If no European card, insurer or public entitlement covers you, Spain bills you at the official tariff of the region that treats you: €173.10 for an A&E visit in Murcia and €240 in Valencia at 2026 prices, and a single diagnosis-based price — usually several thousand euros — for a hospital admission.
Search for what healthcare costs in Spain without insurance and the same round numbers keep appearing — €100 for a doctor, €200 for A&E or for a day in hospital, ambulances free — on insurance-comparison sites, fintech blogs and forums. None of them says where those numbers come from.
The real figures are public. Spain's regional health services are obliged to claim the cost of care that no public entitlement covers — from another country's health system, from an insurer or from the patient — and they publish the prices they charge in their official gazettes, region by region, in Spanish. We went through those instruments, and through the laws that decide who receives the bill and what happens when it goes unpaid.
This guide is for visitors and new residents with no European card, no insurer willing to pay, or no public entitlement yet. It sets out what each kind of care costs, why the price depends on where you are treated, and how to keep most of the bill from ever reaching you.
Is healthcare free in Spain without insurance?
No. Public care is free at the point of use only for people entitled to it — residents covered by the national system, and visitors whose European card makes their home country pay. Anyone else is treated as a private patient and invoiced afterwards at the official tariff of the region that treated them.
Three provisions decide who receives the bill. Article 3 of Ley 16/2003, de cohesión y calidad del Sistema Nacional de Salud, in the wording given by Real Decreto-ley 7/2018, grants publicly funded care to Spanish nationals living in Spain, to foreign residents, and to people entitled under another legal title, such as the EU's social security rules — in that last case only siempre que no exista un tercero obligado al pago, provided no third party is obliged to pay.
Article 16 of the Ley General de Sanidad (Ley 14/1986) covers everyone else. People without entitlement may use public services con la consideración de pacientes privados — as private patients, under the same access rules as everyone else — and their care is invoiced on the basis of its actual cost. Article 2.7 of Real Decreto 1030/2006 then obliges the health services to claim that cost: from the third party where there is one, and from the patient where there is not.
Urgency does not change the answer. No provision in the current law makes emergency care free regardless of entitlement; the rule that came closest, in the 2012 version of Ley 16/2003, was replaced in 2018. Emergency departments (urgencias) still treat whoever arrives, and Extremadura's tariff decree spells out the other half: las urgencias se facturarán siempre, emergencies are always invoiced, whether or not the patient is admitted. Entitlement decides who receives the invoice, not whether you are seen.
The one change to access in 2026 does not reach tourists. Real Decreto 180/2026, in force since 13 March 2026, sets how foreigners without legal residence claim publicly funded care. Applicants must declare that they are not obliged to hold health insurance, hold no valid visa or residence document, cannot bring cover from their own country and have no third party obliged to pay, and anyone on a temporary stay also needs a favourable report from regional social services. A visitor with travel insurance or a home scheme fails those conditions by definition, and where an application is refused, the decree says the care is billed.
How much does A&E cost in Spain without insurance?
An emergency attendance without admission costs €173.10 in Murcia and €240 in Valencia under their 2026 tariffs, the most recent emergency prices verified in an official text. Other regions' published figures run from €100.40 to €293.08, mostly from older instruments, and each region decides differently whether tests and medication are included.
Prices verified at 2026 levels
| Service, uninsured patient | Murcia | Valencian Community | Basque Country |
|---|---|---|---|
| A&E visit, no admission | €173.10, tests and medication extra | €240.00 | — |
| A&E observation, per day | €317.35, in place of the A&E fee | — | — |
| GP visit at a health centre | €72.70 | €77.16 first · €65.00 follow-up | — |
| Urgent or out-of-hours GP visit | €138.48 | €107.27 | — |
| Nurse visit | €32.31 | €50.00 | — |
| Specialist, first · follow-up | €201.95 · €121.17 | €121.71 · €90.00 | — |
| Ward, per day | €385.44* | €440.59† | €1,347 |
| Intensive care, per day | €1,821.01* | €1,870.41† | €2,094 (special units) |
| Day hospital, per session | €133.86 | €117.11 (oncology €291.03) | — |
| Instrument | Orden de 17 de junio de 2026 (BORM 140), applied from 1 July 2026 | Ley 20/2017 de tasas, as amended by Ley 5/2026 (DOGV, 10 August 2026) | Osakidetza tariffs for 2026 (BOPV, 15 January 2026) |
* Murcia applies these day rates only to admissions shorter than 24 hours, and bills 60% of them; longer stays are priced per diagnosis group. † Valencia prices most admissions per diagnosis group; the day rates apply to stays outside that system. A dash means we have not verified that figure in the official text.
What the A&E price includes differs, and it changes the total. Murcia states that the emergency price no incluye las pruebas complementarias ni medicación — tests and medication are billed on top — and its observation charge replaces the emergency fee rather than adding to it. Catalonia bills every emergency attendance whether or not the patient is admitted. Ceuta and Melilla make no separate emergency charge when the patient is admitted, and Galicia bills an emergency that ends in admission as a hospital stay.
The main tourist regions
Each of these regions publishes its tariff in a long annex. The table gives the verified figures and names the instrument that sets the rest, so you can check any price you are quoted.
| Region | Published prices | Instrument in force |
|---|---|---|
| Andalusia | Health-centre visit, booked or urgent: €53.51. Home visit: €160.52. Hospital emergency, stays and intensive care are set in Anexo B of the order. | Orden de 24 de mayo de 2024 (BOJA 108, 5 June 2024), in force since 25 June 2024 |
| Catalonia | At Institut Català de la Salut centres: GP visit €50; urgent GP visit €75, or €115 at home; CUAP urgent-care centre €105, or €130 with observation. Every emergency attendance is invoiced, admitted or not. | ORDRE SLT/71/2020 (DOGC 8153, 12 June 2020) |
| Madrid | General hospital emergency: €185, in the region's own costing for its current order. Specialist visit €132 first, €79 follow-up, from the same costing. Admissions priced per diagnosis group. | Orden 1975/2023 (BOCM 310, 30 December 2023) |
| Balearic Islands | Admissions priced per diagnosis group: an appendicectomy from €5,219, a hip or femur fracture repair from €10,045, a heart attack from €5,476. Other prices are set in the resolution's annex. | Resolución of 5 December 2022 (BOIB 168), in force since 1 January 2023 |
| Canary Islands | Levels reported in April 2024: GP visit €71, average ward day €717, adult intensive care €2,697 a day. Raised 1% in 2025 and a further 1% by a resolution published on 4 September 2026. | Decreto 81/2009, uprated by Resolución of 14 August 2026 (BOC 178) |
The Catalan figures apply at centres run by the Institut Català de la Salut; every price compared in CatSalut's own order for the claims it makes (ORDRE SLT/63/2020) is identical.
The rest of Spain
| Region and source | A&E visit | Ward, per day | Intensive care, per day |
|---|---|---|---|
| Navarre (2025 tariffs, press report) | €293.08, tests extra | €614.63, meals and medication included | €2,577.08 |
| La Rioja (January 2025 order, Rioja Salud announcement) | €246 | €736 | €1,698 |
| Extremadura (Decreto 20/2018, base prices uprated each year) | €277.13 | €830.67 | €2,343.61 |
| Asturias (Decreto 72/2023, amended again in June 2026) | — | €673.83 at HUCA · €439.66 at other hospitals | €1,240.97 · €1,197.48 |
| Galicia (Decreto 56/2014) | — | €528.95 | €1,142.47 |
| Castilla y León (Decreto 25/2010) | €100.40 | €321.89 to €404.69 by hospital | €965.66 to €1,043.28 |
| Castilla-La Mancha (November 2014 order, press report) | €236 (urgent consultation) | — | — |
| Ceuta and Melilla (INGESA, 2013; service prices from a press report) | No separate charge if admitted | €549.79 | €1,284 |
Read the older figures as floors. Several instruments uprate their prices every year or have been amended since: Extremadura's decree allows annual updates, and Asturias changed its prices again in June 2026. Cantabria and Aragón are not in the table — a draft replacement for Cantabria's 2017 order went to public consultation in August 2025, and Aragón's published orders set what the region pays private providers, not what it bills patients.
One more number circulates that is not a patient price. Spain's 2026–2029 agreements with motor insurers pay public hospitals €324 per emergency attendance, €766 per ward day and €1,534 per intensive-care day for traffic-accident victims. Those rates were negotiated with insurers; a patient paying their own bill is charged the regional tariff instead.
How much does a hospital stay cost in Spain?
Most regions do not bill an admission by the day. They charge one price for the whole episode, set by diagnosis group (grupo relacionado por el diagnóstico, GRD) and severity, graded 1 to 4. At published 2023–2026 prices, an uncomplicated pneumonia admission costs about €2,750 to €3,600; a complicated appendicectomy or hip fracture can exceed €25,000.
| Admission and region · severity 1 to 4 |
|---|
| Pneumonia (GRD 139) |
| Madrid 2023 · €2,779 to €8,519 |
| Murcia 2026 · €2,754.84 to €6,142.38 |
| Valencia · €2,911.76 to €7,691.31 |
| Catalonia 2020 · €2,936 to €12,801 |
| Balearics 2023 · €3,592 to €10,923 |
| Heart attack, medical treatment (GRD 190) |
| Madrid 2023 · €3,215 to €8,316 |
| Valencia · €3,110.65 to €6,446.84 |
| Balearics 2023 · €5,476 to €12,725 |
| Stroke (GRD 045) |
| Madrid 2023 · €3,636 to €10,922 |
| Catalonia 2020 · €5,031 to €19,153 |
| Balearics 2023 · €4,990 to €13,389 |
| Seizures (GRD 053) |
| Madrid 2023 · €3,214 to €12,642 |
| Catalonia 2020 · €3,579 to €16,584 |
| Balearics 2023 · €3,411 to €19,066 |
| Appendicectomy (GRD 225) |
| Valencia · €3,583.61 to €13,195.28 |
| Balearics 2023 · €5,219 to €25,062* |
| Basque Country 2026 · €5,176 to €25,680 |
| Hip or femur fracture surgery (GRD 308) |
| Madrid 2023 · €7,532 to €16,925† |
| Balearics 2023 · €10,045 to €21,676 |
| Basque Country 2026 · €7,939 to €25,889 |
Ranges run from severity 1 (minor) to severity 4 (extreme). * The Balearics price appendicectomy as GRD 234, or GRD 233 with a complex diagnosis (€7,551–€22,043). † From Madrid's 2023 draft order. Valencia's episode prices come from a legal-database copy of its tax law.
Severity moves the price as much as the diagnosis does: a Balearic hand or wrist operation runs from €5,364 at severity 1 to €51,331 at severity 4. What the episode price includes differs as well. The Balearic price covers toda la asistencia sanitaria, tests and implants included, with half the cost of a prosthesis added where it exceeds half the episode value; Valencia's includes the emergency care before admission but bills prostheses at cost; Murcia bills care before admission and after discharge separately.
Ceuta and Melilla's 2013 list, on an older grouping system, adds two reference points the others lack: a vaginal delivery at €2,122.80 to €2,326.72, and an uncomplicated appendicectomy at €3,431.06. Press reports of Navarre's 2025 tariffs put a delivery at €3,293 to €13,470.
Where a day rate is published, read the condition attached to it. Murcia's €385.44 ward rate and €1,821.01 intensive-care rate apply only to admissions shorter than 24 hours, and only 60% is billed — €231.26 and €1,092.61 — plus tests and medication. Anything longer is billed as a diagnosis-group episode, which is why a figure like “€200 a day” tells you very little about the bill for an admission.
How much does an ambulance cost in Spain?
A public ambulance is free for anyone whose care is covered, including European card holders. Without cover, Murcia bills €43.85 for a conventional ambulance and €1,045.52 for an advanced life-support unit, plus €1.38 per kilometre, and €8,146.09 for a medical helicopter. Other regions' helicopter tariffs run from about €4,500 to €8,200.
| Road ambulance and helicopter, by region |
|---|
| Murcia · 2026 order Conventional €43.85 Advanced life support €1,045.52 Helicopter €8,146.09 Plus €1.38 per km on every service |
| Valencia · Ley 20/2017 de tasas Non-urgent €27.09 Basic life support €350 Advanced life support: €420 transport plus €900 for the medical team Helicopter €8,200 Transport prices: legal-database copy |
| Castilla y León · Decreto 25/2010 Urban ambulance €54.76 Basic life support €223.08 Advanced life support €740.22 Helicopter €4,897.62 |
| Extremadura · Decreto 20/2018 Medicalised ambulance €1,216.90 Helicopter €7,828.03 Base prices, uprated each year |
| Galicia · Decreto 56/2014 Basic life support €385.29 (urban) Advanced life support: €158.36 an hour for staff, plus €4.09 per km Helicopter €7,991.99 |
| Navarre · 2025 tariffs, press report Scheduled ambulance €55.50 Advanced life support €606.49 plus staff Helicopter €4,506 plus staff |
For an uninsured patient, a 20-kilometre advanced life-support transfer in Murcia comes to €1,073.12 before any hospital charge. In Valencia the medical team's care and the transport are separate charges, €1,320 together.
The more common way a covered visitor ends up paying for an ambulance is by being taken to a private hospital. UK travel advice for Spain, updated on 7 October 2026, warns that some hotels may call private doctors or ambulances that take patients to private hospitals, where the card will not be accepted, and advises dialling 112 and asking for an ambulance. In a June 2026 case reported from Mallorca, a family paid €1,095 for a private ambulance called by a hotel doctor; their insurer reimbursed €400, the cost of a public one.
The Balearic government itself routes some urgent visitor cases to private hospitals, under Decreto-ley 1/2024. Since an agreement with the State in December 2024, a transfer requires the patient's explicit consent and a choice between at least two centres with different owners, and the centres are paid 65% of public prices. The scheme referred 24,802 cases in 2024, according to the specialist health press.
What does a GP visit cost without insurance?
At a public health centre (centro de salud), a non-entitled patient pays the region's tariff: €53.51 in Andalusia, €72.70 in Murcia, €77.16 in Valencia and €50 at a Catalan ICS centre. Urgent and out-of-hours visits cost more. Private clinics set their own fees, and no study with a stated method publishes them.
Urgent visits cost €75 at a Catalan health centre and €105 at a CUAP, Catalonia's urgent primary-care centres, or €130 with a period of observation. Valencia charges €107.27 for an out-of-hours visit and Murcia €138.48 for an urgent visit at a health centre. Private patients follow the same access rules as residents, so these are the same urgent and out-of-hours services residents use.
Private prices are harder to pin down. Spain does not regulate them, the large hospital groups mostly do not publish self-pay prices — Vithas, for instance, says it gives each patient an individual quote — and the one consumer survey of private prices, by the consumers' organisation OCU, covers dentistry only. The ranges that circulate online, €25 to €60 for a private GP and €100 to €250 for a private emergency department, come from an insurance-comparison site, and the emergency range has no stated source at all.
Spain's consumer code (Real Decreto Legislativo 1/2007, Article 20) requires any offer that states a price to give the full final price, taxes included. Ask a private clinic for that price before you are seen, ask whether tests are included, and ask for a written quote before any planned treatment.
The pattern we see most often in our own consultations is a request that arrives after a private visit rather than instead of one: someone has paid a clinic to confirm they need a medicine they were already taking at home. A prescription for an established treatment is the one part of this that does not require being in a room with a doctor.
Already know what you need?
A Spanish-licensed doctor can review a request for a medication you already take, at a price fixed before you start — anything urgent still belongs at urgencias.
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What does a GHIC or EHIC cover in Spain, and what do you still pay?
With a valid European card, medically necessary care in the public system is given as if you were insured in Spain: GP, specialist, hospital and emergency care carry no charge, and a public ambulance is free. Your home system settles the cost with Spain. You still pay part of the price of prescribed medicines.
The card is the European Health Insurance Card (EHIC) for people insured in the EU, the EEA or Switzerland, or the UK's Global Health Insurance Card (GHIC), which Spain treats identically. Under Article 19 of Regulation (EC) No 883/2004, a card holder on a temporary stay is entitled to the care that becomes medically necessary during it, on the host country's terms, and Article 35 obliges the home institution to reimburse Spain. Spain's national contact point puts it plainly: the card holder será tratado como un paciente nacional con seguro público. The EU's Your Europe service adds that a hospital may not bill a patient who has shown the card, because the country where the patient is insured pays.
The card does not reach everything. It is not accepted in private clinics or hospitals — in the European Commission's words, if you are asked to pay upfront, you are not being treated under the public system. It does not cover mountain rescue or repatriation, according to UK government guidance; dental care is generally not available in the state system; and it does not cover a trip made in order to receive treatment.
Without the card at the desk, you are charged as a private patient. UK visitors can get a Provisional Replacement Certificate from NHSBSA Overseas Healthcare Services on +44 (0)191 218 1999, Monday to Friday, 8am to 6pm. If you have paid for state care, NHSBSA refunds it according to Spanish rules and rates, against the original invoices, but it does not refund private treatment or co-payments. EU visitors claim from their own insurer.
What card holders pay at the pharmacy
UK and EU guidance both say card holders pay 50% of the price of a prescribed medicine, or 10% with a UK State Pension, and that the charge is not refundable. The figure comes from a 2012 Spanish instruction that applied the middle income band to visitors, whose income cannot be checked at the counter. Spain rebuilt those bands by Real Decreto-ley 11/2026, in force since 14 May 2026: residents now pay 40%, 45%, 50% or 60% depending on income, with monthly caps in the lower bands, and most pensioners pay 10%. The new text has no rule for people insured in another country and no instruction on visitors has followed it, so 50% remains the rate official guidance gives. For common medicines, the difference between bands is a matter of cents.
The reduced rate applies only to medicines prescribed by a public doctor. A private prescription, including one issued online, is dispensed at the full price, card or no card.
It is the question card holders ask us most: whether their card lowers the price of a medicine we prescribe. It does not. Our prescriptions are private, so the pharmacy charges its full official price — which, for the common medicines in the table further down, is between about €2 and €10 a pack.
What if your cover is from the US, Canada or Australia?
Then no reciprocal agreement moves the bill: Spain invoices you at the regional tariff unless an insurer accepts liability, and your home scheme pays little or nothing towards it. Medicare usually pays nothing abroad, Ontario's OHIP pays at most C$400 a day for higher-level inpatient care, and Australia's Medicare pays nothing in Spain.
What each home scheme pays towards emergency care in Spain:
- US Medicare, Parts A and B: usually nothing; it pays only in rare cases.
- US Medicare Part D: never covers medicines bought abroad.
- Medigap Plans C, D, F, G, M and N: 80% of foreign-travel emergency care, up to plan limits; Plans A, B, K and L pay nothing.
- Ontario (OHIP): up to C$400 a day for higher-level inpatient care such as intensive care or an operating theatre; C$200 a day for other inpatient care; for outpatient care, C$50 a day or the bill, whichever is less.
- British Columbia (MSP): C$75 a day for emergency inpatient care.
- Australia (Medicare): nothing, because Spain is not one of the 11 countries with which Australia has a reciprocal health care agreement.
Set Ontario's C$400 a day against Valencia's €1,870.41 for a day in intensive care and the gap falls on you or your travel insurer. These visitors also pay the full price of any medicine. If you need a Schengen visa to enter Spain, the visa itself requires travel medical insurance with at least €30,000 of cover, including urgent care and repatriation, under Article 15 of Regulation (EC) No 810/2009.
What happens after treatment if you can't pay?
You receive an assessment (liquidación) with a payment deadline, one month from notification in Murcia. Left unpaid, it becomes a public debt that can be sent to the regional tax agency for enforced collection, adding surcharges of up to 20%. No official source links an unpaid Spanish hospital bill with refusal of entry or residence.
At the admissions desk
Murcia's health service asks patients without public cover to sign a payment undertaking (compromiso de pago), accepting the invoice unless a third party is documented. Showing an insurer's card is not enough — la presentación de la tarjeta de la compañía no acredita el derecho — and if the insurer's written guarantee has not arrived within ten days, the invoice is issued to the patient. The Canary, Galician and INGESA instruments all put the cost on a patient who does not name the party obliged to pay. If you are insured, ask your assistance company to send the hospital a written guarantee straight away.
For planned, non-urgent care, some regions allow payment up front. Extremadura's decree lets its centres require advance payment, a deposit or the full amount (pago anticipado, provisión de fondos, el depósito); Andalusia's order allows advance payment, a prior deposit or a guarantee where there is a risk of non-payment, mainly for non-residents from outside the EU and existing debtors; and Valencia's charge may be demanded at the time of service. None of these rules makes emergency treatment conditional on payment.
The bill
The charge arrives as a liquidación incorporated in an invoice. Murcia allows one month from notification, accepts cash or card at the hospital's billing office, and offers deferral or instalments for temporary hardship, with no guarantee required below €50,000. Extremadura follows the tax calendar: notices served in the first half of a month are payable by the 20th of the next month, later ones by the 5th of the month after. There is no single national deadline, so the date printed on your assessment is the one that counts.
If it goes unpaid
Most regions charge precios públicos, which Article 27.6 of Ley 8/1989 makes collectable through the administrative enforcement procedure (apremio). Murcia sends unpaid bills to the Agencia Tributaria de la Región de Murcia, which, in the health service's own words, embargaría el importe adeudado — would seize the amount owed. Once a debt is in enforcement, Article 28 of the General Tax Law (Ley 58/2003) provides surcharges of 5%, 10% or 20% depending on when it is paid, with late-payment interest added at the 20% stage. Valencia levies its charge as a tax (tasa) rather than a public price, and Osakidetza's tariffs are private-law charges.
From abroad, collection has relied on private agents: the Balearic health service hired a collection firm after tourists left more than €7 million of bills unpaid between 2019 and 2022. The EU directive on mutual assistance for debt recovery excludes contractual dues, and no official source shows Spain using it for hospital bills.
To challenge a bill, the routes are those for public revenue: in Murcia, an optional appeal for reconsideration (recurso de reposición), then a claim to the regional finance minister (reclamación económico-administrativa), then the courts; in the Balearics, appeals are decided by IB-Salut's secretary general. If you were billed despite showing a valid European card, claim from your home insurer.
Identification is where the money is lost, which is why the desk asks so firmly for your card or your insurer's details. Spain's Court of Audit (Tribunal de Cuentas) found that the country billed other European states €441.2 million for care given in 2009, and that lost entitlement forms were one of the main reasons it failed to collect. In 2025 the Balearic health service billed €76.5 million to third parties, €41.8 million of it under European card agreements and €7.4 million to individuals.
Claiming on travel insurance?
A Spanish-licensed doctor can assess you online and, where the assessment supports it, issue a medical certificate for your insurer.
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Can you pay into the Spanish public health system?
Yes, if you have lived in Spain for at least a year. The convenio especial created by Real Decreto 576/2013 costs €60 a month under 65 and €157 from 65, covers the same basic services as public insurance from the day you sign, and excludes prescription medicines, which you pay in full.
The agreement point by point, from the decree and the health authorities:
- Monthly fee: €60 under 65; €157 at 65 or over (Article 6). Unchanged since 2013; a region may charge more only if it adds services.
- Who can join: one continuous year of effective residence immediately before applying, registration on the municipal roll (padrón) when applying, and no public cover by any other route. Holders of an S1 form cannot join.
- The qualifying year: Madrid and the Ministry of Health count residence in another EU or EEA country, Switzerland or the UK.
- Where to apply: the regional health service for the municipality where you are registered (INGESA in Ceuta and Melilla), not the Social Security office (INSS).
- Decision: within 30 days; no answer counts as approval; three months to sign.
- Cover starts: the day the agreement is signed, with no co-payments or waiting periods.
- What it covers: the basic common portfolio — GP, specialist, hospital, emergency and diagnostic care — with the same guarantees as insured patients.
- What it excludes: outpatient prescription medicines, orthoprosthetics, dietary products and non-urgent transport, all paid in full.
- Travel in Europe: temporary stays in the EU, EEA, Switzerland and the UK, through a Provisional Replacement Certificate from the INSS.
- Ending it: missing the first payment or two consecutive payments, or cancelling in writing; after that you cannot rejoin for a year.
The pharmacy exclusion is settled. Article 2.2 of the decree limits the agreement to the basic common portfolio of services in Article 8 bis of Ley 16/2003; outpatient medicines belong to the separate supplementary portfolio of Article 8 ter, which carries user contributions. The Ministry of Health lists outpatient pharmacy at 100% contribution by the patient, the Community of Madrid excludes prestación farmacéutica in terms, and UK government guidance says convenio members pay the full cost of prescription medication. For short courses of common medicines that is a few euros; for an expensive long-term treatment it becomes the main running cost.
The first-year gap
The year of residence leaves new arrivals exposed. EU citizens living in Spain without work, and EU students, must hold un seguro de enfermedad que cubra todos los riesgos en España — health insurance covering all risks — under Article 7 of Real Decreto 240/2007. A non-lucrative residence permit requires a public or private policy with an insurer authorised in Spain, and consulates typically add that it must have no waiting periods, no co-payments and no cover limit, and must not be travel insurance. Because Ley 16/2003 excludes residents who must prove cover by another route, these residents sit outside public funding in their first year and are billed like visitors if their policy does not pay. UK government guidance is blunt: residents of under a year without other cover will need to buy private health insurance.
At €720 a year under 65, or €1,884 from 65, the convenio has to be weighed against private quotes for the same person; no published average premium allows a general comparison, and insurers' “from” prices depend on age and co-payments. No official source states whether immigration offices (oficinas de extranjería) accept the convenio as the insurance a residence renewal requires, so ask the office handling your file before relying on it.
Among long-stay visitors, the cost question we hear most is not what a hospital charges but whether they can simply pay into the public system — and the year of residence it requires is usually the detail that changes their plans.
If you are bridging that first year with a treatment you already take, our guide to repeat prescriptions for long stays in Spain explains how to keep it going without gaps.
Living in Spain without public cover yet?
A Spanish-licensed doctor can review an established treatment online and, when it is safe to continue, issue a private e-prescription valid at any pharmacy in Spain.
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Why is the medicine the cheap part?
Because medicine prices are set nationally while treatment prices are set by each region. An interministerial commission fixes the price the national system pays, and the Ministry adds fixed wholesale and pharmacy margins plus 4% VAT. At October 2026 official prices, the common treatments below cost between €1.90 and €9.52 a pack.
| Medicine | Pack | Official price, VAT included |
|---|---|---|
| Amoxicillin 500 mg | 20 capsules | €3.50 (cheapest brand €2.50) |
| Amoxicillin and clavulanic acid 875/125 mg | 20 tablets | €9.52 |
| Azithromycin 500 mg | 3 tablets | €5.62 |
| Fosfomycin 3 g | 1 sachet | €2.50 |
| Ibuprofen 600 mg | 40 tablets | €1.97 |
| Paracetamol 1 g | 20 tablets | €1.90 |
| Omeprazole 20 mg | 28 capsules | €2.42 |
| Salbutamol inhaler, 100 micrograms (Ventolin) | 200 doses | €4.09 |
| Cetirizine 10 mg | 20 tablets | €3.12 |
Those are the prices the national system pays, published in the Ministry of Health's Nomenclátor. Under Article 94.7 of Real Decreto Legislativo 1/2015, the price outside that system is, as a general rule, equal to or higher than it, so a private prescription can occasionally cost a little more at the counter. Without entitlement, or on any private prescription, ours included, you pay the full price rather than a share of it. Our guide to medication prices in Spain covers a wider range of treatments.
A prescription written outside the EU or the EEA cannot be dispensed in a Spanish pharmacy, and one from inside it only when it carries specific details; how prescriptions work in Spain explains which ones work and why.
Which cost claims about Spanish healthcare are wrong?
The most repeated ones: that emergency care and ambulances are free for everyone, that a hospital day costs about €200, that a European card works at any clinic, and that the convenio especial has a waiting period or is arranged through the Social Security office. Each is contradicted by the official texts.
- “Emergency care is free for everyone.” Free for people entitled to public care and for European card holders. Others are invoiced: Extremadura's decree says emergencies se facturarán siempre.
- “Ambulances are free.” Free in the public system for covered patients. Without cover, an advanced life-support ambulance costs €1,045.52 plus €1.38 per kilometre in Murcia.
- “A hospital day costs about €200.” Verified 2026 ward days run from €440.59 in Valencia to €1,347 in the Basque Country, and most admissions are billed as a single diagnosis-group episode.
- “A doctor's visit costs about €100.” It depends on the visit. A routine GP visit at a public health centre costs €53.51 in Andalusia, €72.70 in Murcia and €77.16 in Valencia; a first specialist visit costs €121.71 in Valencia and €201.95 in Murcia. Private fees are unpublished.
- “Your EHIC or GHIC works at any clinic.” Only in public facilities. A private clinic bills you, and NHSBSA does not refund private care.
- “The convenio especial has a waiting period.” Cover starts the day the agreement is signed (Real Decreto 576/2013, Article 4.4), with no co-payments or waiting periods.
- “You apply for the convenio at the INSS.” You apply to the regional health service where you are registered on the padrón.
- “The convenio covers prescriptions.” Outpatient medicines are excluded and paid in full.
- “An unpaid hospital bill will stop you entering Spain.” No official source links the two; unpaid bills go to regional tax enforcement.
What online care cannot do, ours included
It cannot examine you, treat an emergency or reduce a hospital bill. An online consultation suits a narrow set of problems: continuing a treatment you already take, conditions judged from symptoms and history, and certificates after an assessment. Anything that needs hands, a stethoscope, a test or a scan belongs in a clinic or hospital.
We cannot prescribe medicines that need Spain's special narcotics prescription (strong opioids, ADHD stimulants), we don't prescribe benzodiazepines or Z-drugs online, we can't examine anyone, and we don't handle emergencies (112). No prescription is guaranteed before a doctor reviews the case. If the doctor can't prescribe, the patient isn't charged.
Two more limits matter on a page about cost. Our prescriptions are private, so a European card does not reduce what you pay at the pharmacy. And we cannot certify an illness we have not assessed: a certificate for an insurer follows a consultation, not the other way round.
If you are weighing up where to be seen, our guide on how to see a doctor in Spain compares the public, private and online routes in more detail.
Frequently asked questions
How much does it cost to go to A&E in Spain without insurance?
It depends on the region that treats you. Under their 2026 tariffs, an emergency attendance without admission costs €173.10 in Murcia and €240 in Valencia; other regions' published figures run from about €100 to €290. Tests and medication are often billed on top, and if you are admitted, the stay is usually priced as one diagnosis-group episode.
Is emergency treatment free in Spain for tourists?
Only if something covers it. With a valid EHIC or GHIC, emergency care in the public system costs nothing, because your home country pays. Without a card, travel insurance or public entitlement, you are treated as a private patient and invoiced afterwards. Emergency departments treat first either way, so cost should never delay care in a real emergency.
How much does a hospital stay cost in Spain?
Most regions bill a whole admission as one episode priced by diagnosis and severity, not by the day. At published 2023 to 2026 prices, an uncomplicated pneumonia admission costs about €2,750 to €3,600, while a complicated appendicectomy or hip fracture can exceed €25,000. Where day rates apply, verified 2026 ward days run from €440.59 to €1,347.
How much does an ambulance cost in Spain?
A public ambulance is free if your care is covered, including with a European card. Without cover, Murcia's 2026 tariff is €43.85 for a conventional ambulance and €1,045.52 for an advanced life-support unit, plus €1.38 per kilometre, and €8,146.09 for a medical helicopter. A private ambulance called by a hotel or clinic is billed privately.
Does my EHIC or GHIC cover everything in Spain?
No. It covers medically necessary care in public facilities on the same terms as a Spanish resident, with no charge for GP, specialist, hospital or emergency care. It does not cover private clinics, mountain rescue or repatriation, and you still pay part of the price of medicines prescribed by a public doctor: 50%, or 10% with a UK State Pension, according to official guidance.
What happens if I can't pay a hospital bill in Spain?
The bill is an assessment with a payment deadline, one month from notification in Murcia, which also offers instalments for temporary hardship. If it stays unpaid, it becomes a public debt that can be sent to the regional tax agency for enforced collection, with surcharges of up to 20%. No official source links an unpaid hospital bill with refusal of entry.
Can I pay into the Spanish public health system?
Yes, once you have lived in Spain for a continuous year and are registered on the padrón. The convenio especial costs €60 a month under 65 and €157 from 65, and covers GP, specialist, hospital and emergency care from the day you sign. You apply to the regional health service where you live, not to the Social Security office.
Does the convenio especial cover prescriptions?
No. Real Decreto 576/2013 limits the convenio to the basic common portfolio of services, and outpatient medicines belong to the supplementary portfolio. The Ministry of Health, the Community of Madrid and UK government guidance all state that holders pay the full price of prescription medicines. Orthoprosthetics, dietary products and non-urgent transport are excluded too.
Can a Spanish hospital ask me to pay upfront?
For planned, non-urgent care, some regions allow it. Extremadura and Andalusia let their centres require advance payment, a deposit or a guarantee where there is a risk of non-payment, and Valencia's charge can be demanded at the time of service. None of these rules makes emergency treatment conditional on payment; for emergencies, the bill comes afterwards.
Is a private clinic cheaper than the public system for visitors?
Not necessarily. A routine GP visit at a public health centre is billed at a published tariff — €53.51 in Andalusia, €72.70 in Murcia and €77.16 in Valencia — while private clinics set their own fees and rarely publish them. With a European card, public care is free, which no private clinic matches. Ask any private clinic for its price before you are seen.
Sources
- Boletín Oficial del Estado — Ley 16/2003, de cohesión y calidad del Sistema Nacional de Salud, consolidated text. Supports entitlement under Articles 3, 3 bis and 3 ter as worded by Real Decreto-ley 7/2018, the third-party condition, and the basic and supplementary portfolios in Articles 8 bis and 8 ter. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Ley 14/1986, General de Sanidad, Article 16. Supports the treatment of non-entitled users as private patients invoiced on actual cost. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto 1030/2006, Article 2.7. Supports the health services' duty to claim costs from third parties and from private patients. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto 180/2026, de 11 de marzo. Supports the 2026 access procedure for foreigners without legal residence, its declaration and social-services report, and billing where an application is refused. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto-ley 11/2026, de 12 de mayo. Supports the pharmacy co-payment bands and caps in force since 14 May 2026. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto 576/2013, de 26 de julio. Supports the convenio especial's fees, eligibility, decision period, start date, scope and termination. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto 240/2007, Article 7. Supports the health insurance requirement for EU citizens living in Spain without work and for EU students. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Ley 8/1989, de Tasas y Precios Públicos, Article 27.6. Supports the collection of unpaid public prices through apremio. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Ley 58/2003, General Tributaria, Article 28. Supports the 5%, 10% and 20% enforcement surcharges. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto Legislativo 1/2007, the consumer code, Article 20. Supports the requirement to state a full final price. Accessed 16 October 2026. boe.es
- Boletín Oficial del Estado — Real Decreto 1718/2010 on medical prescriptions, consolidated text. Supports the rule that only prescriptions from EU and EEA countries can be dispensed in Spain. Accessed 12 October 2026. boe.es
- Servicio Murciano de Salud — Orden de 17 de junio de 2026 on public prices (BORM 140, 20 June 2026). Supports all Murcia tariffs, the day-rate and diagnosis-group rules, what the emergency price excludes, and the payment and collection articles. Accessed 16 October 2026. murciasalud.es
- Servicio Murciano de Salud — third-party billing questions and answers. Supports the payment undertaking, the ten-day window for an insurer's guarantee, payment methods, instalments and enforced collection. Accessed 16 October 2026. murciasalud.es
- Generalitat Valenciana — Ley 5/2026, de 31 de julio (DOGV 10425, 10 August 2026), amending Ley 20/2017 de tasas. Supports Valencia's emergency, consultation, nursing, stay, intensive-care, day-hospital and medical-team amounts. Accessed 16 October 2026. boe.es
- iberley (legal database) — Ley 20/2017 de tasas, Article 29.1, consolidated text. Supports Valencia's ambulance and diagnosis-group amounts and when the charge can be demanded. Accessed 16 October 2026. iberley.es
- Osakidetza — 2026 tariff book, under the agreement published in the Boletín Oficial del País Vasco on 15 January 2026. Supports the Basque ward, special-unit and diagnosis-group prices. Accessed 16 October 2026. euskadi.eus
- Junta de Andalucía — Orden de 24 de mayo de 2024 on public prices (BOJA 108, 5 June 2024). Supports Andalusia's primary-care prices and its advance-payment, deposit and guarantee rules. Accessed 16 October 2026. juntadeandalucia.es
- Comunidad de Madrid — Orden 1975/2023 (BOCM 310, 30 December 2023). Supports Madrid's diagnosis-group prices. Accessed 16 October 2026. comunidad.madrid
- Comunidad de Madrid — costing memo and draft text of the 2023 price order. Support the €185 emergency figure, the specialist visit prices and the hip-fracture episode price. Accessed 16 October 2026. costing memo · draft order
- Diari Oficial de la Generalitat de Catalunya — ORDRE SLT/71/2020 (DOGC 8153) and ORDRE SLT/63/2020 (DOGC 8134), read from copies of the gazette text. Support Catalonia's primary-care and diagnosis-group prices, the identical CatSalut prices and the rule that emergencies are always invoiced. Accessed 16 October 2026. SLT/71/2020 · SLT/63/2020
- Butlletí Oficial de les Illes Balears — Resolución of 5 December 2022 (BOIB 168). Supports the Balearic diagnosis-group prices and what they include. Accessed 16 October 2026. caib.es
- Butlletí Oficial de les Illes Balears — 2017 resolution on reviews of IB-Salut bills. Supports who decides appeals. Accessed 16 October 2026. caib.es
- Boletín Oficial del Estado — December 2024 agreement on the Balearic Decreto-ley 1/2024 (BOE-A-2025-2266). Supports consent, the choice between centres and payment at 65% of public prices. Accessed 16 October 2026. boe.es
- Boletín Oficial de Canarias — Resolución of 14 August 2026 (BOC 178, 4 September 2026) and Decreto 81/2009. Support the 2026 uprating and the rule that a patient who names no third party pays. Accessed 16 October 2026. 2026 resolution · 2009 decree
- Redacción Médica, 18 April 2024 — the Canary Islands' 2024 tariff levels. Accessed 16 October 2026. redaccionmedica.com
- Rioja Salud — announcement of the public-price order published on 14 January 2025. Supports the La Rioja figures. Accessed 12 October 2026. riojasalud.es
- Redacción Médica, 28 March 2025 — Navarre's 2025 tariffs. Accessed 16 October 2026. redaccionmedica.com
- Diario Oficial de Extremadura — Decreto 20/2018 (DOE 35, 19 February 2018). Supports Extremadura's base prices, advance payment and deposits, payment dates and the rule that emergencies are always invoiced. Accessed 16 October 2026. juntaex.es
- Principado de Asturias — annex to Decreto 72/2023. Supports the Asturian stay and intensive-care prices. Accessed 16 October 2026. asturias.es
- Xunta de Galicia — Decreto 56/2014. Supports the Galician stay, intensive-care and transport prices. Accessed 16 October 2026. conselleriadefacenda.gal
- Junta de Castilla y León — Decreto 25/2010 (BOCYL 119, 23 June 2010). Supports the Castilla y León prices. Accessed 16 October 2026. saludcastillayleon.es
- Redacción Médica, 21 November 2014 — Castilla-La Mancha's 2014 prices. Accessed 16 October 2026. redaccionmedica.com
- Boletín Oficial del Estado — INGESA resolution of 19 July 2013 (BOE-A-2013-8240). Supports Ceuta and Melilla's diagnosis-group prices and the rule that emergencies are not charged separately on admission. Accessed 16 October 2026. boe.es
- El Faro de Ceuta, 29 July 2013 — INGESA's service prices. Accessed 16 October 2026. elfarodeceuta.es
- Boletín Oficial del Estado — 2026–2029 agreement on care for traffic-accident victims (BOE-A-2026-16518). Supports the rates paid by motor insurers. Accessed 16 October 2026. boe.es
- European Commission — Using the European Health Insurance Card in Spain. Supports free public care and ambulance transport for card holders, charging without the card, dental care, and the rule on prescriptions from public providers. Accessed 16 October 2026. europa.eu
- legislation.gov.uk — Regulation (EC) No 883/2004, Title III. Supports Articles 19 and 35. Accessed 16 October 2026. legislation.gov.uk
- Ministerio de Sanidad, national contact point — questions from incoming patients. Supports the treatment of card holders as nationally insured patients. Accessed 16 October 2026. mscbs.gob.es
- Your Europe — payments and reimbursements, frequently asked questions. Supports the rule that a hospital may not bill a card holder who has shown the card. Accessed 16 October 2026. europa.eu
- Govern de les Illes Balears — copy of the 2012 Spanish instruction on co-payments for visitors. Supports the origin of the 50% rate. Accessed 16 October 2026. caib.es
- GOV.UK — Healthcare for UK nationals visiting Spain. Supports the GHIC's scope and exclusions, the 50% and 10% prescription charges and the Provisional Replacement Certificate. Accessed 16 October 2026. gov.uk
- GOV.UK — Foreign travel advice, Spain: health, updated 7 October 2026. Supports the warning about private doctors and ambulances called by hotels. Accessed 16 October 2026. gov.uk
- GOV.UK — Healthcare in Spain, for UK nationals living there. Supports the first-year insurance requirement, the convenio's full charge for prescriptions and the S1 exclusion. Accessed 16 October 2026. gov.uk
- NHS Business Services Authority — refunds for state treatment abroad. Supports the refund rules. Accessed 16 October 2026. nhsbsa.nhs.uk
- Mallorca Magazin, 12 October 2026 — a private-ambulance case in Mallorca. Accessed 16 October 2026. mallorcamagazin.com
- Redacción Médica, 6 March 2025 — referrals under the Balearic private-hospital scheme. Accessed 16 October 2026. redaccionmedica.com
- Medicare.gov — travel outside the US, and the Medigap plan comparison. Support what Medicare and Medigap pay abroad. Accessed 16 October 2026. travel · Medigap
- Government of Ontario — OHIP coverage while outside Canada, updated 16 January 2026. Accessed 16 October 2026. ontario.ca
- Government of British Columbia — leaving B.C. temporarily, updated 27 February 2026. Accessed 16 October 2026. gov.bc.ca
- Smartraveller, Australian Government — reciprocal health care agreements. Accessed 16 October 2026. smartraveller.gov.au
- legislation.gov.uk — Regulation (EC) No 810/2009, Article 15. Supports the €30,000 travel medical insurance requirement for Schengen visas. Accessed 16 October 2026. legislation.gov.uk
- Ministerio de Sanidad — the convenio especial for healthcare. Supports where to apply, the qualifying year, the absence of co-payments and waiting periods, the 100% patient contribution for outpatient pharmacy and cover in Europe. Accessed 16 October 2026. sanidad.gob.es
- Comunidad de Madrid — convenio especial procedure. Supports the pharmacy exclusion and the qualifying year. Accessed 16 October 2026. comunidad.madrid
- Ministerio de Inclusión, Seguridad Social y Migraciones — the non-lucrative residence permit. Supports the health insurance requirement. Accessed 16 October 2026. inclusion.gob.es
- Boletín Oficial del Estado — Tribunal de Cuentas report on billing for care given to people insured in other states (BOE-A-2013-3242). Supports the €441.2 million billed for 2009 and lost forms as a main cause of non-collection. Accessed 16 October 2026. boe.es
- Menorca.info, 19 January 2026 — Balearic third-party billing in 2025. Accessed 16 October 2026. menorca.info
- Majorca Daily Bulletin, 8 June 2022 — the Balearic health service's collection firm. Accessed 16 October 2026. majorcadailybulletin.com
- legislation.gov.uk — Directive 2010/24/EU, Article 2. Supports the exclusion of contractual dues from EU recovery assistance. Accessed 16 October 2026. legislation.gov.uk
- Vithas — frequently asked questions. Supports individual quotes in place of published prices. Accessed 16 October 2026. vithas.es
- OCU — dental price survey, 27 November 2024. Supports the statement that the one consumer survey of private prices covers dentistry. Accessed 16 October 2026. ocu.org
- Selectra, an insurance-comparison site — private consultation prices, May 2025. Supports the ranges that circulate online. Accessed 16 October 2026. selectra.es
- Ministerio de Sanidad — Nomenclátor de facturación, October 2026. Supports the medicine prices in the table. Accessed 16 October 2026. sanidad.gob.es
- Boletín Oficial del Estado — Real Decreto 823/2008 on pharmacy margins. Supports the margins built into retail prices. Accessed 16 October 2026. boe.es
- iberley (legal database) — Real Decreto Legislativo 1/2015, Article 94. Supports the rule that the price outside the national system may be equal or higher. Accessed 16 October 2026. iberley.es