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BRITONS IN SPAIN

What are the rules on accessing the UK health service if you live in Spain?

If you're British and live in Spain you will previously have been registered with the NHS, but once you move abroad things change. Here's what this means for accessing UK healthcare both on a regular basis and if you have an accident or fall sick while on a visit back to the UK.

Published: 24 October 2022 13:30 CEST
nhs uk spain
NHS hospitals won’t turn you away if you cannot prove residency, but they may present you with a bill. (Photo by JUSTIN TALLIS / AFP)

The NHS is described by the British government as a “residence-based health service” which means that if you don’t live in the UK you’re not automatically entitled to NHS care, even if you are a British citizen and even if you still pay tax in the UK.

However funding, access and care rules can vary depending on your circumstances.

Healthcare for Brits in Spain

In order to have access to Spain’s public health system, you need to make social security contributions. 

If you have a contract job in Spain, these contributions will be paid by your employer. If you’re registered as a self-employed worker (aútonomo), then it will be who pays these contributions as a monthly fee. If you have a Spanish pension, then you’re also covered.

If you are a UK pensioner, student or posted worker, it’s likely that the UK will continue to pay for your healthcare through the S1 system.

However, being covered by S1 doesn’t mean that you remain registered with the NHS – S1 is meant for non-UK residents.  

So, once you have your S1 form, you can then register for a public health card in your region of Spain and have the same access to Spanish public healthcare as Spaniards, but it’s the UK government which reimburses your healthcare costs to Spain.

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

If you’re a UK national who wants to move to Spain post-Brexit but doesn’t intend to work in Spain, you will have to get comprehensive private healthcare with the same coverage as public healthcare offers, something difficult and costly for those with pre-existing health conditions. 

Fortunately, after a year of residence in Spain, you can apply for the convenio especial (special agreement), a scheme where you pay either a monthly social security fee of €60 if you are under 65, or €157 if you are over 65, to get full access to public healthcare. 

READ ALSO: What are the pros and cons of Spain’s convenio especial?

Can I stay registered with my UK GP?

No, you need to have a local UK address to be registered with an NHS GP. In practice, many people don’t get around to telling their GP that they have moved and so stay registered for months or even years, but technically you should notify your GP so that you can be removed from the NHS register. 

Even if you do remain registered with a UK GP, they won’t be able to issue prescriptions for you in Spain as most UK GPs are not licensed to practice outside the UK – therefore are not covered by insurance.

If you are on regular medication, it may be possible for your GP to issue you with an advance stock of medication to cover you while you get settled in Spain, but many prescriptions are limited to a maximum of three months.

BRITAIN-NHS-SPAIN

Britons who live in Spain can use the Spanish TSE card for emergency treatment in the NHS. (Photo by Owen Humphreys / POOL / AFP)

What about travelling outside Spain?

Once you’re registered in the Spanish system you will be able to get a European health insurance card known as the Tarjeta Sanitaria Europea (TSE), which covers medical care while on trips in Europe. 

It’s basically the same as the EHIC you might have had while you were registered in the UK but it’s not issued automatically, you have to request it.

TSE card: How to get a Spanish European Health Insurance card

If travelling outside of Europe – ie a holiday in the US – you need to ensure that you have travel insurance with full medical cover in case of any mishaps while abroad. 

What about trips back to the UK?

Although your day-to-day healthcare will be covered by the Spanish system, there’s still the possibility of falling sick or having an accident while on a trip back to the UK. 

If you are an S1 holder you can show this to provide proof that you are entitled to NHS treatment, and if you are covered by the Brexit Withdrawal Agreement you can show your UK-issued EHIC or GHIC to provide proof of your entitlement to NHS care.

However, if you don’t have either of these, the TSE covers emergency treatment in the UK that can’t wait until your return to Spain, according to the Spanish government. 

If you don’t have the chance to get a TSE before travelling to the UK, there’s something called the Certificado Provisional Sustitutorio (CPS), which is valid for 90 days and serves the same purpose. You’ll need Spain’s digital certificate to get it, as it can only be done online here.

READ MORE: How to get Spain’s digital certificate to help with online processes

So if you are charged for medical care while in the UK – because you do not have a UK address – then you will be able to claim the costs back once you return to Spain.

This also means that any Spanish nationals who are with you on your trip – such as a Spanish spouse or partner – have their emergency care costs covered too through the TSE. 

In practice, most UK nationals who need to use the NHS while on trips back to the UK report that no-one ever thinks to ask whether they are UK residents.

It’s true that some Brits living in Spain keep their registration with a UK GP and make regular trips back to get prescriptions, while this can happen in practice it does involve lying or at least being economical with the truth about where you live.

Overall it’s better to get registered with a Spanish GP so that they can get to know you and have a full overview of your care as well as any ongoing medical conditions and prescriptions. Most Brits are pretty happy with Spanish healthcare, which consistently ranks among the best in the world. 

Emergency care

There are certain types of NHS care that are not charged for, such as A&E treatment or treatment from paramedics, but if you need to be admitted to hospital you may have to pay.

NHS hospitals won’t turn you away if you cannot prove residency, but they may present you with a bill when you leave if you cannot prove either residency or health cover in a European country.

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For members

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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