Healthcare for residents in Spain: the S1, work, private cover and the convenio especial

How a resident of the Costa del Sol gets public healthcare, as it stands in October 2026. Spain’s health service is open to the people who live here, but the way in depends on why you are here: work, a pension from another country, or neither. This guide sets out each route, who pays, what you need, the health card that follows, what you pay for prescriptions, and the order to do it in. The facts come from the Spanish law on the health system, the Social Security’s own application form, the decree that sets the state’s paid scheme, the UK government and the Spanish consulate in London, linked where they appear. Which public hospital serves each town, the emergency numbers and how to book a GP appointment are in hospitals on the Costa del Sol, and are not repeated here.

How public healthcare works for a resident

The starting point is article 3 of Ley 16/2003, the law on the national health system. It gives publicly funded care to Spanish nationals and to foreign nationals with legal and habitual residence in Spain, provided they are not obliged to have cover through another route. Anyone outside that can still use the system by paying for care or by joining a special agreement, the convenio especial described below.

Two bodies are involved. The Spanish Social Security records your right to care and gives you a Social Security number. In Andalucía the care itself comes from the regional health service, the SAS, through the health centre for your address. So the order is always the same: first the right, then the health centre, then the card.

Which route records your right depends on your circumstances.

If you work in Spain

Employees and the self-employed get state healthcare on the same basis as Spanish workers, as the UK government’s guidance on healthcare for UK nationals living in Spain explains. The Social Security’s application form for healthcare, form 6-071, states that for workers, and for people drawing a Spanish Social Security pension or other regular benefit, the right is recognised automatically, with no application needed.

You register at your local health centre with your Social Security number, which you get from the Social Security’s general treasury, the TGSS. Your family can be added as your beneficiaries through the same form: a spouse or registered partner, and children, grandchildren or brothers and sisters under 26, or over that age with a recognised disability of 65% or more.

If you draw a UK State Pension: the S1

A UK State Pensioner who lives in Spain can get state healthcare paid for by the United Kingdom. The steps, as gov.uk sets them out, are these.

1. Ask for the S1. It is issued by NHS Overseas Healthcare Services, part of the NHS Business Services Authority, which you call on +44 (0)191 218 1999, Monday to Friday 8am to 6pm and Saturday 9am to 3pm.
2. Register it in Spain. You register the S1 with the Spanish Social Security, the INSS, at a local office or through its online portal.
3. Take the number to your health centre. Once the INSS has processed the S1 it posts you a Spanish Social Security number, and you take that to the health centre for your address.

You and your dependants are then treated on the same basis as a Spanish citizen. A dependant covered by your S1 loses that cover when they start drawing their own UK State Pension, and receives a new S1 of their own to register. S1 holders also receive a UK-issued GHIC to use when travelling, and the NHS card page lists a registered S1 among the grounds for one.

The S1 also matters for the visa. The Spanish consulate in London accepts the receipt of an S1 registered on the Social Security website as the health insurance for the non-lucrative visa, in place of a private policy. The rest of that visa is in Spain’s non-lucrative visa.

A pensioner from another EU country follows the same pattern with their own country’s form. The EU’s guidance on health cover when living abroad says to ask your health insurance institution for an S1, the old E106, and register it with the health insurance where you now live, provided you would be entitled to treatment in the country that pays your pension.

If you live here without work or an S1

This covers, for example, someone who retires here before drawing a UK State Pension, or a retiree from outside Europe with no S1 to register. It runs in three stages.

The first year: private insurance. The non-lucrative visa asks for public or private health insurance with an insurer authorised to operate in Spain, and the policy must cover all the risks covered by Spain’s public health system, in the London consulate’s words. Gov.uk adds that anyone who cannot get public cover in the first year needs private health insurance.

After a year: the convenio especial. This is the state’s own paid scheme, set by Real Decreto 576/2013. Article 3 opens it to anyone who can show a continuous year of effective residence in Spain immediately before applying, is registered on the town hall’s register of residents at the time of applying, and has no access to public cover by any other route. The town hall registration is the padrón, and registering on the padrón explains how each town does it. Article 6 sets the fee:

• €60 a month if you are under 65
• €157 a month if you are 65 or over

It covers the basic common services of the national health system. Gov.uk notes that members pay the full cost of prescriptions, and of non-urgent transport, orthopaedic items, prostheses and dietary products. You apply to the regional health authority for your municipality, which in Andalucía is the SAS. The decree gives it 30 days to decide, treats the application as granted if no decision is notified in that time, and then gives you three months to sign.

After five years: residence. Gov.uk explains that after five years’ residence you can apply for permanent residence and then for state healthcare on the same basis as a Spanish citizen. For that you need a letter from NHS Overseas Healthcare Services confirming that the UK does not cover you, which Spain calls a documento de no exportación. You take it to the INSS, then to your health centre. The Social Security’s form asks the same of any EU, EEA, Swiss or UK national applying as a resident: a certificate from their own country that it does not extend healthcare to Spain, along with proof of legal residence.

The health card

Whichever route you come by, the last step is the health centre for your address. You register there with your Social Security number, and you are given a card to show at the doctor’s, the hospital and the pharmacy. Gov.uk notes that S1 holders are given a medical card.

The padrón registration is worth keeping current, since the convenio especial is granted on it and your health centre is the one for where you live. Appointments, the phone lines and the private hospitals open around the clock are all in the hospitals guide above.

What you pay

Basic state services are free at the point of use once you are registered, although some, such as orthopaedic services, carry a percentage charge. Prescriptions are not free. Residents usually pay between 10% and 60% of the cost of a prescription, depending on their circumstances, and members of the convenio especial pay the full cost, as gov.uk sets out.

A resident with public cover can keep a private policy as well. It pays for care in the private hospitals and clinics, while the public system remains there for everything it covers.

Visitors are different

An owner who visits rather than lives here is not a resident for any of this. The GHIC is the UK’s card for temporary stays, and the 90/180-day rule sets how long those stays can be. The change from visitor to resident is a decision about the visa and the tax as much as the healthcare, and retiring to the Costa del Sol sets the three side by side.

The order to do it in

1. Before you go. If you draw a UK State Pension, ask for the S1. If you need a visa, arrange the cover the consulate will accept: the registered S1, or a private policy with an insurer authorised in Spain.
2. In the first weeks. Register on the padrón. Register the S1, or your work, with the Social Security. Take your Social Security number to the health centre.
3. After a year. Without work or an S1, apply for the convenio especial to the SAS.
4. After five years. With permanent residence, apply to the INSS with the letter confirming the UK does not cover you.

The rest of the move, from the bank account to the driving licence, is set out step by step in moving to the Costa del Sol from the UK.

How I handle it

For a buyer who is moving here rather than visiting, healthcare goes into the plan alongside the visa and the tax, because it decides the timing of the move and the cost of the first year. I check which health centre and which hospital each shortlisted address belongs to before the shortlist is final, and I put the padrón registration on the list for the week you take the keys, since the convenio especial depends on it and the health centre you register with is the one for that address.

I am not a healthcare or immigration adviser, and I say so when a question needs one. What I can do is hold the timetable from the visa to the keys, and introduce you to the lawyer I work with for the residence questions. If you are planning a move and want to talk it through, book a call. Buying with me sets out how I work.

General guidance, not medical, legal or immigration advice. The rules are those of Ley 16/2003, Real Decreto 576/2013 and the Social Security’s form 6-071, with the UK steps as gov.uk published them, all checked on 24 October 2026. Confirm the details for your own health centre with the SAS before you apply.

Common questions