Country guide — Europe
Expat insurance and health insurance in Spain
In short
For a French citizen, also an EU citizen, private health insurance is not required by Spanish law to move to Spain: EU free movement removes the need for any visa. Access to the national health system (SNS) goes through affiliation with Spanish social security, mandatory for an employee or a self-employed person; someone without an activity must check their rights case by case (form S1 for a retiree, private cover in some cases). Without cover during the transitional period, the risk isn't a legal penalty but having to pay 100% of costs, except for life-threatening emergencies.
Key figures
- 85,201 French nationals registered with the consular register in 2025 (82,337 in 2024, +3.48%) — the actual French community is estimated to be far larger, as some residents don't register.
- Life expectancy at birth: 84.01 years in 2024 — the highest in the European Union.
- Health spending: ≈9.7% of GDP, below the European average despite recognised universal access.
Local healthcare system
Spain has a universal system, the Sistema Nacional de Salud (SNS), funded by taxation and run by the 17 autonomous communities, alongside a well-developed private sector (Quirónsalud, Sanitas, HM Hospitales). Access relies on affiliation with the Seguridad Social (through employment, self-employment under the RETA scheme, or as a dependant), which gives the tarjeta sanitaria individual (TSI).
The empadronamiento (registration on the municipal roll) is an almost systematic prerequisite, including for the tarjeta sanitaria in several autonomous communities. Royal Decree 7/2018 guarantees access to general practice and emergency care for anyone empadronado, regardless of their administrative status. A non-affiliated EU citizen can use the EHIC, but only for a temporary stay.
Legal and visa obligations
- EU citizen: no insurance required by law, but travel insurance is recommended for the period before full affiliation, and essential for repatriation.
- Employee or self-employed: mandatory Seguridad Social affiliation as soon as employment or activity begins (RETA scheme for autónomos).
- Person without an activity: EU law requires, beyond 3 months, sufficient resources and comprehensive health cover — how Spain applies this in practice should be checked case by case.
- Mandatory registration: Certificado de Registro de Ciudadano de la Unión (NIE number) for any stay longer than 3 months.
- Seconded employee: form A1, staying on the French scheme for up to 24 months (extendable).
- Retiree: form S1 for affiliation with no new contribution, in place of the EHIC.
Cost of some medical procedures
Orders of magnitude from specialised sources, not official fee schedules.
| Procedure | Public sector | Private sector |
|---|---|---|
| GP consultation | — | ≈€60 |
| Specialist consultation | — | €70 to €110 |
| Emergency care (public sector) | Free for an affiliated or empadronado resident | — |
| Emergency care (private sector) | — | €120 to €300 for the initial consultation, more with further tests |
| Blood tests | — | €24 to €50 for a basic panel, more for a full panel |
| MRI | — | €85 to €500 depending on the body area and city |
| CT scan | — | €90 to €400 on average, up to €800 depending on the area scanned |
| Night of private hospitalisation | — | ≈€250/day (room, equipment and treatment included) |
Social security agreements with France
As Spain is an EU member, there is no classic bilateral agreement: coordination is via the EU regulations 883/2004 and 987/2009 (in force since 1 May 2010).
- Temporary stay: the EHIC (to be requested at least 20 days before departure) allows cover as a Spanish-insured person would receive; it covers neither repatriation nor planned care.
- Long-term move: switching to the Seguridad Social then the tarjeta sanitaria; form S1 for a retiree.
- Seconded employee: form A1, staying on the French scheme for up to 24 months (extendable).
- Reimbursement of costs paid upfront in Spain is possible on return via form S3125.
Which insurance for my profile
General matrix — does not recommend any specific product or insurer.
| Profile | Regulatory constraint | Points of attention |
|---|---|---|
| Working holiday visa | Not applicable (France-Spain = EU free movement) | — |
| Student | No visa required | EHIC for a temporary stay, full affiliation for a long stay; supplementary repatriation cover is worth considering |
| Seconded employee | Staying on the French scheme via form A1 | Health/repatriation supplementary cover useful for quick access to the private sector |
| Local employee / self-employed (RETA) | Mandatory Seguridad Social affiliation | Private supplementary cover commonly used to reduce public waiting times |
| Retiree (form S1) | Affiliation with no new contribution | Supplementary cover worth considering for access to the private sector and uncovered needs |
Hospitals and care network
- Madrid: Hospital Universitario La Paz (public, ranked by Newsweek 2025) and Hospital Universitario Quirónsalud Madrid (private, international patient base).
- Barcelona: Hospital Clínic de Barcelona (leading public Catalan hospital), Hospital Quirónsalud Barcelona and Hospital Vall d'Hebron (private, well-ranked).
Practical steps
- Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds).
- NIE: apply at the relevant Spanish police station or the Spanish consulate in France (≈2 to 6 weeks).
- Empadronamiento: registration on the municipal roll (Ayuntamiento), usually right after the NIE.
- Certificado de Registro de Ciudadano de la Unión: for any stay longer than 3 months.
- Seguridad Social affiliation and tarjeta sanitaria for an employee or self-employed person.
- Retiree: request form S1 from your French pension fund.
- Register with the roll of French nationals living abroad (Madrid or Barcelona).
Frequently asked questions
Does a French citizen need a visa to move to Spain?
No. As an EU citizen, a French national does not need a visa. Registration on the foreign nationals' roll (Certificado de Registro) is required beyond 3 months of stay.
Is the EHIC enough for a French national settling in Spain long-term?
No. The EHIC covers temporary stays. A long-term resident must switch to full Seguridad Social affiliation, or via form S1 for a retiree.
What is the empadronamiento and why does it matter so much?
It's registration on the municipal roll of residents. It's a prerequisite for many procedures, including, depending on the autonomous community, getting the tarjeta sanitaria.
Does an employee seconded from France need to register with Spanish Seguridad Social?
No, if they hold form A1 confirming they stay on the French scheme, for a period not exceeding 24 months (extendable under conditions).
Does someone without a professional activity need private insurance to move to Spain?
EU law requires, for an inactive EU citizen staying more than 3 months, sufficient resources and comprehensive health cover — how Spain applies this in practice is worth checking case by case.
Moving to Spain? Get a quote
Written by Expavy
Sources
- France Diplomatie — Spain, Health
- CLEISS — Holidays in Spain
- CLEISS — Social security for employees in Spain
- Comunidad de Madrid — Tarjeta Sanitaria
- CLEISS — Form S1
- France Diplomatie — Global register of French nationals abroad (2025)
- El Independiente — Hospital price list in Spain (emergency care, hospitalisation)
- ASPE (Spanish private healthcare alliance) — Cost of private hospitalisation
- SaludOnNet comparison tool — CT scan price in Spain