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HEALTH

BREXIT: How Britons can access Spain’s public healthcare if they’re not pensioners or working

Many Brits in Spain are anxious about what Brexit means for their access to public healthcare. Luckily there's a scheme which can solve this: the “convenio especial” (special agreement). Here's what you need to know about it.

Published: 7 September 2020 12:49 CEST
Updated: 6 May 2021 17:07 CEST
BREXIT: How Britons can access Spain's public healthcare if they're not pensioners or working
La Paz hospital in Madrid. Photo: PIERRE-PHILIPPE MARCOU/AFP

The question of healthcare weighs heavily on the minds of many Brits in Spain now that the UK is officially out of the EU. What the best healthcare option for them is depends largely on their individual situation. 

UK nationals who have a job or are self-employed in Spain get access to Spain’s public healthcare through social security contributions, as do British people with a Spanish pension or UK state pensioners who can get treatment at Spain’s public hospitals through the S1 form.

READ ALSO: Healthcare in Spain – the steps to apply for the S1 form for UK state pensioners

Then there are Brits who were living in Spain before January 1st 2021 and are now applying for residency, and therefore have to prove they have comprehensive private health coverage equivalent to that offered by Spain’s sanidad pública (public healthcare).

There are also the elderly Britons who were already residents in Spain before Brexit but who might not qualify for the S1 scheme and who pay for an expensive private health insurance policy, especially if they have pre-existing conditions.

And there are countless other scenarios in which Brits in Spain who are out of work or are having to deal with other difficult situations find themselves worrying about whether they’ll be covered by Spain’s healthcare system, especially now that there’s a pandemic.

In fact, one of the main problems foreigners in Spain have faced in recent months has been the lack of access to the Covid vaccine as many only have private health policies and only Spain’s public healthcare institutions have been inoculating the population. This has for the most part been resolved fortunately, as you can find out by reading the articles just below.

READ ALSO: Region by region – What foreigners in Spain should do to register for the Covid-19 vaccine

Luckily, there is a healthcare agreement in Spain which can resolve the problem of long-term access to Spain’s public healthcare if Britons are not working or are not pensioners, or if they don’t want to carry on paying private health insurance. It’s called the convenio especial.

What is el convenio especial?

This “special agreement” allows Brits and other foreigners who have been registered in Spain for a year to pay a monthly sum into the country’s public health system to have access to it.

This scheme means that those who aren’t working or paying taxes in Spain and those who aren’t using the S1 pension scheme can still use the public health system.

You can apply if you’ve been registered on the ‘padrón’ at your local ayuntamiento (town hall) for at least one year.

Unfortunately, if this isn’t the case you will have to take out private health insurance until you are eligible.

READ MORE: What are the best private health insurance options in Spain for Brits?

What are the costs and benefits of the convenio especial?

Under 65s pay a fixed monthly fee of €60 per month and over 65s pay €157 per month to obtain full cover through Spain’s public health system.

This does represent a big price jump for over 65s (€1,884 a year compared to €720 a year for under 65s) but it is quite possibly the best option out there for those elderly Brits in Spain not covered by S1 and who have pre-existing medical conditions as they will be completely covered.

Although there are private insurance options for seniors that work out cheaper than the convenio especial, they are very unlikely to cover pre-existing medical conditions or will only do so at a much higher rate.

There are also instances in which private health insurance companies scrutinise any medical condition the insured person suffers after taking out the policy under the premise that it may have been pre-existing, whereas with public health cover this won’t happen and the fee will only change once the person turns 65.

Are there situations in which private healthcare in Spain is better?

Spain has been consistently ranked among the world’s best for its standard of public healthcare as well as being a global leader in organ transplants for decades.

But prior to the coronavirus pandemic, patients in many parts of the country were having to wait long periods for appointments and operations, a situation which has worsened as Covid-19 sufferers take up hospital beds and medical staff’s attention.

In 2018, patients in Spain waited an average of 93 days for surgery at a public hospital. One in every eight patients waited for over six months.

As often happens in Spain, there remain big disparities between regions. Whereas in Madrid and La Rioja the average waiting times were 47 days, in the Canary Islands and Catalonia they were 147 and 132 days respectively.

There were also reports that cancer patients were registering in different regions despite not living there in order to get access to the latest life-saving cancer treatments, not evenly distributed across the country.

The biggest advantage of taking out a private healthcare policy in Spain is that waiting times are greatly reduced if medical attention is needed.

It’s also worth noting that if you opt out of the “convenio especial” you will not be able to sign up again until a year has passed. The “convenio especial” doesn’t entitle you to a Spanish EHIC either. 

How do I apply for the convenio especial?

Unfortunately, these inconsistencies between regions may also apply to the availability of the “convenio especial” to its residents.

For example, in 2018 Andalusia’s regional health department got rid of this ‘special agreement’, only to reintroduce it in 2019.

So the first thing you should do is find out at your local health centre if the convenio especial is available in your autonomous community in Spain, and if so what the requirements and documentation are.

These are the general requirements to be able to apply, which may differ according to your region:

1. You can prove that you have been living in Spain continuously for at least one year prior to the application. (If you have lived in different areas of Spain in the last year, this can done be through multiple “certificados de empadronamiento” or “padrón”).
2. You are currently registered/“empadronado” at the town hall of the autonomous community that you are applying from.
3. You do not have access to another health care agreement, bilateral agreement between Spain and your home country or another form of health cover.
4. You are residing legally in Spain.
5. Every member of the family needs to make their own individual application. In some cases, children and pregnant women may be exempt.

These are the documents that are usually needed for the application, which again my differ between regions:

1. Copy of and original Passport/NIE/Residency document
2. Document proving that you have lived continuously in Spain for a period of at least one year- This can include a rental agreement, utility bills etc.
3. “Padrón” certificate from your local town hall, issued recently in order to prove current registration.
4. A filled-out application form (specific to the autonomous community) which includes your personal and contact details, banking information through which direct debit payments can be set up(“domiciliación de pago”).
5. Some regions ask for a “Declaración responsable”to declare that you are not part of or entitled to another bilateral agreement or healthcare scheme. This can usually be downloaded from the regional health department’s website.

Here are some useful links that can help you to find out more about the “convenio especial” in regions of Spain popular with Brits.

Andalusia

Balearic Islands

Catalonia

Canary Islands

Murcia

Valencia region

Madrid

Asturias

Conclusion

If you live in Spain, you don’t work or have a pension and have a pre-existing medical condition, the “convenio especial” is probably the best and most affordable option for you to have full medical cover.
It’s particularly favourable for Brits in this situation who are under the age of 65, and even for those over 65 it may be the only viable option.

If you are in good health, it’s worth considering the possibility of becoming self-employed in Spain and contributing to the country’s social security system, as this will also give you and your spouse/children access to state healthcare.

READ MORE: Moving to Spain: What’s the difference if I move before or after December 31st?

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BRITS IN SPAIN

Six factors British people need to consider before retiring to Spain

If you're a UK national and thinking of retiring to Spain, there are some important factors you need to think about before making the move, and before you make any decisions about your UK pension.

Published: 3 May 2024 09:59 CEST
Six factors British people need to consider before retiring to Spain

Retiring to Spain is a dream for many, but in order to make that dream a reality, you need to know that you can financially support yourself.

For most retirees, their main or only income will be a UK pension, so it’s important to understand how your pension will work once you make the move to Spain. 

There are some specific rules and restrictions you should know when your pension is paid outside of the UK. You also need to understand how your pension will be taxed in Spain.

Financial adviser, Maeve Hoffman, from Spectrum IFA Group, emphasised that people should not take these decisions lightly, telling The Local: “Figuring out what to do with your pension should be part of your wider financial plans for your life”.

“This may be your most important asset, besides your home, and the best answer for what to do with your pension is highly individual. There are no sweeping generalisations when it comes to advice on private pensions. Everyone’s situation is different,” she said.

This article is intended as an overview of how the system works for UK pensioners and is not intended as a substitute for individual financial advice. It’s aimed at people who have worked most or all of their career in the UK and then plan on retiring to Spain – the situation is slightly different for people who have worked in Spain and then retire here.

READ ALSO: Which UK benefits can Brits keep if they move to Spain?

Long-term or short-term

The first thing you need to decide is if you’re moving Spain for the long-term or short-term. 

If you’re looking to stay here permanently, there are certain advantages you can benefit from, but they could make things extra complicated if you end up returning to the UK in the future.

Make sure you ask yourself the tough questions so you can think about every eventuality. Is there a chance that you will have grandchildren in the future that you’ll want to be close to them? Have you ever spent a significant time in Spain, before, apart from just for short holidays? Do you have connections to Spain, such as friends, family or a home? If your health deteriorates, will you want to be cared for in Spain or the UK?

If are unsure about the answers to these questions, then take some time to really think about them. There are alternatives to permanently moving to Spain if you are unsure – for example, you can stay here for three months without the need for a visa.

Understand the different tax rules

British retirees should be aware that the UK and Spain have very different tax systems.

Once you become a tax resident in Spain you have to file a yearly declaration on your global income. Your UK pension will be taxed in Spain and you will no longer be liable to UK taxation, unless you have a government service pension.

You can check if your pension is classified as ‘government’ here.

The UK state pension, as well as any other private pensions, will be taxable in Spain.

Because of this, will want to think about whether your previous plans for your private pension were only advantageous to you as a UK resident. Once you become a Spanish tax resident, they could have unforeseen implications.

For example, there is no tax-free lump sum in Spain. If you want to take out a lump sum, taking it while you are still a UK resident will save you a lot in tax.

Taxes also depend on the region in which you decide to retire to. Some are a lot more advantageous than others, so it’s important you know the rules of where you plan on moving to. 

READ ALSO: Why you should move to this region in Spain if you want to pay less tax

Get reliable, expert financial advice before doing anything

If you have decided you want to be in Spain permanently, then you will need some expert tax and pension advice – but you need to be careful who you take advice from, this is a highly specialist area and it’s unlikely that high street financial advisers will have the knowledge that you need. 

Brexit has also made getting financial advice more complicated, with fewer experts available.

Hoffman told The Local: “Because of Brexit, you cannot use a UK-based financial adviser anymore – you have to use an EU-registered one. This has made things more complicated. When picking an adviser, seek out someone who has expertise on the local taxation rules. They should also be regulated with the financial regulator where you live and where they work”. 

It can be especially complicated to work out who you should and shouldn’t take advice from – for example, some UK-based advisers have continued to give advice to EU-based clients, even though are not following EU regulations anymore. 

Hoffman adds: “There are free, government-based services in the UK that can help you understand your private pension – Pension Wise and Money Helper. Before doing anything, you should consult the free services. Any financial adviser worth their salt would recommend this too. 

“These services have begun to have longer wait times, so be sure to book well in advance of when you plan to draw from your pension.”

Decide whether to transfer your pension

Another question that is important for Brits to think about is whether or not to transfer their pension into either a UK-based SIPP for non-residents, or a QROPS (Qualifying Recognised Overseas Pension Schemes).

The SIPP will keep your pension in the UK, while the QROPS moves it out of the UK. 

These options can be helpful for residents in Spain, but you need to familiarise yourself with their benefits and drawbacks.

“The QROPS is not for someone who is unsure of their future, as if you return to the UK within five years of the pension transfer, HMRC will seek their tax back as if it was a full encashment,” Hoffman said.

You should also beware of scams on this subject, as the post-Brexit period saw many scammers seeking to persuade Brits that it was now mandatory to transfer their UK pension – always be wary of any cold-calling or unsolicited financial advice.

Determine how you will draw from your pension

The next factor to consider is how you want to receive your pension – either as regular income or as a lump sum. The option that you chose will have tax implications in Spain.

Generally, the tax rate will depend on the amount of your pension, but can range from 19 to 47 percent in Spain.

Remember that there is no ‘tax-free lump sum’ in Spain, so it’s best that you don’t draw from your pension that way.

Healthcare and Social Security

You won’t automatically be covered for healthcare in Spain if you retire here, because you won’t be working and therefore won’t be paying social security.

Thankfully, there are various options. UK nationals who retire to Spain (and have never worked in Spain) and have already reached the state pension age can apply for the S1. This means that the UK continues to pay for their healthcare costs and they would not be charged social security. Non-working spouses of an S1 holder can also benefit from this.

READ ALSO – Healthcare in Spain: the steps to apply for the S1 form for UK state pensioners

You can also choose to pay for the convenio especial (which translates to ‘special agreement’). This allows foreigners in Spain to pay a monthly sum into the country’s public health system to have access to it, even if they don’t work. To access it, you will pay a monthly fee of €60 if you are under 65 and €157 if you are over 65. 

Of course, you also have the option of getting private health insurance too.

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