Quick answer
As a tourist, emergency care is given to everyone, but anything beyond emergencies can be charged unless you hold a European Health Insurance Card (EU, Switzerland, Norway, Iceland, Liechtenstein) or a bilateral agreement applies. If you move here, access depends on your status; without a right to public healthcare you can sign the special agreement (€60 a month if you are under 65).
Summary: what you are covered for
| Your case | Care you get | Insurance? |
|---|---|---|
| Tourist from the EU, Switzerland, Norway, Iceland or Liechtenstein | Necessary care free with the European Health Insurance Card | Advisable for what the card does not cover |
| Tourist from Andorra, Chile, Morocco, Peru or Tunisia | Bilateral agreement, with a certificate from your country | Advisable |
| Other tourists (US, Latin America, Asia…) | Emergencies guaranteed; the rest may be charged | Strongly advised |
| Resident without a right to public healthcare | Special agreement (€60 a month if under 65) | Depends on your visa |
Information from spain.info and the Ministry of Health, checked on 24 October 2026.
As a tourist: will I be treated without insurance?
According to spain.info, emergency treatment is guaranteed for everyone, in hospitals and some health centres. Care at private centres is always charged. The Ministry of Health adds that the public system may charge foreign visitors who lack a health card or proof of coverage.
In a serious emergency, call 112. More in help in Madrid: theft and emergencies.
European Health Insurance Card: what it covers and what it does not
With the European Health Insurance Card (EHIC), citizens of the EU, Switzerland, Norway, Iceland and Liechtenstein get care for illness or accident without paying, unless the main reason for the trip is specific treatment. Without the card you pay and claim reimbursement at home. Scheduled treatment must be authorised by your home institution. Dental treatment (except extractions) and repatriation for illness are excluded.
UK tourists are covered with their UK EHIC or GHIC, according to the Ministry of Health; confirm with the UK institution which document applies to you.
If you are moving here: public system or private insurance?
It depends on your situation. If you have no right to public healthcare by any other route, the National Health System special agreement costs, according to the Ministry of Health, €60 a month for under-65s and €157 from age 65. Main requirements:
- At least one continuous year of actual residence in Spain before applying.
- Being registered at your town hall (padrón) when you apply.
- No access to public healthcare by another route.
It includes the common basic services, with no copayments or waiting periods. Outpatient prescription medicines, orthoprosthetics and non-urgent transport are paid 100% by the patient.
With the telework visa or many non-working residence visas, a private insurance covering the same risks as the public system is usually required. Check it for your visa.
Residents without legal status in the Madrid region
The Madrid region issues the DASE document to foreigners without legal residence who meet several conditions: more than 90 days since entry, at least 3 months on the municipal register, no valid short-stay visa and no exportable cover from their home country, among others. It is free and lasts 2 years. Book an appointment at your health centre.
Enjoy Madrid with peace of mind
If you are visiting, travel with your card or insurance and enjoy it: a private electric tuk tuk shows you the Royal Palace, Plaza Mayor or the Bernabéu with a driver-guide. See the Madrid in one day plan.
Frequently asked questions
Will a Spanish hospital treat me as a tourist without insurance?
Emergency treatment is guaranteed for everyone, according to spain.info. Anything else may be charged, and private centres always charge.
What is the European Health Insurance Card?
A free card giving access to necessary public healthcare during temporary stays in the EU, Switzerland, Norway, Iceland and Liechtenstein.
How much is the special health agreement in Spain?
€60 a month under 65 and €157 a month from 65, according to the Ministry of Health. It requires a year of actual residence and registration at your town hall.
Do I need private insurance to live in Spain?
It depends on your visa and on whether you have a right to public healthcare. The telework visa, for example, requires insurance covering the same risks as the public system.
Sources
- spain.info: general healthcare
- Ministry of Health: special agreement
- Ministry of Health: healthcare (UK visitors)
- Comunidad de Madrid: DASE
Facts and prices checked on 24 October 2026. They can change: confirm them with the official source before you travel.