Costa del Sol Healthcare for UK Expats: Your Complete 2026 Guide

How Spain's Healthcare System Actually Works: A Quick Primer for UK Arrivals

Spain's national healthcare system — the Sistema Nacional de Salud (SNS) — is consistently ranked among the top ten in the world by the WHO. It is funded through social security contributions and general taxation, and it delivers universal coverage to legal residents. For UK buyers settling on the Costa del Sol, understanding this system is not optional: it directly affects your residency application, your monthly outgoings, and ultimately your quality of life in places like Marbella, Estepona, or Fuengirola.

The SNS operates at regional level. In Andalucía, healthcare is managed by the Servicio Andaluz de Salud (SAS). You register at your local centro de salud (health centre) based on the address recorded on your padrón — the municipal census registration. Your padrón address determines which GP (médico de cabecera) and hospital catchment area you fall under, so completing this step soon after moving is essential.

Day-to-day public healthcare works like this: you visit your assigned centro de salud for primary care, and your GP refers you to specialists or hospitals as needed. Emergency care (urgencias) is available to everyone — including tourists — at any public hospital, regardless of insurance status. Prescription medicines for working-age adults typically carry a co-payment of between 40% and 60% of the cost, depending on income, while pensioners pay a reduced rate capped at a monthly maximum.

Public Healthcare Access for UK Expats After Brexit: What's Changed and What Hasn't

Before 31 December 2020, any UK national living in Spain could access the SNS relatively easily through EU freedom-of-movement rules. Brexit changed the legal framework, but — and this is the critical nuance — it did not eliminate public healthcare access for UK expats. The EU-UK Trade and Cooperation Agreement (TCA) and the earlier Withdrawal Agreement preserved most healthcare rights, provided you meet specific conditions.

If you were legally resident in Spain before 1 January 2021 and hold a TIE (Tarjeta de Identidad de Extranjero) under the Withdrawal Agreement, your healthcare rights are essentially grandfathered. You continue to access the SNS on the same basis as before Brexit.

If you moved to Spain after Brexit, your access route depends on your employment and residency status:

• Employed or self-employed (autónomo) in Spain: You pay into the Spanish social security system and receive full SNS access automatically.
• Retired with a UK State Pension: You can use an S1 form (issued by the NHS Business Services Authority) to register for the SNS. Spain bills the UK government for your care.
• Non-working and under State Pension age: You must demonstrate healthcare coverage — almost always private health insurance — as part of your residency application. There is no automatic SNS access.
• Convenio Especial: Since 2023, non-working residents without other coverage can buy into the SNS through the Convenio Especial de Prestación de Asistencia Sanitaria. In 2026, this costs approximately €60/month for under-65s and €157/month for those aged 65 and over.

MUNDO Tip: Many UK buyers purchasing property in towns like Benahavís or Mijas assume that owning a home automatically grants healthcare access. It does not. Healthcare entitlement is tied to your residency status and social security situation, not property ownership. Get your NIE, complete your padrón registration, and then address healthcare — in that order. Our buying process guide walks you through the full sequence.

EHIC, GHIC, and the S1 Form: Which Card Do You Actually Need in 2026?

The alphabet soup of healthcare cards causes more confusion among UK expats than almost any other topic. Here is exactly what each one does — and does not — cover in 2026.

UK Global Health Insurance Card (GHIC)

The GHIC replaced the EHIC for UK residents after Brexit. It entitles you to medically necessary state-provided healthcare during temporary visits to EU countries, on the same terms as a local resident. It is free and valid for five years. However, it is designed for holidays and short stays — not for people who live in Spain. Once you become a Spanish resident, the GHIC issued by the UK is no longer valid for your routine care in Spain.

S1 Form (Certificate of Entitlement to Healthcare)

The S1 is the golden ticket for UK State Pensioners moving to Spain. It is a portable document issued by the NHS Business Services Authority (NHSBSA) that registers you in the Spanish public healthcare system at the UK government's expense. You take it to your local Instituto Nacional de la Seguridad Social (INSS) office in Spain, and they issue you a Spanish healthcare card (tarjeta sanitaria). In 2026, S1 holders receive full SNS access including GP visits, hospital care, specialist referrals, and subsidised prescriptions.

Key eligibility for an S1: you must be in receipt of a UK State Pension or certain other qualifying benefits (such as an exportable disability benefit). Early retirees who have not yet reached State Pension age generally cannot obtain an S1 — this is the rule that catches the most people out, particularly those retiring at 55 or 60 with private pension income but no State Pension in payment.

Spanish Tarjeta Sanitaria

Once you are registered in the SNS — whether through employment, an S1, or the Convenio Especial — you receive a tarjeta sanitaria individual (TSI). This green card is your proof of entitlement. Guard it carefully; you will need it at every centro de salud visit and hospital appointment.

Private Healthcare on the Costa del Sol: Hospitals, Clinics, and What to Expect

The Costa del Sol has one of the highest concentrations of private healthcare facilities in southern Europe, driven by decades of demand from international residents. Whether you are settling in Benalmádena or Nerja, you are rarely more than 20 minutes from a well-equipped private hospital.

Major Private Hospitals

• Hospital Quirónsalud Marbella — Part of Spain's largest private hospital group. Full A&E, oncology, cardiology, orthopaedics, and maternity. English-speaking staff across most departments.
• Hospiten Estepona — A modern 80-bed hospital with 24-hour emergency, diagnostics, and surgical suites. Strong reputation among expats in western Costa del Sol.
• Hospital Vithas Xanit Internacional (Benalmádena) — 180-bed international hospital with over 30 medical specialties. Designated international patient department with translators.
• Hospital Clínica Ochoa (Marbella) — Established private hospital with a loyal expat following. Known for fast specialist access and personalised care.
• HC Marbella International Hospital — Boutique-style private hospital offering oncology (including proton therapy partnerships), diagnostics, and surgery.

What Private Healthcare Feels Like Day-to-Day

The practical difference for most expats is speed and convenience. A private GP appointment can typically be arranged same-day or next-day. Specialist consultations — dermatology, cardiology, endocrinology — are usually available within 3–10 days. MRI and CT scans can often be arranged within a week. Compare this to the public system, where non-urgent specialist waits in Andalucía can run 60–120 days, and diagnostic imaging waits of 30–50 days are common in 2026.

Most private hospitals on the Costa del Sol operate extensive outpatient clinics as well as inpatient services. You can often see a specialist, have blood work done, and receive imaging results in a single visit — a level of integrated efficiency that UK expats accustomed to fragmented NHS pathways find genuinely refreshing.

How Much Private Health Insurance Costs in 2026: Real Quotes by Age and Cover Level

Private health insurance in Spain is significantly cheaper than equivalent cover in the UK or the US, largely because the underlying cost of medical care is lower. In 2026, premiums on the Costa del Sol vary by age, pre-existing conditions, cover level, and whether you choose co-payment (copago) or full-cover policies.

The following table shows indicative annual premiums for the most common insurers used by UK expats on the Costa del Sol, based on real broker quotes gathered in Q1 2026:

Key terms explained: A copago (co-payment) policy means you pay a small fee — typically €3–€15 per GP visit, €5–€20 per specialist visit, and €15–€50 per diagnostic test — but your monthly premium is much lower. Full-cover policies eliminate these per-visit costs but carry significantly higher annual premiums. For healthy expats who visit the doctor infrequently, copago policies offer excellent value.

The most popular insurers among Costa del Sol expats in 2026 include Sanitas (owned by Bupa), Adeslas (part of SegurCaixa), Asisa, DKV, and Cigna. Sanitas and Adeslas have the widest hospital networks in Andalucía. It is worth noting that most Spanish health insurers impose an age limit of 65–70 for new applicants (existing policyholders can usually renew beyond this), and pre-existing conditions are typically subject to waiting periods of 6–12 months.

MUNDO Expert Insight: When budgeting for your move to the Costa del Sol, include health insurance alongside your property purchase costs — mortgage fees, IBI, comunidad charges, and notary fees all add up. Use our cost calculator to build a complete picture of annual ownership and living costs before committing. Healthcare is not an afterthought; it is a core line item in your annual budget.

Public vs Private: An Honest Side-by-Side Comparison for Everyday Expat Life

Both the public and private systems on the Costa del Sol are clinically competent. The differences lie in access speed, language support, and patient experience. Here is a candid comparison based on real expat experiences in 2026:

In practice, many established Costa del Sol expats use a hybrid approach: they register with the public system (if entitled) for prescriptions, chronic disease management, and emergency care, while maintaining a copago private policy for fast specialist access and diagnostics. This combination — public tarjeta sanitaria plus a basic private policy at €800–€1,500/year — gives the best of both worlds and is the most cost-effective strategy for expats over 50.

Residency Status and Healthcare Entitlement: The Rules That Catch People Out

Healthcare entitlement in Spain is intimately connected to your immigration and residency status. Misunderstanding these links leads to some of the most stressful situations UK expats face on the Costa del Sol. Here are the scenarios that cause the most problems:

1. The Early Retiree Gap

You are 58. You have sold your UK property, purchased a beautiful villa in Benahavís, and applied for a non-lucrative visa (visado de residencia no lucrativa). As part of this visa, Spain requires you to hold private health insurance with no co-payments and full cover in Spain — travel insurance or policies with territorial limitations to the UK will be rejected. You will not qualify for an S1 because you are not yet receiving the UK State Pension. You cannot access the SNS through employment because the non-lucrative visa prohibits you from working. This means private insurance is your only healthcare option, potentially for seven or more years until you reach State Pension age. Budget accordingly: at age 58–65, you are looking at €2,000–€4,500/year for compliant full-cover insurance.

2. The 90-Day Trap

UK nationals can stay in Spain for up to 90 days in any 180-day period without a visa. During this time, the GHIC covers emergency and medically necessary treatment. But some buyers spend extended periods overseeing property renovations or settling in, inadvertently overstaying. After 90 days without residency, you have no legal healthcare coverage — the GHIC is invalid, you are not a resident, and you cannot register with the SNS. If you plan to spend significant time at your new property, apply for residency promptly. Our UK buyers hub has up-to-date guidance on visa timelines.

3. The Autonomo Surprise

If you work as a freelancer or run a business from your Costa del Sol home, you must register as autónomo (self-employed). The minimum social security contribution for autónomos in 2026 starts at approximately €230/month (under the new income-based system introduced in 2023). This contribution grants you full SNS access. However, if you fail to register — or if you work remotely for a UK company without proper Spanish tax and social security setup — you may find yourself in a legal grey zone with no public healthcare entitlement and potential back-tax liabilities. Take professional fiscal advice before assuming your remote-work arrangement is compliant.

4. The Padrón Requirement

You cannot register with a centro de salud without a padrón certificate from your local ayuntamiento (town hall). The padrón requires proof of your address — typically your escritura (title deed) or a rental contract — plus your NIE and passport. If you have just completed your property purchase, take your escritura to the town hall immediately. Some municipalities process the padrón in a single visit; others may require an appointment booked weeks in advance. Do not delay this step: it is the gateway to healthcare registration, and in some towns it also affects your IBI (council tax) records and comunidad (community of owners) correspondence.

How to Set Up Your Healthcare Before You Move: A Step-by-Step Checklist

The best time to sort your healthcare is before you arrive. Follow this sequence, adapted for UK buyers moving to the Costa del Sol in 2026:

1. Determine your residency route (3–6 months before the move): Non-lucrative visa? Golden visa? Employment or autónomo registration? Each route has different healthcare requirements. Understand yours before you begin paperwork.
2. Apply for an S1 form if eligible (2–3 months before): Contact the NHSBSA Overseas Healthcare Services. Processing takes 4–8 weeks. If you are receiving a UK State Pension, request this immediately.
3. Obtain compliant private health insurance (2–3 months before): If you need private insurance for your visa application, policies must be issued by a company authorised to operate in Spain, with no co-payments for the visa-compliant version, and with cover across Spanish territory. Sanitas, Adeslas, Asisa, and Cigna all offer visa-compliant products. Get quotes from at least three providers.
4. Apply for your GHIC (as a backup): Even as a future resident, carry a valid GHIC during your transition period. It covers you during the initial days or weeks before your residency and Spanish healthcare are formally set up.
5. Complete your padrón registration (first week after arrival): Take your escritura or rental contract, NIE, and passport to your local ayuntamiento. Some towns (Marbella, Mijas, Fuengirola) offer online appointment booking for the padrón — check their websites ahead of time.
6. Register at the INSS if you have an S1 (within 2 weeks of arrival): Take your S1, passport, NIE, and padrón certificate to your nearest INSS office. They will process your registration and direct you to collect your tarjeta sanitaria.
7. Register at your centro de salud (immediately after INSS or insurance setup): Whether public or private, you need a designated GP. For public healthcare, your centro de salud is assigned by your padrón address. Bring your tarjeta sanitaria, passport, and padrón certificate. Staff will assign you a médico de cabecera.
8. Transfer medical records: Request a summary of your UK medical records from your NHS GP before you leave. Bring these to your Spanish GP — both public and private doctors appreciate having your history, particularly medication lists, allergies, and chronic conditions.
9. Register with a local pharmacy: Spanish pharmacies (farmacias) are highly professional and can dispense many medications that would require a GP visit in the UK. Establishing a relationship with a local pharmacist is valuable — they can advise on minor ailments, manage repeat prescriptions, and direct you to urgent care when needed.
10. Review and budget annually: Insurance premiums increase with age. The Convenio Especial rates may be adjusted. Your entitlement may change when you reach UK State Pension age. Treat healthcare as a recurring review item, not a one-off setup task. Factor it into your annual cost planning alongside IBI, comunidad fees, plusvalía considerations, and other running costs covered in our costs and taxes guide.

Final Thought: Healthcare Is Part of the Property Decision

Where you buy on the Costa del Sol affects your healthcare options. Properties in central Marbella or Fuengirola place you within minutes of multiple public and private hospitals. A rural finca above Benahavís or in the hills behind Nerja may be 30–40 minutes from a major hospital. For buyers over 60, proximity to healthcare facilities should be a genuine factor in your property search — not just views, square metres, and pool specifications. Consider it as carefully as you would the tasación (property valuation) or the orientation of the terrace. Your health is, after all, the reason you are moving to the sunshine in the first place.