European Health Insurance Card vs Private Health Insurance in Spain
Many newcomers arrive in Spain with a European Health Insurance Card (EHIC) or UK Global Health Insurance Card (GHIC) and wonder if they still need private health cover. The short answer: the card is helpful for short trips, but it doesn't replace full private health insurance, especially if you live in Spain or need a visa.
Key Takeaways
EHIC/GHIC gives access to medically necessary state healthcare during a temporary stay, on the same basis as a local resident. It doesn't cover private clinics, repatriation, lost income or non-urgent treatment, and is not a replacement for travel insurance.
- EHIC/GHIC covers state healthcare during temporary stays only – not private clinics
- For visas like Non-Lucrative or Digital Nomad, you need full private health insurance without copays
- EHIC doesn't cover repatriation, lost income or non-urgent treatment abroad
- Common expat setup: EHIC/GHIC for short EU trips, private insurance in Spain for everyday care
- Private health insurance is often mandatory for residency and visa compliance
What the European Health Insurance Card Covers in Spain
State Healthcare, Not Private Clinics
EHIC (or GHIC for most UK residents) allows you to receive medically necessary state-provided care during a temporary stay in Spain. You're treated on the same financial terms as someone insured in the Spanish public system.
Important points:
- Only public hospitals and clinics are covered
- Private hospital bills are generally not reimbursed when you use EHIC/GHIC
- You may still pay a share of the cost where local residents must also contribute
Temporary Stays, Not Long-Term Residence
EHIC/GHIC is designed for trips: holidays, business visits, short stays with family and similar. For long-term residence, most countries expect you to be insured via the local system or private insurance, not an EHIC that was issued by another country.
If you register as resident in Spain or apply for a residency visa, Spanish authorities usually look for other proof of cover.
What EHIC/GHIC Does Not Cover
EHIC/GHIC does not replace:
Private Health Insurance
For accessing private hospitals and English-speaking clinics
Travel Insurance
Cancellation, lost baggage, repatriation
Long-Term Non-Urgent Treatment
Outside the local state system
This means that if you prefer private doctors, want English-speaking clinics, or need cover for flying home after a serious illness, you cannot rely on the card alone.
Private Health Insurance in Spain: When and Why You Need It
Visa and Residency Requirements
For many non-EU nationals, visas like the Non-Lucrative Visa or Digital Nomad Visa require:
- Full private health insurance with no copays
- Nationwide cover across all of Spain
- No waiting periods, or a clear waiver
- A certificate suitable for consulate or immigration office
EHIC is not accepted as a replacement for this type of cover when applying for Spanish visas or residency.
Everyday Access and Comfort
Even if you're entitled to Spanish public healthcare, you may choose private insurance because:
Shorter Waiting Lists
For many specialist appointments
English-Speaking Doctors
And international clinics
More Flexibility
Second opinions, private hospitals
Spain has strong public healthcare, but many expats appreciate the flexibility private cover adds.
Combining EHIC/GHIC, Private Health and Travel Insurance
A typical combination for many expats:
EHIC/GHIC
For unexpected treatment on short visits to other EU countries
Private Health Insurance in Spain
For day-to-day healthcare and visa compliance
Travel Insurance
For trips outside the EU and for cancellation, baggage and repatriation
This layered approach gives you the best protection: state care backup when travelling in Europe, comprehensive private cover at home in Spain, and full travel protection when venturing further afield.
Expert reviewed
Written and reviewed by licensed insurance agents Maya Kallio and Marco Elsinger, who have helped over 15,000 expats in Spain since 2012.
Maya Kallio
Licensed Insurance Agent
Since 2012
Marco Elsinger
Licensed Insurance Agent
10+ years
Languages: English, Finnish, Spanish, German
Frequently asked questions
Still have questions? Check these answers or get in touch.
If I live in Spain with an EHIC, do I still need private health insurance?
If you're a long-term resident, yes, relying only on EHIC is risky. The card is intended for temporary stays and state care only, so it won't help in private clinics, it doesn't cover repatriation and it isn't accepted as proof of comprehensive healthcare for visas or most residency processes. Private health insurance gives you access to private hospitals and clearer protections, and in many visa cases it's mandatory, so most expats need more than an EHIC or GHIC.
Can I use EHIC or GHIC alongside private health insurance?
Yes. Many expats carry both. When you travel to another EU country from Spain, EHIC/GHIC can help with medically necessary state care, while your private policy may cover extra costs or private providers depending on its terms. In Spain, you'll normally use your private health insurance card at private clinics, while EHIC is more relevant for short trips abroad. Always tell the clinic which cover you want to use and keep both cards handy when travelling.
Does EHIC cover all my medical costs in Spanish public hospitals?
Not always. EHIC entitles you to medically necessary state healthcare on the same basis as someone insured in that country. If Spanish law requires local insured patients to pay part of a treatment, you may have to pay that part too. It doesn't cover private rooms, private hospitals or planned medical tourism. That's why many visitors still buy travel insurance and residents rely on local or private insurance, using EHIC only as a backup, not the main solution.
Is private health insurance expensive in Spain compared to other countries?
Private health insurance in Spain is often cheaper than in many northern European countries, especially for younger adults and families. Typical premiums for expats can start around a few dozen euros per month and rise with age, coverage level and extras such as dental or worldwide cover. When you compare prices, always check what is included: copays, hospital network quality and whether the policy is visa-compliant if you need it for immigration.
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