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Healthcare in Spain: What you need to know

Tapas, sangria, flamenco…all these wonderful Spanish clichés await you in your new life in Spain.

Healthcare in Spain: What you need to know
Photo: monkeybusiness/Depositphotos

Just one thing before you grab your castanets and go. You should really take the time to look into the healthcare system in your new country. It’s always good to know the basics, just in case.

Unless you’re already fluent in Spanish and familiar with Spain, knowing where to start can send your head spinning. That’s why we’ve pulled together this nifty guide to help you get sorted, so if you feel la fiebre coming on, you know who to call.

Registering for healthcare

You’ll be pleased to hear the Spanish healthcare system offers free or subsidised health services and prescriptions for official residents and their family members. That means once you’re a legal resident and pay Spanish social security you get access to the same healthcare as Spanish citizens. ¡Olé!

Don’t panic if you’re not paying social security. There are also deals if, for example, you’re a retired British pensioner living in Spain and not paying into the Spanish system. 

When your situation is clearer, you can start the process of registering with a doctor. But first, you’ll have to register with the state healthcare system. Spanish healthcare is decentralised, and each of the 17 regions is responsible for itself. That means you should check with your regional health authority to find out what services are available to you and how to access them.

You’ll also have to register your address on the padrón at your local town hall, or ayuntamiento, where you will be given a certificate of empadronamiento. When you first register with your doctor, remember to take this with you – it also comes in handy for other situations where you may need proof of address.

If you’re living or staying for an extended time in Spain but not eligible for state healthcare, you can take out private healthcare insurance. Insurance companies like Cigna Global offer excellent packages that include access to its global network of hospitals, clinics and doctors, as well as a 24-hour helpline so you have support around the clock.

Finding a doctor

Most likely you’ll have a health clinic, centro de salud, or an individual practice, médico de cabacera, nearby. These offer all the regular primary care services, and you can usually find one through the phone book under medicos or your local healthcare authority.

In some of the more remote or less populated areas, you may have to travel to find a healthcare provider, or there may be a doctor or nurse available on specific days. If you know people in the area they might be able to recommend a doctor, and your embassy may also maintain a list of English-speaking doctors in your area.

Once you’ve found a doctor, you will need to register before you can make an appointment. This is when you’ll need to show your empadronamiento – which must have been issued within the last three months.

You should also take your TGSS (Tresoreria General de la Seguridad Social) certificate, passport, and Foreigners’ Identity Number (N.I.E.). All three are needed to apply for your health card, or tarjeta sanitaria individual, as well as a Sistema de Informacion Poblacional, which is a non-transferable card that gives you access to Spanish healthcare.

Each time you visit the doctor, hospital, or pick up prescription meds you will be required to show this card. It will mean you are entitled to receive state health without charge, so make sure to keep it somewhere safe!

Emergency care

If you need urgent medical care you should go straight to your nearest hospital’s emergency room, or urgencia (there’s a nice easy word to remember). Most chemists, or farmacias, will also be able to tell you where to go if you need urgent medical treatment.

Spain’s general emergency number is 112, so if you need a paramedic or require an ambulance then dial that number straight away. It’s a good idea to learn the Spanish translation if you suffer from an existing medical condition or allergy so there’s no confusion over how to treat you.

In case of emergency, you will be required to show your health card to receive state treatment. Or if you have private health insurance make sure to keep your details handy.

Cigna Global’s International Health Insurance covers emergency medical care, including reasonable transportation costs to the closest centre of medical excellence in the event that the correct treatment is not locally available in an emergency. It’s good to have this peace of mind while living abroad, so there’s no doubt over what care you and your family are entitled to in case of an emergency.

Find out more about Cigna Global health insurance

Specialist care

To see a specialist through the state system you will need to get a referral from your doctor. If you have private health insurance in Spain you can often skip this step and make an appointment directly with a specialist clinic, saving you time spent potentially worrying or in pain.

With a private health care provider like Cigna Global you will get an appointment faster than if you go through the state system. Cigna can also find you an English-speaking doctor so there’s no language barrier throughout the diagnosis and treatment.

Get a free quote from Cigna Global

Pharmacies

Spanish farmacias are easy to spot, just look out for the flashing green cross in or outside the window. Unlike in some other countries, all medicine, including over the counter painkillers like paracetamol and ibuprofen, must be purchased in a farmacia. If you are new to your area and not sure where your closest farmacia is, you can find it here.

If you have a minor ailment or common illness, the highly-trained pharmacists can provide you with treatment. In the bigger cities where there are more tourists this can often be done in English; however, further inland or in remote areas this may not be as easy. If your problem is more serious or ongoing, you should still see your doctor for a proper diagnosis.

Make sure to take your health card along with you when you pick up any prescription medicines. You still have to pay 60 percent of the cost, but in general, medication is fairly reasonable. If you are a pensioner you are entitled to free prescriptions.

Something to keep in mind is that you are living in the land of the siesta, so most farmacias close for a couple of hours in the afternoon and re-open around 5pm. On weekends they can close earlier, so make sure to check and visit early on in the day if necessary. Some regions have emergency pharmacies that are open 24 hours so if it’s urgent you can pick up medicine out of regular hours.

Insurance

Although the Spanish state healthcare system is one of the best in the world, it’s always useful to have access to private healthcare. Cigna Global specialises in healthcare for expats, offering flexible coverage at every level so you can enjoy your paella without worrying about all that cholesterol in the prawns.

This article was produced by The Local Client Studio and sponsored by Cigna Global.

 
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AMERICANS IN SPAIN

Navigating Spain’s real estate market: A guide for American homebuyers

There are some key matters US nationals looking to buy a Spanish home should consider, from legal complexities, to tax, property inspections and the role of buyer's agents. This quick guide by an international lawyer in Spain has you covered.

Navigating Spain's real estate market: A guide for American homebuyers

Buying a residential property in Spain can be an exciting yet complex endeavour, especially for American buyers unfamiliar with the intricacies of the Spanish real estate system.

With varying regulations at the state, regional, and local levels, it is crucial to be well-informed and well-prepared.

In this article, Maryem Essadik, immigration lawyer and head of English-speaking international law firm Marfour, offers US nationals a breakdown of the key considerations when buying a Spanish property.

Legal Complexities

Spain’s legal framework for real estate transactions is multifaceted, involving regulations that differ significantly between the national, regional, and local levels. Therefore, engaging specialized real estate lawyers is highly advisable.

1. State, Regional, and Local Regulations: The Spanish legal system is characterized by its decentralized nature. Each autonomous community in Spain can have distinct laws affecting real estates and property transactions. For example, while some regions may establish restrictions for renting out properties (ie. Limitations or prohibitions on carrying out short-rental activities, limitations on long-term rental prices etc.), others might have significantly varying taxes and fees associated with property purchases, and others can also count with a singular regional Civil Code that regulates in a particular manner important aspects such as the initial down payment contract (“Arras” in Spanish) when buying a property. Municipal regulations can also considerably impact property use and renovations.

READ ALSO: Which cities in Spain have new restrictions on tourist rentals?

2. Legal Representation: A lawyer with expertise in Spanish real estate law can navigate these complexities, ensuring compliance with all applicable regulations. They can conduct due diligence, verify property titles, and check for any encumbrances or legal issues that could affect the purchase. Legal representation is not just a formality but a necessity in Spain to avoid potential pitfalls.

READ ALSO: What’s the difference between a gestor, a lawyer and a notary in Spain?

3. Immigration legal advice: In connection with the property you want to buy in Spain you should receive the proper immigration law advice. Nationality and Immigration regulations in Spain are a complex but at the same time exciting field to navigate to find the best solution that will be matching your concrete case and circumstances (i.e: Digital Nomad Visas, Non Lucrative visas etc.)

LISTED: The visa options Americans can apply for to live in Spain

Fiscal Considerations

Taxation is another critical area that requires careful attention. Spain’s tax system includes various taxes that can impact the overall cost and benefits of owning a property.

1. Tax Residency: Determining your tax residency status is essential as it influences the taxes you are liable to pay. If you spend more than 183 days in Spain in a calendar year, you are considered a tax resident. You can also qualify as tax resident in Spain if having in this country the centre of your economic interests. Tax residents are subject to Spanish income tax on their worldwide income, while non-residents are taxed only on income generated in Spain.

READ ALSO: Do I have to pay tax twice if I’m an American living in Spain?

2. Income Tax and Wealth Tax: Spain imposes income tax (IRPF) and wealth tax (Impuesto sobre el Patrimonio) differently across its autonomous communities. The rates and allowances can vary, so understanding the specific regulations in the region where you plan to buy is crucial. For instance, some regions might have higher exemptions for wealth tax, impacting the overall cost of owning high-value properties.

3. Rental Income: If you plan to rent out your property, you need to be aware of the taxation rules on rental income. US tax residents are currently taxed for their rental incomes in Spain at a 24 percent flat rate on rental income (not being allowed to deduct any expense), whereas Spanish tax residents include rental income in their general taxable income (with different expenses being tax deductible), which could be taxed at progressive rates. Counting with the appropriate assistance of tax lawyers specialized in American clients and with a full knowledge of the US-Spain Tax Treaty can considerably help you to improve your tax bill.

READ ALSO: What the new Spain-US social security deal means for Americans

4. Special Tax Expats Regime: Implemented at the time that David Beckham joined Real Madrid (and known because of that as “Beckham Regime”), that regime may allow you enjoying the pros of being a tax resident in Spain, by living in this country exceeding 183 days per year, but taking advantage of a 24% flat rate and only making taxable in Spain labour incomes together with other incomes generated in Spain but not being taxable in Spain those sourced abroad. This tax regime has a maximum total 6 years duration and those who are eligible for it they also avoid filing Wealth Tax in Spain for their worldwide wealth.

To properly apply for it, it is always recommendable carrying out a previous tax planning and analysis with specialized Tax Lawyers before buying your property and moving to Spain.

READ MORE: 

Property Inspections

A thorough technical inspection by a qualified architect is advisable to ensure the property meets all regulatory standards and is free from structural defects.

1. Construction Defects: Architects can identify potential issues such as structural integrity, water damage, and compliance with building codes. This is especially important for older properties or those that have undergone renovations.

2. Urban Planning Compliance: The inspection should also verify that the property complies with local urban planning regulations. Non-compliance can result in significant fines or even demolition orders.

READ ALSO: Do I need planning permission in Spain and how do I apply for it?

Buyer’s Agents

Unlike real estate agents who typically represent the seller and defend his interests, buyer’s agents work in the interest of the buyer, offering numerous advantages.

1. Local Market Knowledge: Buyer’s agents are well-versed in the local market conditions and can provide valuable insights into different neighbourhoods, school districts, community amenities etc. This knowledge helps in identifying properties that best match your preferences and needs.

2. Fair Pricing: Buyer’s agents can help negotiate better prices. They are familiar with the local market rates and can prevent the common practice of overpricing properties for foreign buyers.

3. Due Diligence: By conducting thorough market analyses and property evaluations, buyer’s agents can ensure that you make an informed decision. They also handle the negotiation process, striving to secure the best possible deal on your behalf.

READ ALSO:

Financial Advice

Securing favourable financial terms can result in substantial savings, making it essential to seek expert financial advice.

1. Currency Exchange: For American buyers, currency exchange rates can significantly impact the cost of purchasing a property. Working with a reputable currency exchange provider can help you get the best rates, reducing overall expenses.

2. Mortgage Conditions: Comparing mortgage conditions from different lenders is crucial. Spanish banks offer various mortgage products, and an independent financial advisor can help you find the most favourable terms, considering interest rates, repayment periods, and other conditions.

READ ALSO: What non-residents should now about getting a mortgage in Spain

Conclusion

Buying a residential property in Spain involves navigating a complex legal and fiscal landscape.

By engaging specialized lawyers, conducting thorough property inspections, utilizing the services of buyer’s agents, and counting with expert financial advice, American buyers can mitigate risks and make informed decisions.

With careful planning and the right support, purchasing a home in Spain can be a rewarding investment and a gateway to enjoying the country’s rich culture and beautiful landscapes.

This article was written by Maryem Essadik, immigration lawyer and head of English-speaking international law firm in Madrid Marfour (Contact: +34 698 917 840, [email protected]).

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