Public healthcare in Spain as a foreigner: with papers, without papers, and emergencies
The first thing you need to know: healthcare in Spain is (almost) universal
Arriving in a new country and not knowing whether you can see a doctor is one of the worst feelings. Fear of the bill, fear of being asked for your papers, fear of being turned away. This article exists to make that fear go away.
Since 2018, Spain brought back universal healthcare with Royal Decree-Law 7/2018. That means no matter where you're from or what your administrative status is, you have the right to public medical care. The key is knowing how to activate that right.
The costliest mistake: going to the ER without your health card sorted out first
Here's something nobody tells you, and it can cost you: if you go to the emergency room without having processed your access to public healthcare, some regions may try to charge you for the visit.
The law protects you, but you need to have done the paperwork beforehand. If you don't have a health card or a proof-of-access document yet, remember this: get it sorted before you need it. Don't wait until you're sick.
Your situation: which one is yours?
| Your situation | Access to healthcare? | What do you need? |
|---|---|---|
| Legal residency (TIE) and working | ✅ Full and free | NIE + Social Security number + padrón registration |
| Legal residency, not working | ✅ Full | TIE + padrón registration. Request the card at your health center |
| Undocumented, registered on padrón for more than 3 months | ✅ Full and free | Passport + padrón certificate (min. 3 months) + DASE form or regional equivalent |
| Undocumented, newly arrived (temporary stay) | ✅ Same terms as a Spanish citizen, with one extra step | Art. 3 ter.1 of Law 16/2003 isn't limited to emergencies: it grants the right "on the same terms as people with Spanish nationality." If you are on a temporary stay, art. 3 ter.3 additionally requires a favorable prior report from social services in your region. Request it: don't settle for the ER thinking that's all you're entitled to |
| International student (more than 90 days) | ✅ Access similar to Spanish citizens | Padrón registration + university enrollment + passport |
Undocumented but registered on the padrón: here's exactly how it works
The law is clear. If you've been in Spain more than 90 days and you're registered on the padrón, you have the right to healthcare under the same conditions as any Spanish citizen.
What a lot of people don't know is that you don't need to go to the immigration office or the police. The paperwork is done directly at the health center that corresponds to your address, based on your padrón registration.
The three conditions are set out in art. 3 ter.2 of Law 16/2003, and it's worth reading them exactly as written because they get misquoted:
- Not be required to prove coverage through another route — under European Union law, bilateral agreements, or other applicable regulations.
- Not be able to export healthcare coverage rights from your country of origin or of provenance. Note the "or of provenance": it's not just the country you're a national of, but also the one you're coming from.
- No third party be obligated to pay — a company, an insurer, a family member required to cover you.
And what is NOT a requirement: the 90 days. The article does not require any minimum length of stay. The 3 months of padrón registration are the route many regions use to ask you to prove where you live, not a condition set by the law — if you haven't reached them, you still have the right, and what applies is the social services report, not waiting.
How to get your health card, step by step
If you have papers (legal residency + job):
- Go to your health center (CAP or Primary Care Center) with your TIE or NIE, Social Security number, and a recent padrón certificate (less than 3 months old).
- Ask them to assign you a GP and issue your Individual Health Card (TSI).
- You'll get a provisional slip you can use from that same day. The physical card arrives later.
If you don't have papers (no legal residency):
- Register on the padrón at your town hall — you can do this even without an NIE or residency permit. You just need your passport and a document proving where you live.
- Wait until you've been registered for at least 3 months.
- Go to your nearest health center. Ask for the universal healthcare access form (in Madrid it's called DASE; other regions use different names).
- Bring: passport + padrón certificate + a signed statement declaring you have no other healthcare coverage.
- You'll receive a provisional proof-of-access document on the spot, valid while your application is being processed.
- The final document arrives within a maximum of 3 months.
Watch out for this: differences between regions
The most common trap is assuming the process is the same everywhere in Spain. It's not. Healthcare is managed by each autonomous region, and while the right itself is the same across the whole country, the paperwork and documents they ask for vary.
- In Madrid: the document for people without legal residency is called DASE and is processed at the health center assigned to your address.
- In Andalusia: the Andalusian Health Service (SAS) has its own application form, which you can download at sspa.juntadeandalucia.es.
- In Aragón: the process is also handled through your nearest health center.
- In the Valencian Community: you need to book an appointment with the health center's social worker to start the process.
What isn't the same everywhere is the timeframe: art. 3 ter.3 of Law 16/2003 lets each region set its own procedure for requesting and issuing the document. In some it's issued on the spot; in others, it isn't. Ask at your health center about the specific timeframe before counting on it.
Emergency care: what you should know before you need it
In a real emergency, go straight to the ER at your nearest hospital. Call 112 if it's serious.
Emergency care for accidents, serious illness, pregnancy, childbirth, and postpartum care is always free for anyone in Spain, regardless of immigration status and regardless of whether you have a health card.
For minors, care is always full and free, no conditions attached.
What exactly does public healthcare cover?
Once you have your health card or proof-of-access document, you get access to:
- GP and nursing care
- Specialists (with a referral from your GP)
- Hospital emergency care
- Prescription medication (co-pay based on income: 40% general rate, less or 0% for lower incomes)
- Vaccines on the official schedule (free)
- Prenatal, childbirth, and postpartum care
- Pediatric care for minors
- Family planning
What public healthcare doesn't cover: adult dental care (except emergencies), glasses and contact lenses, cosmetic treatments, or most over-the-counter medication.
Your next step
Do this tomorrow:
- If you're not registered on the padrón yet: go to your town hall with your passport and proof of where you live (a rental contract, a letter from a family member, or even a utility bill). Registering on the padrón carries no legal risk and is the first step toward many rights in Spain.
- If you've already been registered for 3 months: find the health center assigned to your address (look it up on your region's health service website), book an appointment or just walk in, and bring your passport plus a recent padrón certificate. Walk out with the provisional document in hand.
- If you have legal residency: go to your health center with your TIE, Social Security number, and padrón certificate. The card gets processed that same day.