How much does it cost to join Spain's public health system with the convenio especial, and who can?

Checked on 2026-10-25

Under Real Decreto 576/2013, residents without publicly funded healthcare can join the public system through a convenio especial for €60 a month under 65 or €157 a month from 65. You need one year of continuous residence before applying, padrón registration and no access to public health cover by any other route. Regions may charge more.

Key facts

What	The source says	Source
Legal basis	People without the right to publicly funded care can get it by paying under a convenio especial	Ley 16/2003, art. 3.3
Fee under 65	€60 a month	RD 576/2013, art. 6.1.a; Ministry of Health guidance, point 2
Fee from 65	€157 a month	RD 576/2013, art. 6.1.b; Ministry of Health guidance, point 2
Regional surcharge	Regions may raise the fee if they add services from their own complementary portfolio	RD 576/2013, arts. 2.2 and 6.1
Residence	Effective residence in Spain for at least one continuous year immediately before applying	RD 576/2013, art. 3.a
Padrón	Registered in a municipality of the region when you apply	RD 576/2013, art. 3.b
No other cover	No access to public health protection by any other route (Spanish law, EU regulations or bilateral agreements)	RD 576/2013, art. 3.c
Who signs with you	The regional health service where you are registered, or INGESA in Ceuta and Melilla	RD 576/2013, art. 2.1; Ministry of Health guidance, point 4
Decision	Within 30 days; no answer in time means approved	RD 576/2013, art. 4.2
Start	From the day the convenio is formalised; you have three months after approval to formalise it	RD 576/2013, art. 4.3–4.4

What the law says

Ley 16/2003 lets anyone who does not qualify for publicly funded healthcare get it by paying a fee under a convenio especial (art. 3.3). Real Decreto 576/2013 sets the basic rules.

Fee. €60 a month if you are under 65 and €157 a month if you are 65 or older (art. 6.1). These are the amounts the decree set in 2013; the decree says they are revised by ministerial order, and the BOE lists no later order changing them. A region can charge more if it adds services from its own complementary portfolio (arts. 2.2 and 6.1). The Ministry of Health’s page gives the same two amounts.

Who can sign. People living in Spain who are not entitled to publicly funded care and who (art. 3):

have lived in Spain effectively for at least one continuous year immediately before applying;
are registered on the padrón of a municipality in the region when they apply;
have no access to public health protection by any other route, whether Spanish law, EU social security regulations or a bilateral agreement.

The Ministry of Health’s guidance adds that residence in another EU or EEA country, Switzerland or the UK counts towards the one year.

Procedure. You apply to the health administration of the region where you are registered (art. 2.1 and 4.1). It must decide and notify within 30 days; if it doesn’t, the application counts as approved (art. 4.2). You then have three months to formalise the convenio, and cover starts on the day you formalise it (art. 4.3–4.4).

What it covers

The convenio gives access to the common basic portfolio of National Health System services with the same guarantees as insured people (art. 2.2). The Ministry of Health says this comes without copayments or waiting periods, but that outpatient pharmacy, orthoprosthetic products, dietary products and non-urgent medical transport are paid 100% by the patient. You get an individual health card, valid in your region and during temporary stays in other regions.

When it ends

The convenio ends if you stop meeting the requirements, become insured in the National Health System, move your padrón to another region, cancel it, or don’t pay the first fee, two consecutive monthly fees or three alternate ones (art. 7.1). If it ends because you cancelled it, didn’t pay or broke its conditions, you can’t apply for a new one for a year (art. 7.3).

Who the ministry says it is for: economically inactive foreigners who need health insurance to live in Spain; pensioners with a certificate of entitlement from the state paying their pension, such as the S1 form, do not need it (Ministry of Health guidance).

Sources

Change history

2026-10-25: Page created

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