1. Private cover — the one the visa requires
Every residence route asks for health cover valid in Spain. For the digital nomad visa and the non-lucrative visa it must be full cover without significant exclusions and without waiting periods. Ordinary travel policies almost never qualify, and a policy bought to satisfy a checklist rather than the wording is a common reason for a request to amend.
2. The convenio especial — for your second year, not your first
The convenio especial lets economically inactive residents buy into the public system, with no copayments on what it covers. But it requires at least one year of continuous prior residence in Spain or another EU/EEA, Swiss or UK territory. If you are budgeting a move on the assumption that €60 a month starts on arrival, the budget is wrong by a year of private premiums.
Two exclusions are worth knowing before you rely on it: pharmacy is not covered at all — you pay 100% of prescriptions — and neither are orthoprosthetic devices, dietary products or non-urgent transport.
3. Contributions through work
Working and contributing to Spanish Social Security brings public cover for you and your dependants in the ordinary way. It is the simplest route and the least discussed, because it applies to the people who were never worried about the question.
UK state pensioners: the S1
If you draw a UK state pension you may be entitled to an S1, issued by NHS Overseas Healthcare Services and registered in Spain with the INSS; dependants can be included. Entitlement turns on your pension status, so confirm it with the NHS directly. And note the sequencing trap again: the S1 presupposes residence, so it does not cover the insurance requirement at the visa application stage.
The pattern across all three routes: the visa is assessed while you are still abroad, and every public route depends on already being here. Private cover first is not an upsell — it is the only order that works.
Frequently asked questions
Do I need private health insurance for a Spanish visa?
Yes. The residence routes require health cover valid in Spain, and for the digital nomad and non-lucrative visas it must be full cover without significant exclusions and without waiting periods. Travel policies generally do not satisfy this.
What is the convenio especial?
A paid agreement that lets economically inactive foreign residents join the public health system. The fee is €60 a month under 65 and €157 a month at 65 and over, and there are no copayments on the services it covers.
Can I use the convenio especial as soon as I arrive?
No — and this is the detail that reorders people's plans. It requires at least one year of continuous prior residence in Spain or another EU/EEA/Switzerland/UK territory, evidenced by a residence certificate or the padrón. It is a route for your second year, not your first.
Does the convenio especial cover prescriptions?
No. Pharmacy is entirely at your own cost under this agreement, as are orthoprosthetic devices, dietary products and non-urgent transport. That is a meaningful gap for anyone on regular medication.
I am a UK state pensioner — can I use an S1?
You may be entitled to one. The S1 is issued by NHS Overseas Healthcare Services and registered in Spain with the INSS, and dependants can be included. Entitlement depends on your pension status, so confirm it directly with the NHS rather than relying on a summary — including ours.
Does an S1 replace the insurance my visa requires?
Not at the application stage. The S1 route depends on being resident in Spain, whereas the visa is assessed before you are. Plan for private cover to get the visa, and treat the public route as the step that follows.
- Ministerio de Sanidad — convenio especial de prestación de asistencia sanitaria (fees, one-year prior residence, exclusions) in force since 1 Jan 2026
- Ministerio de Asuntos Exteriores — health cover requirement in residence visa applications in force since 1 Jan 2026
- NHS Overseas Healthcare Services — S1 for UK pensioners, registered with the INSS in Spain in force since 1 Jan 2026