire to Spain?
Usually not. Medicare.gov says Medicare usually does not cover care outside the US, with a few rare exceptions. US retirees in Spain need private insurance and may later apply for the convenio especial.
What should I check in health insurance for expats over 65 in Spain?
Check the maximum age to join, how pre-existing conditions are treated, copayments, how premiums rise with age, renewal rules and whether the hospital network is near your home. For a visa, it must have no copayments or pre-existing exclusions.
Do I pay for prescriptions as a pensioner in Spain?
Usually yes, but not much. Pensioners in the public system pay 10% of most medicines, with a monthly cap from €8.23 to €18.52 depending on income, or 60% with a €61.75 cap from €100,000 a year. Some low-income pensioners pay nothing.
Related guides
Sources
This content is written and reviewed by a licensed physician with reference to the following sources.
- GOV.UK: Healthcare in Spain, including the Balearic and Canary Islands
- NHS Business Services Authority: Applying for an S1
- European Commission: Social security FAQ, sickness benefits
- CLEISS: Retiring to an EU/EEA country or Switzerland (in French)
- EU-Gleichbehandlungsstelle: Information on form S1 (in German)
- BOE: Royal Decree-law 11/2026 on the pharmacy contribution (in Spanish)
- Comunidad de Madrid: How much do I pay for my medicines? (in Spanish)
- BOE: Royal Decree 576/2013, convenio especial (in Spanish)
- Ministry of Inclusion: Non-lucrative residence permit (in Spanish)
- Consulate General of Spain in San Francisco: Non-lucrative residence visa
- Medicare.gov: Travel outside the U.S.
- Ministry of Health: Lifelong vaccination calendar (in Spanish)
- Ministry of Health: Recommended lifelong vaccination calendar 2026 (in Spanish)
- Your Europe: Prescriptions in another EU country
