Private Health Insurance Spain: Complete Guide to Insurers, Costs & Coverage 2025

Introduction

Spain's public healthcare system is excellent and free for residents, yet over 20% of the population maintains private health insurance (seguro médico privado). Why? Private insurance offers faster appointments, English-speaking doctors, and access to specialists without referrals.

This guide compares Spain's four major private health insurers—Sanitas, Adeslas, Asisa, and DKV—and explains costs, coverage, pre-existing condition policies, and who benefits most from private insurance.

Quick Overview:

• Cost: €50-150/month per person
• Major insurers: Sanitas, Adeslas, Asisa, DKV
• Coverage: Outpatient, specialist, diagnostic tests, hospitalization
• Application: Usually instant, no medical exam for basic plans
• Pre-existing conditions: Often excluded or waiting periods apply

Whether you're an expat moving to Spain, a resident seeking faster care, or someone applying for a visa that requires health insurance, this guide helps you make an informed decision.

Why Get Private Health Insurance in Spain?

Spain's public healthcare (Sistema Nacional de Salud) is comprehensive and largely free, but it has limitations that drive many to supplement with private insurance:

Speed and Convenience

Public healthcare waiting times can be lengthy:

• GP appointments: 5-15 days
• Specialist referrals: 30-90 days
• Non-urgent surgery: 3-6 months or longer

Private insurance typically offers:

• Same-day or next-day GP appointments
• Specialist visits within 48-72 hours
• Elective surgery within 2-4 weeks

English-Speaking Doctors

Most public system doctors speak only Spanish. Private insurers maintain networks of English-speaking doctors, particularly in expat areas like Madrid, Barcelona, Costa del Sol, and Costa Blanca. This is crucial for accurate diagnosis and understanding treatment options.

Direct Specialist Access

In the public system, you must see a GP first, who then refers you to a specialist. With private insurance, you can book directly with specialists—cardiologists, dermatologists, gynecologists—without referrals, saving weeks or months.

Choice of Facilities

Private insurance lets you choose from their network of modern clinics and hospitals, often with shorter wait times and more comfortable facilities than public hospitals.

Visa and Residency Requirements

Non-lucrative visas, digital nomad visas, and other residence permits often require comprehensive private health insurance as a condition of approval. Insurance must cover all medical expenses without copays, making Spanish insurers ideal since they understand these requirements.

Major Private Health Insurers: Comparison

Spain's private health insurance market is dominated by four major companies, all offering comprehensive coverage with extensive provider networks.

1. Sanitas

Overview: Spain's largest private health insurer with over 2.4 million policyholders. Part of the international Bupa Group, Sanitas operates its own hospitals and clinics (Hospitales Sanitas) throughout Spain.

Strengths:

• Largest network of owned facilities
• Excellent for expats (strong English support)
• Well-represented in all major cities
• Digital app for appointment booking
• Quick claims processing

Monthly Costs:

• Basic plan: €55-80/month (ages 30-50)
• Mid-tier plan: €90-120/month
• Premium plan: €140-180/month
• Family discounts available

Best For: Expats in major cities, families, those prioritizing English-speaking care

2. Adeslas

Overview: Part of SegurCaixa Adeslas (owned by CaixaBank and Mutua Madrileña), Adeslas insures over 2.1 million people. They don't own hospitals but have Spain's largest network of affiliated providers—over 40,000 doctors and 1,100 medical centers.

Strengths:

• Widest provider network in Spain
• Strong presence in rural and coastal areas
• Competitive pricing
• Good digital platform (Adeslas Contigo app)
• Popular with Spanish nationals and expats

Monthly Costs:

• Basic plan: €50-75/month (ages 30-50)
• Mid-tier plan: €85-115/month
• Premium plan: €130-170/month

Best For: Those living outside major cities, people wanting maximum provider choice, budget-conscious buyers

3. Asisa

Overview: Spain's oldest health insurer (founded 1971) with approximately 2 million policyholders. Asisa operates its own hospitals and maintains strong relationships with public hospitals, allowing policyholders to use public facilities through their private insurance.

Strengths:

• Access to some public hospitals (unique advantage)
• Own clinic and hospital network
• Competitive pricing
• Strong in Valencia, Catalonia, and Madrid
• Good for chronic condition management

Monthly Costs:

• Basic plan: €50-70/month (ages 30-50)
• Mid-tier plan: €80-110/month
• Premium plan: €125-160/month

Best For: Those with chronic conditions, people who want access to both public and private facilities, value-seekers

4. DKV

Overview: Part of German insurance giant ERGO Group (Munich Re), DKV insures over 1.8 million in Spain. Known for international coverage and comprehensive wellness programs.

Strengths:

• Strong international coverage options
• Excellent for frequent travelers
• Focus on preventive care and wellness
• Good English support
• Dental coverage often included in upper tiers

Monthly Costs:

• Basic plan: €60-85/month (ages 30-50)
• Mid-tier plan: €95-125/month
• Premium plan: €145-190/month

Best For: International professionals, frequent travelers, those wanting dental included, preventive care focus

Coverage Details: What's Included

All major Spanish private health insurers offer similar core coverage, with differences emerging in premium tiers:

Standard Coverage (All Basic Plans)

• General practitioner visits: Unlimited
• Specialist consultations: Unlimited (cardiology, dermatology, gynecology, etc.)
• Diagnostic tests: Blood work, X-rays, ECG, ultrasounds
• Hospitalization: Room, surgery, anesthesia
• Emergency care: 24/7 emergency services
• Maternity: Prenatal care, delivery (often after 8-10 month waiting period)
• Pediatrics: Full coverage for children
• Pharmacy: Typically not covered (major difference from public system)

Mid-Tier and Premium Additions

• Dental: Cleanings, extractions, fillings (often 20-50% copay)
• Mental health: Psychology, psychiatry sessions (usually 5-15 sessions/year)
• Physiotherapy: Typically 10-20 sessions per year
• Alternative medicine: Acupuncture, osteopathy, homeopathy
• Second medical opinions: International specialists
• Private room upgrades: Single room during hospitalization
• International coverage: Emergency care abroad

Common Exclusions

• Prescription medications: Most plans don't cover pharmacy costs
• Chronic medication: Long-term prescriptions excluded
• Pre-existing conditions: Often excluded or subject to waiting periods
• Cosmetic procedures: Unless medically necessary
• Experimental treatments: Not covered
• Dental prosthetics: Implants, crowns often excluded or high copay

Pre-Existing Conditions: The Critical Question

Pre-existing conditions (condiciones preexistentes) are the most important factor when choosing private insurance in Spain.

What Counts as Pre-Existing?

Any medical condition diagnosed or treated before your insurance start date:

• Diabetes, hypertension, high cholesterol
• Cancer (past or current)
• Heart disease, previous heart attack
• Mental health conditions (depression, anxiety)
• Chronic pain conditions
• Autoimmune disorders
• Previous surgeries or ongoing treatments

How Insurers Handle Pre-Existing Conditions

Standard Approach: Most Spanish insurers exclude pre-existing conditions entirely. You'll have coverage for new conditions that arise after your policy starts, but not for anything existing when you enrolled.

Medical Questionnaire: When applying for comprehensive coverage (needed for visas), insurers typically require a detailed health questionnaire. Based on your answers:

• No conditions: Instant approval, full coverage
• Minor conditions: Approval with specific exclusions
• Major conditions: May be declined or offered limited coverage

Waiting Periods: Some conditions have waiting periods even if not pre-existing:

• Maternity: 8-10 months
• Major surgery: 6-12 months
• Specific treatments: 3-6 months

Important: For visa applications requiring "comprehensive coverage without copays," insurers understand this requirement and offer specific plans. Be honest on applications—insurers can deny claims if you misrepresent health status.

Options with Pre-Existing Conditions

1. Basic coverage: Accept exclusions, get coverage for new conditions
2. Public healthcare: Free coverage including pre-existing conditions (if eligible)
3. Specialized insurers: Some offer coverage with higher premiums
4. Group plans through employers: Often don't screen for pre-existing conditions

Who Needs Private Health Insurance in Spain?

Absolutely Required For:

• Non-lucrative visa applicants: Must have comprehensive insurance with no copays
• Digital nomad visa holders: Insurance requirement in visa conditions
• Student visa applicants: Comprehensive coverage required
• Non-EU residents without work authorization: No access to public system

Highly Beneficial For:

• Expats without Spanish language fluency: Access to English-speaking doctors
• Self-employed (autónomos): Faster care means less work time lost
• Parents with young children: Quicker pediatrician access
• People with demanding jobs: Can't afford long public system wait times
• Coastal/rural residents: Private networks often better than local public hospitals

Probably Don't Need If:

• You have public healthcare access and speak Spanish: Public system is excellent
• You're healthy and patient: Can wait for appointments
• Budget is very tight: Public system is free
• You're near a major public hospital: Quality comparable to private

How to Choose the Right Plan

Step 1: Define Your Priorities

Cost-focused?

• Choose Adeslas or Asisa for lowest premiums
• Accept larger provider networks vs. owned facilities
• Basic plan covers essentials

Convenience-focused?

• Sanitas or DKV for owned clinics and fastest appointments
• Premium plans for single rooms and extra services
• Pay more for peace of mind

International needs?

• DKV for best international coverage
• Important if you travel frequently or split time between countries

Step 2: Check Provider Networks

Visit insurer websites and verify they have contracted doctors/clinics in your area:

• Search by postal code
• Filter by English-speaking providers
• Check specialist availability in your field (e.g., pediatrics if you have children)

Step 3: Compare Coverage Details

Create a comparison spreadsheet:

• Monthly premium
• Copay amounts (if any)
• Waiting periods
• Specific services you need (e.g., physiotherapy, mental health)
• Dental inclusion/exclusion

Step 4: Consider Age-Related Pricing

Premiums increase significantly with age:

• Under 30: €40-70/month
• 30-50: €50-120/month
• 50-65: €80-180/month
• Over 65: €150-300/month

Some insurers increase premiums annually based on age; others lock in rates for longer periods. Ask about pricing policies.

Step 5: Read the Fine Print

Critical questions to ask:

• Renewable? Most are annually renewable, but some may decline renewal
• Price guarantees? How much can premiums increase annually?
• Claims process? Direct billing or reimbursement model?
• Cancellation policy? Can you cancel anytime or only at renewal?
• Grace period? How quickly does coverage begin?

Application Process: Step-by-Step

1. Request Quotes (1-2 days)

Contact insurers directly or use comparison websites:

• Provide: age, postal code, desired coverage level
• Receive: Premium quotes and coverage summaries
• Compare: At least 3-4 insurers

2. Complete Application (15-30 minutes)

Online or phone application includes:

• Personal information (name, NIE/passport, address)
• Health questionnaire (be thorough and honest)
• Payment information
• Beneficiary designation (for families)

3. Medical Review (Instant - 5 days)

• Basic plans: Usually instant approval, no medical review
• Comprehensive plans: Questionnaire review, possible exclusions identified
• High-risk applicants: May require additional information or be declined

4. Payment and Activation (Immediate)

• Pay first month's premium
• Coverage typically starts immediately or on specified date
• Receive policy documents via email
• Download insurer's app for appointment booking

5. Register with a GP (Optional, 1-2 weeks)

Some insurers ask you to select a primary care doctor from their network. This doctor coordinates your care, though you can usually change doctors or see specialists directly.

Costs: Complete Breakdown

Monthly Premiums by Age (Mid-Tier Plans)

• 0-10 years: €35-50/month
• 11-20 years: €40-60/month
• 21-30 years: €50-75/month
• 31-40 years: €65-95/month
• 41-50 years: €85-130/month
• 51-60 years: €120-180/month
• 61-70 years: €180-280/month
• 70+ years: €250-400/month

Family Discounts

Most insurers offer discounts for multiple family members:

• 2 people: 5-10% discount
• 3 people: 10-15% discount
• 4+ people: 15-20% discount

Example: Family of four (2 adults age 35, 2 children age 5 and 8)

• Individual pricing: €75 + €75 + €40 + €40 = €230/month
• With 15% family discount: €195/month
• Annual cost: €2,340

Additional Costs to Consider

• Copays: Basic plans often charge €3-10 per specialist visit
• Dental copays: 20-50% of treatment costs
• Prescription medications: Full cost (not covered)
• Premium increases: Expect 3-8% annually

Making the Switch: From Public to Private (or Vice Versa)

Adding Private Insurance

You don't lose public healthcare when you buy private insurance. Most Spanish residents maintain both:

• Use public system for prescriptions (heavily subsidized)
• Use private insurance for appointments and specialists
• Keep public system as backup for catastrophic care

Cancelling Private Insurance

You can cancel at annual renewal (usually). Consider:

• Will you lose visa eligibility?
• Can you re-qualify if you develop health conditions?
• What are alternatives for English-speaking care?

Conclusion: Is Private Health Insurance Worth It?

For most expats and many Spanish residents, private health insurance offers excellent value:

Worth the investment if:

• You need English-speaking doctors
• Your time is valuable (faster appointments)
• You require it for visa/residency
• You want specialist access without referrals
• You value peace of mind and choice

Probably not necessary if:

• You have public healthcare and speak Spanish fluently
• You're very healthy and rarely need doctors
• Budget is extremely tight
• You live near excellent public hospitals

Bottom line: At €50-150/month, private health insurance in Spain costs less than one nice dinner out. For most expats, the speed, convenience, and English-speaking care make it an essential investment in quality of life.

Next Steps

1. Get quotes: Contact Sanitas, Adeslas, Asisa, and DKV for personalized quotes
2. Check provider networks: Verify English-speaking doctors in your area
3. Review visa requirements: If applying for residency, confirm coverage meets requirements
4. Compare carefully: Create spreadsheet comparing coverage, costs, and networks
5. Apply: Choose your insurer and complete the application

Ready to compare health insurance options? Lifetti's provider directory helps you find English-speaking doctors, compare insurance plans, and understand Spain's healthcare system. Explore verified providers now.