# Pay full Spanish taxes but get no health care?



## hbjhbj (May 22, 2017)

It seems to be that in Spain as an permanent non-lucrative resident expat, you pay full Spanish taxes, but don't get Spanish citizens' health care benefits? Is that true or am I missing something?


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## xabiaxica (Jun 23, 2009)

hbjhbj said:


> It seems to be that in Spain as an permanent non-lucrative resident expat, you pay full Spanish taxes, but don't get Spanish citizens' health care benefits? Is that true or am I missing something?


:welcome:

Yes I'm afraid it's true. You have to be contributing to Social Security in order to access state healthcare.

In areas where it's available, once you have been resident for 12 months you can join the _convenio especial_ & use the state system - although again it's contributory.


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## hbjhbj (May 22, 2017)

xabiachica said:


> :welcome:
> 
> Yes I'm afraid it's true. You have to be contributing to Social Security in order to access state healthcare.


Wow, that's terribly unfair, especially given Spain's outrageous tax rates.


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## hbjhbj (May 22, 2017)

xabiachica said:


> :welcome:
> 
> Yes I'm afraid it's true. You have to be contributing to Social Security in order to access state healthcare.
> 
> In areas where it's available, once you have been resident for 12 months you can join the _convenio especial_ & use the state system - although again it's contributory.


And thanks for the welcome!


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## xabiaxica (Jun 23, 2009)

hbjhbj said:


> And thanks for the welcome!


Coming from the USA as your flags suggest, you'll find private healthcare insurance to be comparatively incredibly inexpensive.


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## hbjhbj (May 22, 2017)

xabiachica said:


> Coming from the USA as your flags suggest, you'll find private healthcare insurance to be comparatively incredibly inexpensive.


Is there a preferred company many US expats like?


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## snikpoh (Nov 19, 2007)

hbjhbj said:


> Wow, that's terribly unfair, especially given Spain's outrageous tax rates.


Not at all.

I think you are under the misapprehension that taxes pay for health care - they don't.

If you make social security payments in Spain, then you get state health care. It's nothing to do with paying taxes.

Also, you are not a Spanish citizen but a Spanish resident - two different things.


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## palooka (May 9, 2017)

hbjhbj said:


> Is there a preferred company many US expats like?


I'm also curious about this. The travel insurance I've seen excludes things like cancer and pre-existing conditions, which concerns me as a hypochondriac and asthmatic respectively. 
:spy:


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## Phil Squares (Jan 13, 2017)

palooka said:


> I'm also curious about this. The travel insurance I've seen excludes things like cancer and pre-existing conditions, which concerns me as a hypochondriac and asthmatic respectively.
> :spy:


If you are looking as "travel insurance" as a form of insurance while you are resident in Spain, you will be in for a big surprise. It will not be acceptable. 

We use Sanitas. It is not the cheapest, but it works for us. No excess/deductible for us, plus they have a decent dental coverage and optical coverage. It is less than $300/month for my wife and myself. I am 65 and she is 56.


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## palooka (May 9, 2017)

Phil Squares said:


> If you are looking as "travel insurance" as a form of insurance while you are resident in Spain, you will be in for a big surprise. It will not be acceptable.
> 
> We use Sanitas. It is not the cheapest, but it works for us. No excess/deductible for us, plus they have a decent dental coverage and optical coverage. It is less than $300/month for my wife and myself. I am 65 and she is 56.


It explicitly says on the explanation of benefits that the plan satisfies Visa requirements; this was also something I requested when talking to the insurance agent. We're meeting with the consulate tomorrow so I guess we'll see.

Anyway, I found the cancer exclusion problematic and will use a different company after the first month. I will look at Sanitas. Thanks!


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## Phil Squares (Jan 13, 2017)

palooka said:


> It explicitly says on the explanation of benefits that the plan satisfies Visa requirements; this was also something I requested when talking to the insurance agent. We're meeting with the consulate tomorrow so I guess we'll see.
> 
> Anyway, I found the cancer exclusion problematic and will use a different company after the first month. I will look at Sanitas. Thanks!



Unless the rules have changed since the beginning of this month, I can assure you travel insurance is not acceptable. The policy we have does include cancer and just about every disease known to man. It also has a travel part which acts as the standard travel insurance. 

If you have a policy issued by a non-Spanish company, you might have trouble. They can really say what they want but at the end of the day it's up to the person sitting on the other side of the desk.


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## skip o (Aug 1, 2011)

HBJHBJ, If you are considering moving from the US to Spain, I highly recommend you talk to many different Spanish accountants about income taxes, wealth taxes (in particular on retirement accounts) and the 720. Compared to the US, I have found accountants in Spain to give wildly conflicting answers to many important questions, and Spain is a bit more abusive in how they dole out fines for incorrect tax filings. Property taxes are lower in Spain, and health care is waaaaaaay less expensive. I find most procedures & medicines are 1/4 to 1/10 the price in Spain, even when paying out of pocket. I have not found a single thing that the US does better than Spain in regards to healthcare.


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## Ramouz (Feb 27, 2015)

Hi guys, I have a question about this as well. My wife and I and 4 year old daughter are considering moving to Spain. I don't know yet what Visa I have to apply for but we want to stay there permanently, if we choose to go. I don't think I will get the non-lucrative visa but another one, not sure which.

I work from home with a Canadian company and will continue working from home if we go to Spain. Canada and Spain have a tax treaty so I should only pay taxes in Spain, from what I understand.
Will we be getting free health care? If not, how do I pay for social security in order to get health care coverage?


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## Blanco53 (Mar 6, 2017)

Ramouz said:


> Hi guys, I have a question about this as well. My wife and I and 4 year old daughter are considering moving to Spain. I don't know yet what Visa I have to apply for but we want to stay there permanently, if we choose to go. I don't think I will get the non-lucrative visa but another one, not sure which.
> 
> *I work from home with a Canadian company and will continue working from home if we go to Spain.* Canada and Spain have a tax treaty so I should only pay taxes in Spain, from what I understand.
> Will we be getting free health care? If not, how do I pay for social security in order to get health care coverage?


You use the expression "work from home with a Canadian company" are you employed or self - employed? If it is the later then you should look at articles about Spain's Autonomo system. Under this system, you pay for social security which provides health care coverage.

Alternatively, if you are employed, the Canadian company that employs you will need to have discussions with the authorities in Spain. There are many rules and regulations about working for foreign domiciled companies that go way beyond my area of expertise.


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## Ramouz (Feb 27, 2015)

Blanco53 said:


> You use the expression "work from home with a Canadian company" are you employed or self - employed? If it is the later then you should look at articles about Spain's Autonomo system. Under this system, you pay for social security which provides health care coverage.
> 
> Alternatively, if you are employed, the Canadian company that employs you will need to have discussions with the authorities in Spain. There are many rules and regulations about working for foreign domiciled companies that go way beyond my area of expertise.


I am a contractor, so I assume self-employed. I do *not* have employee status.
I'll look at the autonomo system. Can I get a visa under that system or that's just for work permits?


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## skip o (Aug 1, 2011)

"Canada and Spain have a tax treaty so I should only pay taxes in Spain, from what I understand."

It is probably not as simple as that. I don't know anything about Canadian taxes but I have to file both Spanish and US taxes. Most of what I pay in Spain is deducted from what I would pay in the US, but I am not guaranteed to be able to deduct everything.


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## Ramouz (Feb 27, 2015)

Thanks for your answer! I'll ask the embassy here in Ottawa to make sure.


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## Ifn (Jan 29, 2017)

palooka said:


> It explicitly says on the explanation of benefits that the plan satisfies Visa requirements; this was also something I requested when talking to the insurance agent. We're meeting with the consulate tomorrow so I guess we'll see.
> 
> Anyway, I found the cancer exclusion problematic and will use a different company after the first month. I will look at Sanitas. Thanks!


Yes, you can buy private insurance that will cover any and every disease. But NOT if you actually already have that disease or a history of that disease. So, high cholesterol, glaucoma and cancer were not only excluded but I was denied all coverage by all spanish companies, including Sanitas.
I ended up with an expensive policy from one of the global insurance companies, in my case, Aetna. There are several of these that will give you a policy. But they too will exclude pre existing conditions. The person who sold me the policy told me that it would be cheaper to just pay a doctor out of pocket for those conditions.
The good news, is I discovered that all my medicines are available over the counter with no prescriptions. I will see a doctor for a glaucoma check and another doctor for a cancer check. After this first year, I’ll be eligible to join the government health system which has no restrictions on pre existing conditions and costs about €160 per month.


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## Elyles (Aug 30, 2012)

hbjhbj said:


> Is there a preferred company many US expats like?




Try Sanitas


Sent from my iPad using Tapatalk


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## Nononymous (Jul 12, 2011)

skip o said:


> "Canada and Spain have a tax treaty so I should only pay taxes in Spain, from what I understand."
> 
> It is probably not as simple as that. I don't know anything about Canadian taxes but I have to file both Spanish and US taxes. Most of what I pay in Spain is deducted from what I would pay in the US, but I am not guaranteed to be able to deduct everything.


It's not always a simple or straightforward process, but a Canadian does have the option of declaring non-residency, so if it's a long-term move away from Canada without leaving a lot of assets behind, it's possible to wind up affairs and have no further obligation to file Canadian tax returns. Unlike the US, which demands lifelong compliance of its citizens (which is often ignored).


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## littleweed (Sep 20, 2013)

hbjhbj said:


> Wow, that's terribly unfair, especially given Spain's outrageous tax rates.


Yes it is isn't it. That Social Security contributions fund the Health Service is one of those expat myths. It used to be the case up until 1999 but after that its been paid for entirely by
general taxation ( IVA, Income tax etc). Even in the latest major reform of the system in 2012 anyone earning more that 100,000 was excluded.


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