# Healthcare in Spain



## alfp (May 17, 2013)

Hello
My wife and I are thinking of renting for part of the year in Almeria, as this may be more convenient than buying. Can we continue to access NHS care in the UK and how would we stand for emergency care in Spain. Alternatively, if we were to buy and could show some proof of income, would this be any easier.
Thanks
Alf


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## extranjero (Nov 16, 2012)

Depends how long you live in Spain-once you live here over 6 months you are no longer eligible for UK NHS care, and you have to sign on the citizens register and would also be liable for Spanish income tax on your incomes from UK. The EHIC card is only valid for up to 3 months for emergency care.You would have to contact Travel ins companies for longer stays. Whether you buy or rent makes no difference.
Best solution is to come over for stays of 3 months or less.


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## xabiaxica (Jun 23, 2009)

extranjero said:


> Depends how long you live in Spain-once you live here over 6 months you are no longer eligible for UK NHS care, and you have to sign on the citizens register and would also be liable for Spanish income tax on your incomes from UK. The EHIC card is only valid for up to 3 months for emergency care.You would have to contact Travel ins companies for longer stays. Whether you buy or rent makes no difference.
> Best solution is to come over for stays of 3 months or less.


not quite... you aren't eligible for UK healthcare from the minute you are resident in Spain - you are considered to be resident after 90 days (whether you register or not) from then you aren't entitled to UK healthcare

you are supposed to register at/by 90 days - up to that point you can still be considered to be on holiday..& use your EHIC card here as a tourist for emergency care

owning a property _might _make a difference, but at the moment you need to show proof of income into a Spanish account & healthcare provision

tax residency is a separate issue entirely


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## jojo (Sep 20, 2007)

As a resident of Spain and having paid into the UK NI system, you can fill in the S1 form, which then gives you reciprocal care in Spain

Jo xxx


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## xabiaxica (Jun 23, 2009)

jojo said:


> As a resident of Spain and having paid into the UK NI system, you can fill in the S1 form, which then gives you reciprocal care in Spain
> 
> Jo xxx


yes, for a limited period - of course if they get a UK state pension it lasts as long as they do


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## alfp (May 17, 2013)

extranjero said:


> Depends how long you live in Spain-once you live here over 6 months you are no longer eligible for UK NHS care, and you have to sign on the citizens register and would also be liable for Spanish income tax on your incomes from UK. The EHIC card is only valid for up to 3 months for emergency care.You would have to contact Travel ins companies for longer stays. Whether you buy or rent makes no difference.
> Best solution is to come over for stays of 3 months or less.


Hello
3 months at a time sounds OK, but would that be a maximum of 6 months per year?
Thanks
Alf


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## extranjero (Nov 16, 2012)

*Healthcare*

For each 3 month period


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## 90199 (Mar 21, 2010)

I was resident in Spain for over 90 days, I had Spanish residency. 

For the remaining 274 days I was resident in the U.K.

I used the Spanish health service whilst in Spain, and quite legally used the U.K. NHS whilst there, in fact my doctor in the U.K. prescribed my tablets for the duration of my stay in Spain.


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## extranjero (Nov 16, 2012)

*Healthcare*



Hepa said:


> I was resident in Spain for over 90 days, I had Spanish residency.
> 
> For the remaining 274 days I was resident in the U.K.
> 
> I used the Spanish health service whilst in Spain, and quite legally used the U.K. NHS whilst there, in fact my doctor in the U.K. prescribed my tablets for the duration of my stay in Spain.


This goes against everything I have been told!
So why are we told:
a) after 90 days you are removed from the UK NHS if resident in Spain
b) you cannot be on both the Spanish AND the UK health service at the same time


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## alfp (May 17, 2013)

Yes, but could I only legally spend a maximum of 6 months of the year without needing to apply for residency.
Alf


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## baldilocks (Mar 7, 2010)

alfp said:


> Yes, but could I only legally spend a maximum of 6 months of the year without needing to apply for residency.
> Alf


and only in blocks of up to 90 days and in order to apply for residency you must show that you have sufficient income going into a Spanish bank account *and* have healthcare provision (EHIC does not count!)


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## extranjero (Nov 16, 2012)

Whether you sign on the citizens register or not (no residency now)you will be regarded as resident and liable for income tax on all your incomes from UK(except crown pensions) to be paid in Spain!


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## extranjero (Nov 16, 2012)

It's now called signing on the citizens register , not applying for residency. Just by being in Spain longer than 183 days you are regarded as resident and liable for income tax in Spain(even if not registered on the Spanish tax system) on incomes from UK. the two are inter linked, not separate as someone else said.


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## baldilocks (Mar 7, 2010)

extranjero said:


> It's now called signing on the citizens register , not applying for residency. Just by being in Spain longer than 183 days you are regarded as resident and liable for income tax in Spain(even if not registered on the Spanish tax system) on incomes from UK. the two are inter linked, not separate as someone else said.


and signing onto the Padrón (the local register) is something else and also very important!


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## extranjero (Nov 16, 2012)

Hepa said:


> I was resident in Spain for over 90 days, I had Spanish residency.
> 
> For the remaining 274 days I was resident in the U.K.
> 
> I used the Spanish health service whilst in Spain, and quite legally used the U.K. NHS whilst there, in fact my doctor in the U.K. prescribed my tablets for the duration of my stay in Spain.


 Hepa-Please can you comment on my reply to this post?


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## alfp (May 17, 2013)

extranjero said:


> For each 3 month period


Sorry, I wasn't very clear, could I only spend 2x 90 day stays in Spain in any given year to avoid having to apply for residency.


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## alfp (May 17, 2013)

Presumably, cost of private health insurance would not be a flat rate and would depend on existing illnesses.
Alf


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## xabiaxica (Jun 23, 2009)

alfp said:


> Presumably, cost of private health insurance would not be a flat rate and would depend on existing illnesses.
> Alf


yes, but cheaper than you might expect if you're a Spanish resident

if you're a UK citizen on holiday here (for up to 90 days at a time, for as many 90 day periods as you like, in theory, bearing in mind the tax residency issue, which arguably means you're resident in any case), then you can use your EHIC - if the computer system doesn't pick up on the fact that you've used it a lot & 'decide' that you're resident anyway...........

if you're resident here, you might qualify for state healthcare with a form S1 - if you have a UK state pension then that's automatic & lasts as long as you do - if not, then you might still qualify for a limited period if you've recently paid enough NI in the UK

once resident in Spain - & you are considered to be resident after 90 consecutive days even if you neglect to register - you are no longer entitled to use the UK NHS except as a tourist, using the Spanish version of the EHIC


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## alfp (May 17, 2013)

Do you mean that private healthcare is cheaper in Spain, or is it possible to pay into the state scheme.


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## 90199 (Mar 21, 2010)

extranjero said:


> This goes against everything I have been told!
> So why are we told:
> a) after 90 days you are removed from the UK NHS if resident in Spain
> b) you cannot be on both the Spanish AND the UK health service at the same time


Dunno, ask the person who told you. I can only relate my experiences of the systems as I found them.

Both Health services were quite happy to treat me, and although I registered as a Spanish resident, at that time I was spending more time in the U.K. so needed health car there, more so than in Spain.


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## snikpoh (Nov 19, 2007)

alfp said:


> Do you mean that private healthcare is cheaper in Spain, or is it possible to pay into the state scheme.


Yes, private care is cheaper in Spain

No, you can't just pay into the state scheme unless you are working and paying your SS (NI) contributions.


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## xabiaxica (Jun 23, 2009)

alfp said:


> Do you mean that private healthcare is cheaper in Spain, or is it possible to pay into the state scheme.


yes, it's cheaper - & as snikpoh says, currently you would have to be working in order to 'pay into' the state system

my point though was that you might not have to - if you qualify for S1s, the UK pays for your healthcare here by way of a reciprocal agreement


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## extranjero (Nov 16, 2012)

*health care*



Hepa said:


> Dunno, ask the person who told you. I can only relate my experiences of the systems as I found them.
> 
> Both Health services were quite happy to treat me, and although I registered as a Spanish resident, at that time I was spending more time in the U.K. so needed health car there, more so than in Spain.


I think you will find it is not allowed, and possibly the UK doctor could get into trouble if he treated you knowing you were a resident in Spain, unless you were using the EHIC issued by UK to Pensioners in Spain by DWP for emergency use. I did not get the impression that this was the case!


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## alfp (May 17, 2013)

xabiachica said:


> yes, it's cheaper - & as snikpoh says, currently you would have to be working in order to 'pay into' the state system
> 
> my point though was that you might not have to - if you qualify for S1s, the UK pays for your healthcare here by way of a reciprocal agreement


Understood. This is for 2 years I think, which is a useful breathing space, if that's the case?


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## 90199 (Mar 21, 2010)

extranjero said:


> I think you will find it is not allowed, and possibly the UK doctor could get into trouble if he treated you knowing you were a resident in Spain, unless you were using the EHIC issued by UK to Pensioners in Spain by DWP for emergency use. I did not get the impression that this was the case!


Of course it was allowed. I was spending 274 days in the U.K., because I was spending the remainder 91 days here, by Spanish, law I had to apply for residencia, this I did gladly, for ferry and air fares then came at half price.

In the U.K. I resided at the same address I had resided at for the previous 25 years, the same doctor treated me, just because I chose to take an extended winter break, 91 days or more, did not disqualify me from U.K. health care when I returned.

Same for those who go on 7month world cruises, they are not disqualified from U.K. health acre when they return. 

If the Canarian health authorities were willing to treat my ailments with no charge, then I was willing to let them. 

You think what you will, possibilities and probabilities are of no interest to me, I relate previous experiences and only deal in facts. If you do not like the answers I give, then please feel free to ignore them.


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## extranjero (Nov 16, 2012)

*Health*



Hepa said:


> Of course it was allowed. I was spending 274 days in the U.K., because I was spending the remainder 91 days here, by Spanish, law I had to apply for residencia, this I did gladly, for ferry and air fares then came at half price.
> 
> In the U.K. I resided at the same address I had resided at for the previous 25 years, the same doctor treated me, just because I chose to take an extended winter break, 91 days or more, did not disqualify me from U.K. health care when I returned.
> 
> ...


You did not say whether you registered on the Spanish health service. If so, then I cannot understand how you were allowed free NHS care in both countries. Obviously as a resident in Spain you weren't allowed to use the EHIC issued in UK for use in the EEC.


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## Guest (May 18, 2013)

extranjero said:


> This goes against everything I have been told!
> So why are we told:
> a) after 90 days you are removed from the UK NHS if resident in Spain
> b) you cannot be on both the Spanish AND the UK health service at the same time


The bottom line in all this is WHO from the UK NHS is going to monitor ( and therefore
chase up your current UK residency status ) the answer is No one.
If your last UK residency address is your parents address, your laughing.
The cash strapped NHS is too busy trying to make ends meet with its NHS Trusts
to afford to setup a team to check everyone's current residency status in Britain.

HMRC on the other hand can afford to do it and of course its always in their
best interests to do so - as tax evasion is a big issue.

Speaking personally I find my campaigns in Spain, lasting no longer than 3 months
and of course, while I'm out in the field. I could be traveling from one encampment
to the other in different regions of Spain, so need to Register on the Padron.
Of course if ever any of my campaigns lasted longer than 3 months, I could honestly
say that I'm of 'No fixed abode, being attached to Wellington's field headquarters'


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## gus-lopez (Jan 4, 2010)

extranjero said:


> You did not say whether you registered on the Spanish health service. If so, then I cannot understand how you were allowed free NHS care in both countries. Obviously as a resident in Spain you weren't allowed to use the EHIC issued in UK for use in the EEC.


Pensioners have full healthcare in Spain & the Uk.

" have lived lawfully in the UK for at least ten years continuously in the past and are now living in an EEA member state, or Switzerland, or in a country with which the UK has a healthcare agreement. Your spouse, civil partner and dependent children are also entitled to free NHS hospital treatment if they fall ill. They must be living with you throughout your stay in the UK "


Citizens Advice - NHS charges for people from abroad


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## extranjero (Nov 16, 2012)

*ex pats healthcare*



gus-lopez said:


> Pensioners have full healthcare in Spain & the Uk.
> 
> " have lived lawfully in the UK for at least ten years continuously in the past and are now living in an EEA member state, or Switzerland, or in a country with which the UK has a healthcare agreement. Your spouse, civil partner and dependent children are also entitled to free NHS hospital treatment if they fall ill. They must be living with you throughout your stay in the UK "
> 
> ...


So why are we told to have EHIC card/travel insurance when visiting Britain. Why then did I receive a letter from the NHS after moving to Spain, informing me I was no longer on the NHS in the UK. The Govt aren't going to pay for your healthcare in Spain AND in UK, leaving you to be a health tourist, helping yourself when you like!


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## gus-lopez (Jan 4, 2010)

extranjero said:


> So why are we told to have EHIC card/travel insurance when visiting Britain. Why then did I receive a letter from the NHS after moving to Spain, informing me I was no longer on the NHS in the UK. The Govt aren't going to pay for your healthcare in Spain AND in UK, leaving you to be a health tourist, helping yourself when you like!


You've lost me. 
When you reach retirement age the UK gov. pays a set amount to Spain, assuming you are registered , for your health care under the reciprocal agreement/EU rules. The EHIC is supplied by the UK as they are actually paying for your healthcare & it saves on cost , as there is no point Spain supplying it to then claim back from the UK.


"If you're receiving a UK state pension or long-term incapacity benefit, you may be entitled to healthcare paid for by the UK. You will need to apply for form S1 (or an E121 if you are moving to Iceland, Liechtenstein, Norway or Switzerland), which you need to present to the health authorities in your new country of residence. You will then be treated on the same basis as a resident of that country.

Once you have registered your S1 (or E121) in your new country of residence, you will be entitled to a UK-issued European Health Insurance Card (EHIC), allowing you to access state-funded necessary medical treatment when you visit other EEA countries besides the one in which you are resident, including when you return to the UK."

from here under "Receiving a UK state pension or long-term incapacity benefit " ;

Living abroad - Healthcare abroad - NHS Choices


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## Guest (May 19, 2013)

gus-lopez said:


> You've lost me.
> When you reach retirement age the UK gov. pays a set amount to Spain, assuming you are registered , for your health care under the reciprocal agreement/EU rules. The EHIC is supplied by the UK as they are actually paying for your healthcare & it saves on cost , as there is no point Spain supplying it to then claim back from the UK.
> 
> 
> ...


Surprised nobodies popped the question of what happens if you choose to
go Private. That is choose the BUPA equivalent medical cover for Spain, for
like the NHS, the Spanish State health care system has it's limitations.
Particularly if you need treatment urgently but don't want to be fobbed
off with the usual long wait to see a hospital consultant.


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## xabiaxica (Jun 23, 2009)

Lieut Campers said:


> Surprised nobodies popped the question of what happens if you choose to
> go Private. That is choose the BUPA equivalent medical cover for Spain, for
> like the NHS, the Spanish State health care system has it's limitations.
> Particularly if you need treatment urgently but don't want to be fobbed
> off with the usual long wait to see a hospital consultant.


funny you should bring that up

I know someone with private health insurance here who started having similar symptoms to one of my daughters at about the same time she did - sometime in February

I took her to her state paediatrician - he went to his private GP - I made the appointment online the day before - he had to wait a week

a week later we were back for a check-up & the paediatrician said an x-ray & scan were required

the appointments were made by the receptionist that day for the following week - my friend was still waiting to see his private GP

the day after the scan & x ray - back at paediatrician - referral to hospital consultant for the following week - the hospital is 20 minutes away

my friend had now seen the GP & was waiting to be sent an appt for an x ray & scan - the hospital is an hour away

consultant appt for my daughter - 10 sessions of physio required - we can have this done in our local centro de salud so we made a detour, dropped the letter off & they rang me the next day for an appt the following day - she had 10 sessions over next 3 weeks & was given an 8am appointment so that she didn't have to miss too much school - just before the last appt I was to phone the hospital for a check up - which was arranged for a couple of days later - 6 more physio sessions required, which were spread over the next couple of weeks & then a final check up appt at the hospital made there & then...........


so, since February she has had 3 paediatrician appointments, 3 hospital appointments apart from the scan & x ray & 16 physio sessions - & is now fine 

my friend has so far seen a consultant twice, had a scan & an x ray & had 2 physio appts - they still don't know what's wrong & he's in agony - & no - none of the medical staff he has encountered speak English..............


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## extranjero (Nov 16, 2012)

*Health*



gus-lopez said:


> You've lost me.
> When you reach retirement age the UK gov. pays a set amount to Spain, assuming you are registered , for your health care under the reciprocal agreement/EU rules. The EHIC is supplied by the UK as they are actually paying for your healthcare & it saves on cost , as there is no point Spain supplying it to then claim back from the UK.
> 
> 
> ...


I know that, am not arguing with it. The EHIC is for emergency treatment only; for all care after that you need travel ins. You can't use your former GP in the NHS in UK for other treatment if you are registered on the Spanish health system.You are no longer eligible as you have been removed from the NHS list. You can't flit between UK and Spain as a health tourist.


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## gus-lopez (Jan 4, 2010)

extranjero said:


> I know that, am not arguing with it. The EHIC is for emergency treatment only; for all care after that you need travel ins. You can't use your former GP in the NHS in UK for other treatment if you are registered on the Spanish health system.You are no longer eligible as you have been removed from the NHS list. You can't flit between UK and Spain as a health tourist.


No the Uk issued EHIC entitles you to full healthcare in the UK as well as Spain where you are registered.

" you will be entitled to a UK-issued European Health Insurance Card (EHIC), allowing you to access state-funded necessary medical treatment when you visit other EEA countries besides the one in which you are resident, including when you return to the UK."

Not just emergency care. Anyone is entitled to emergency healthcare anywhere , whether holding an Ehic/ TSE or not.


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## Calas felices (Nov 29, 2007)

Surely the key word is necessary??


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## xabiaxica (Jun 23, 2009)

Calas felices said:


> Surely the key word is necessary??


yes - though I still reckon it _might not _cover you for a hospital stay, even if it was 'necessary'.....


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## 90199 (Mar 21, 2010)

Paying taxes and Nat Ins. to the U.K. coffers for the past 50 years, and still reluctantly paying taxes. 

One would expect full heath cover throughout Europe, if not, why have I been paying huge amounts in Taxes and Nat Insurance, since I was 15 years old.


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## extranjero (Nov 16, 2012)

*Healthcare*

There appears to be confusion. We are advised by the Consul that travel insurance is necessary, as well as the EHIC, which we are told is for emergency treatment;so I would assume that when you have been resuscitated you will be covered by EHIC. when you finish your recovery in the ward your travel ins takes over, no?
Hepa- as UK NHS care is residence based, they won't care if you've been paying taxes, N.I for umpteen years. If you don't live there for over 183 days of the year you're not entitled, except as described above. Harsh, but true!


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