Healthcare in Madrid for Expats: Public System, Convenio Especial and Private Insurance in 2026
Spain’s public healthcare system, the Sistema Nacional de Salud, is genuinely excellent by international standards, but access for expats depends entirely on your legal and employment situation. In Madrid it’s administered regionally by SERMAS, the Servicio Madrileño de Salud. Here’s how the routes actually work in 2026.
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In this guide
How Expats Qualify for Public Healthcare
There are several routes into the public system: paying Social Security contributions through employment, the S1 form for EU/UK state pensioners, the Convenio Especial pay-in scheme, or eventual permanent residence. Which route applies to you depends on your visa type and work status, so it’s worth confirming your specific route before assuming you’re covered.
The Convenio Especial: Spain’s Pay-In Scheme
The Convenio Especial is designed for people who live in Spain long-term but don’t qualify for state cover through work, Social Security, an S1 form or another bilateral agreement. It requires 12 months of prior residence in Spain before you can apply, and it’s strictly per individual — it does not automatically cover a spouse or children, so each family member must apply separately. In 2026, it costs approximately €60/month for people under 65 and €157/month for people over 65. Coverage includes virtually all public healthcare services, but notably does not include dental care.
Getting Your Tarjeta Sanitaria (Health Card)
Once you qualify for public coverage — whether through employment, the Convenio Especial or another route — you register for your Tarjeta Sanitaria Individual (TSI) at a health centre (centro de salud), a SERMAS hospital, or one of the Health Ministry’s registration offices in Madrid (Aduana 29, Castellana 280 or Sagasta 6). You’ll need your DNI, NIE or valid passport, and proof of residence in Madrid; having your Social Security number already assigned speeds up the process. Once verified, you receive your card, which assigns you to a local health centre for primary care and referrals.
When Private Insurance Still Makes Sense
Private health insurance continues to matter even after you have public access: it’s required for many visa applications, it covers the gap for anyone not yet qualifying for public healthcare, and it gets you faster specialist appointments than the public system, which can have longer waits for non-urgent referrals. Private policies for under-65s typically range from €80 to €250/month depending on coverage level. Many expats settle on a mixed approach: rely on the public system where they’re entitled to it, but keep a private policy for speed and for dental care, which the Convenio Especial doesn’t cover.
Frequently Asked Questions
Does the Convenio Especial cover my spouse and children too?
No. It’s strictly per individual, so every family member who wants coverage under it needs to apply separately, and each must independently meet the 12-month prior residence requirement.
Is dental care covered by Spanish public healthcare?
Basic dental coverage under the Convenio Especial is not included. Most expats who want dental coverage arrange it through private insurance or pay out of pocket, as is common practice among Spanish residents as well.
How do I register at a Madrid health centre?
Bring your DNI, NIE or valid passport plus proof of Madrid residence to a centro de salud, a SERMAS hospital, or one of the Health Ministry’s registration offices (Aduana 29, Castellana 280, Sagasta 6). Having your Social Security number ready speeds the process.
Your Madrid Healthcare Action Plan
Follow this sequence to get properly covered without gaps, whether you’re arriving through employment or independently.
| Step | Action |
|---|---|
| 1 | Identify which access route applies to you: employer Social Security, S1 form, Convenio Especial, or permanent residence |
| 2 | If relying on the Convenio Especial, confirm you’ve accumulated the required 12 months of prior residence before applying |
| 3 | Apply separately for every family member who needs coverage — approval is not automatic for dependents |
| 4 | Register for your Tarjeta Sanitaria Individual at a centro de salud with your ID and proof of address |
| 5 | Decide whether to add private insurance for faster specialist access and dental coverage, budgeting €80–250/month |
Expat Essentials for Spain
A few quick wins make settling into Spain easier while you work through this guide. An Airalo eSIM keeps you online from the moment you land, EKTA bridges your health cover until residency, and NordVPN protects your logins on public wifi. See our full list of trusted services below.
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