One of the things that tends to surprise tourists and expatriates in Spain is the amount of older people enjoying an active life. Spaniards not only live longer but they live healthier and remain active longer than any of their European counterparts. The rankings vary depending on the sources and the methodology, but Spain shows consistently at the top of this type of classifications.

One of the most comprehensive studies recently carried out, based on 20 years of data collection in Europe, Australia and North America and published by prestigious The Lancet, puts Spain at the top of the “Years of Healthy Life” category.

Diet, weather and a relaxed attitude are usually credited for it, but less attention is put on the exceptional Spanish healthcare system ranked among the best in the world.  The definition of a good healthcare system is highly subjective, political and controversial, as well as the traditional rankings about it, but some facts help us precise the discussion; we like to highlight how Spain has been for 25 years now world leader in organ donation and transplants.

The latest analysis by the OCDE corroborates those findings, placing Spain second in life expectancy just behind Japan. The World Health Organization also supports this view and stresses the combination of longer and healthier years.



The economic crisis has taken a toll in the availability of health services, and since 2013 only permanent residents have access to universal, public health care, while non-lucrative visa holders –as explained in the legal section—must provide their own insurance. Spain and the US maintain a bilateral Social Security agreement but this refers only to pensions and other benefits, not healthcare.

When you become permanent resident you are automatically granted all public health services. If you do not bring your own international insurance you will have to pick a private one in Spain. There is a wide range of options with the same high standards as the public practice and some added advantages, like shorter waiting lists and a wider availability of English-speaking doctors. Most large private insurance companies have policies specifically designed to suit the needs of expatriates.

There are different types of policies, with assorted proportion of copayments and degrees of restriction when choosing hospitals or professionals, so it is always advisable to shop around before making a decision. The very good news is that this high quality healthcare can be acquired for a fraction of the cost in the US, and you can get a very comprehensive coverage for less than €150 a month.

Some of the private companies offering health insurance for non permanent residents are Caser,  Sanitas and  DKV. And, although at higher prices, all major international insurance companies like BupaCigna,  Blue Cross or  Axa can also cover your stay in Spain.