Spain is one of the most popular destinations for Americans moving abroad — for the lifestyle, the cost of living and, not least, the healthcare. But there is one thing every American needs to understand before the move: your US Medicare does not come with you, and you’ll need private health insurance in Spain, both to meet the visa rules and to access care. This guide explains exactly how healthcare works for Americans in Spain and what cover you need.
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This is the single most important thing for Americans to understand, and the answer is clear: no, Medicare does not cover you in Spain. Medicare generally does not pay for healthcare received outside the United States, whether you are travelling temporarily or living abroad permanently. There are only narrow exceptions — essentially certain emergencies near the US border — none of which help someone living in Spain.
Some Medigap (Medicare Supplement) plans include limited foreign-travel emergency cover — typically only in the first 60 days of a trip, with a deductible and a lifetime cap — which is designed for holidays, not for living in another country. In short, if you move to Spain, you cannot rely on Medicare for your day-to-day healthcare, and you will keep paying Medicare premiums for cover you can’t use unless you return to the US.
Source: Medicare.gov — Travel outside the U.S. and the official Medicare Coverage Outside the United States fact sheet.
Since Medicare will not cover care in Spain, a common question is whether to keep paying for it at all. The practical picture for most Americans:
Part A (hospital) is usually premium-free if you or your spouse paid Medicare taxes long enough, so many people simply keep it — it costs nothing and is there if you return to the US. Part B (medical) carries a monthly premium and cannot be used in Spain, so paying for it while abroad means paying for cover you cannot access. However, dropping Part B and re-enrolling later can trigger a permanent late-enrolment penalty and coverage gaps, so it is a decision to take carefully — ideally with advice — based on whether you expect to return to the US.
Whatever you decide about Medicare, it does not change the core point: for your actual healthcare in Spain, you need a Spanish private plan.
Not automatically. Spain’s public health system is excellent, but access to it is tied to your status. You generally get public cover if you work in Spain and pay into social security (as an employee or as a self-employed autónomo), or in certain other defined situations. As a newly arrived American on a residence visa — particularly a retiree or someone not working in Spain — you will not have automatic public cover when you arrive.
That is precisely why Spain’s residence visas for non-working Americans require you to hold private health insurance. Even once some people do gain public access (for example after starting work), many keep private cover as well, to skip the public waiting lists for specialists and planned treatment.
US citizens are “third-country nationals” in Spanish terms — not EU citizens — so to live in Spain beyond the 90-day tourist limit you need a residence visa. The right one depends on your situation, and almost all of them require private health insurance as a condition. The main routes for Americans are:
| Visa route | Best for |
|---|---|
| Non-Lucrative Visa (NLV) | Retirees & those with income who won’t work in Spain |
| Digital Nomad Visa (DNV) | Remote workers & freelancers with foreign clients |
| Student Visa | Those studying in Spain |
| Work / Highly Qualified visas | Those with a Spanish job offer |
Whichever route fits, private health insurance that meets the visa standard is part of the application. Read our full guides to the Non-Lucrative Visa and the Digital Nomad Visa.
As an American you can enter Spain and the wider Schengen area visa-free for up to 90 days in any 180-day period — fine for a holiday, but not for living there. To stay longer you must hold a residence visa, and crucially, you generally apply for it from the US before you move, at the Spanish consulate that covers your home state.
Spain’s consulates in the US are organised by jurisdiction, so which one you use depends on where you live. The application requires your documents — including your private health insurance certificate — so the insurance must be arranged as part of the process, not after you arrive. This catches people out: in most cases you cannot simply move on the 90-day tourist stamp and sort the visa later from inside Spain.
Getting the health-cover certificate ready in good time is one of the smoother parts of the process when it is handled by an adviser who does it regularly.
For Americans, private health insurance in Spain does three jobs at once:
The good news for Americans is that this is far more affordable than you’ll be used to. See our dedicated guide to health insurance in Spain for Americans for plans, prices and how it works.
For visa purposes, not just any policy will do. Spanish consulates generally expect cover that is genuinely comprehensive, from an insurer authorised to operate in Spain. In practice that means a policy that is:
A US travel-insurance policy or an international plan you already hold usually will not satisfy the requirement, which catches many Americans out. Our guides on copay vs no-copay cover and comprehensive health insurance explain what to look for.
One of the most pleasant surprises for Americans in Spain is the cost of healthcare. Coming from a system where insurance premiums, deductibles and out-of-pocket bills can be enormous, most Americans find private health insurance in Spain remarkably affordable by comparison, while the standard of care is high and Spain enjoys one of the highest life expectancies in the world.
Private consultations, diagnostics and procedures that would carry eye-watering price tags in the US are a fraction of the cost in Spain, and a comprehensive private plan bundles much of it into a modest monthly premium. For many Americans, the healthcare equation is one of the genuine financial upsides of the move — not a worry.
Premiums depend on your age, the province you settle in, the plan and whether you choose a co-pay or no-copay policy. Rather than quote a figure that may not apply to you, the sensible step is a personalised quote — an English-speaking adviser can price a visa-suitable plan for your exact situation. Our pricing guide explains what drives the cost.
Because the same plan often has to satisfy a visa and serve as your everyday healthcare, it’s worth getting the plan right first time rather than buying the cheapest option and finding it doesn’t meet the visa standard.
Beyond the cost, Americans tend to be struck by how differently healthcare works in Spain:
The overall experience — quick appointments, clear costs and high-quality care — is one reason so many Americans say healthcare is a highlight of life in Spain rather than a headache.
Retirement is one of the most common reasons Americans move to Spain, and it’s where the Medicare gap bites hardest — because retirees are the group most likely to be relying on Medicare and most likely to need regular specialist care. The typical route is the Non-Lucrative Visa, which suits those living on retirement or investment income and not working in Spain, and which requires comprehensive private health cover.
Because the long-wait specialties in Spain’s public system — orthopaedics, ophthalmology and the like — are exactly the ones older people use most, private cover is doubly valuable in retirement: it meets the visa rule and it gets you seen quickly. See our guides to health insurance for retirees and cover for the over-60s.
If you work remotely for US clients or an American employer, Spain’s Digital Nomad Visa may be your route. It, too, requires private health insurance. Even if you later register as autónomo and gain public access, private cover remains valuable as a top-up — losing weeks to a public waiting list is costly when your income depends on your time. Our guide to health insurance for autónomos covers the self-employed angle.
If you are moving as a family, everyone needs cover. Each family member included on the visa application generally needs their own visa-suitable private health insurance, and family policies are available that cover spouses or partners and children together. Children can usually be added to a family plan, and cover for dependents is a standard part of arranging a move.
It is worth getting the whole family quoted together so the cover is consistent and each person has the certificate they need for the application. An adviser can structure a family plan that meets the visa rules for every member.
Most of these are easily avoided by getting a visa-suitable plan from the outset and having an adviser confirm it meets the requirement before you apply.
An English-speaking adviser can handle the insurance side end to end — finding a compliant plan and issuing the certificate you need for the application.
Tell us your age, where you’re heading and your visa route, and an English-speaking adviser will find a visa-suitable plan and issue your certificate.
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