Healthcare for UK Expats in Spain and Portugal: What You Need to Know

The good news is that both countries have clear routes into their public systems once you’re legally resident. Spain has several, from social security through work to a paid-for public scheme, while Portugal lets legal residents register with its national health service, the SNS. Which route you take can make a real difference to your first-year budget.

Key takeaways

• Being British doesn’t give you public healthcare in Spain or Portugal, so your access depends on residence, work, social security or an S1.
• Spain takes more planning, as many newcomers need private insurance until they can join the convenio especial after a year.
• Portugal lets legal residents register with the SNS straight away, and most routine user fees were abolished in 2022.

Can you still use the NHS or a GHIC?

Once you move abroad permanently, you can’t assume you’ll keep using the NHS as before. NHS entitlement is based on residence, and GOV.UK warns that UK nationals who move abroad permanently may lose their entitlement to free NHS healthcare.

A UK Global Health Insurance Card (GHIC) isn’t a substitute either. It covers medically necessary state treatment on temporary visits, doesn’t replace travel insurance and doesn’t cover private treatment or getting you home. If you register an S1 in an EU country, the NHS Business Services Authority says you can use your GHIC when you visit other EU countries, but healthcare in the country where you live goes through your registered S1.

This matters if you own a holiday home. If Spain or Portugal is somewhere you visit rather than where you live, a GHIC and good travel insurance are still worth having, as owning a property abroad doesn’t make you resident there. If it becomes your main home, you’ll need to sort out healthcare through work, an S1, Spain’s convenio especial or private insurance instead.

Healthcare in Spain

Spain has several routes into its public health system, the Sistema Nacional de Salud. The right one depends on whether you work, receive a UK State Pension, have lived in Spain long enough to join the paid-for scheme, or need private cover in the meantime.

If you work or are self-employed

If you’re employed in Spain or registered as self-employed (autónomo), your Spanish social security contributions give you state healthcare on the same basis as a Spanish worker. GOV.UK says you should register at your local health centre with your social security number, and that dependants need to register separately with the Instituto Nacional de la Seguridad Social (INSS). You’ll then use the system through your regional health service, usually with a health card, the tarjeta sanitaria.

If you’re still planning the move, our guide to moving to Spain from the UK in 2026 covers residency, visas and registration in more detail.

The S1 form

For retirees, the S1 form is often the key. If you receive a UK State Pension and live in, or are moving to, an EU country, you may be entitled to UK-funded healthcare through an S1. It isn’t limited to people who moved before Brexit, and the NHS Business Services Authority says you can apply online up to 90 days before you move.

In Spain, you must register your S1 with the INSS. Once that’s done, you and any eligible dependants can use Spanish state healthcare in the same way as an insured Spanish resident. In practice, that means getting your S1 from NHS Overseas Healthcare Services, registering it with the INSS and then signing up with your regional health service.

The convenio especial

The convenio especial is Spain’s paid-for route into public healthcare for people who don’t qualify through work, an S1 or another public entitlement. To apply, you generally need to have been registered on your local padrón for at least a year and have no other access to publicly funded healthcare.

According to Spain’s Ministry of Health, it costs €60 a month if you’re under 65 and €157 a month if you’re 65 or over. There’s an important catch: you pay the full cost of outpatient prescriptions, outpatient prosthetics, special medical foods and non-emergency medical transport. So it gives you access to doctors and hospitals, but it isn’t an all-inclusive policy.

Prescription charges changed in 2026

Spain reformed its prescription co-payment system in May 2026. What you pay still depends on your income and whether you’re working or retired, but there are now more income bands and more people have a monthly cap. Pensioners with an annual income below €18,000, for example, pay 10% of the cost of their medicines, capped at €8.23 a month. Older guides quoting a single percentage for all workers or pensioners are now out of date.

Healthcare in Portugal

Portugal is simpler for most new arrivals. Once you’re legally resident, GOV.UK says you can register with the Serviço Nacional de Saúde (SNS) on the same basis as a Portuguese citizen, whether or not you work. There’s no year-long wait like the one for Spain’s convenio especial.

Registering with the SNS

You register at your local health centre, the centro de saúde, and get a user number, the número de utente. Take your residence certificate, passport and Portuguese tax number (NIF), plus your social security number (NISS) if you’re employed or self-employed.

Most user fees have gone

This is where a lot of guides are out of date. Portugal abolished its user fees, the taxas moderadoras, for almost all SNS care from June 2022. They now apply only in hospital emergency departments, and even then not if you were referred by the SNS or are admitted to hospital through A&E. Figures such as €5 for a GP appointment, which still appear in some guides, no longer apply.

You’ll still pay towards some prescriptions under Portugal’s reimbursement rules, although some groups are exempt.

The S1 in Portugal

If you have an S1, register it at any social security office (segurança social) and then at your local health centre. You can then use the SNS like a Portuguese resident.

Private insurance can still be worth having for faster access to specialists, a wider choice of hospitals or English-speaking doctors, but it isn’t your only option once you’re legally resident. For wider budgeting, see our guide to the true cost of living in Portugal as an expat in 2026.

Private health insurance and your visa

Private health insurance often matters most during the visa process, rather than for good.

Spain’s Non-Lucrative Visa

The Spanish consulate in London requires Non-Lucrative Visa applicants to show public or private health insurance from an insurer authorised to operate in Spain, covering all the risks covered by the Spanish public health system. If you have an S1, proof that it’s registered with Spanish social security is accepted instead.

That’s why many newcomers rely on private cover for their first year: the visa needs health cover from the start, but the convenio especial isn’t available until you’ve been resident for a year. Requirements are applied by the consulate handling your application, so check the current wording before you buy a policy. Our comparison of the Spain Non-Lucrative Visa and Digital Nomad Visa for Brits in 2026 can help you work out which route suits you.

Portugal’s D7 visa

For Portugal’s D7 visa, for retirees and people living on their own income, the VFS Global checklist asks for valid travel insurance covering necessary medical expenses, including urgent medical care and possible repatriation. Check the exact requirements with the consulate or visa centre handling your application, as they can vary.

What will private health insurance cost?

Private premiums vary a lot with age, location, existing conditions, hospital limits and co-payments, and with whether the policy has to meet visa requirements.

In Spain, comparison site Póliza Médica puts the average policy without co-payments at about €69 a month for a 35-year-old in October 2026. It estimates €90 to €150 a month for a 55-year-old with hospital cover and no co-payments, and its quotes for a 70-year-old ranged from about €190 to €266 a month across major cities. Policies aimed at foreign residents can cost more: Selectra lists Sanitas International Residents from around €103 a month.

Portugal can start lower. Basic policies covering hospital stays and surgery can start from around €10 a month, according to Immigrant Invest, although cover at that level is limited and premiums rise with age and wider benefits. Prices are going up too: ComparaJá reported that premiums were expected to rise by around 10% on average in 2026. Compare annual limits, exclusions, co-payments, hospital networks, waiting periods and age limits, not just the monthly price.

Spain vs Portugal at a glance

Paying for healthcare in euros

For many British expats, healthcare is also a currency question. If your pension or income is in sterling, every euro bill, whether it’s a €157 monthly convenio especial payment, a €100-plus insurance premium or a dental bill, costs more or less in pounds as the exchange rate moves, even though the bill itself stays the same.

Card payments and bank transfers often include exchange rate margins or fees. For regular costs like insurance premiums, setting up regular euro transfers can make budgeting easier. For a bigger one-off bill, such as dental work, surgery or an annual premium, compare the exchange rate and the total cost in pounds before you pay rather than simply accepting your bank’s rate. What matters is how many euros arrive for your pounds, not just the headline transfer fee, so keep an eye on the GBP/EUR exchange rate if you’ll be paying regularly.

Before you move

Healthcare and immigration rules can change, so check your position with GOV.UK and NHS Overseas Healthcare Services, Spain’s social security or Ministry of Health, or Portugal’s SNS before you buy insurance or rely on an S1 or public entitlement. Getting the right route in place before you go helps you avoid gaps in cover and budget properly for your first year.

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