Health Insurance for Americans Moving to Spain: The Complete 2026 Guide

No. US health insurance plans — including employer-sponsored plans, ACA marketplace plans, and Medicare — are not accepted by Spanish consulates or the Spanish immigration office (Extranjería) as proof of health coverage for any residency visa or permit. They don't meet the legal requirements set by Spain's immigration law: the policy must be issued by an insurer authorized to operate in Spain, cover the full Spanish territory with no copays and no waiting periods, and include medical repatriation. Even comprehensive international plans from US-based insurers like Cigna Global or Aetna International may or may not qualify depending on their specific terms — the safest approach is to obtain a policy from a Spanish-licensed insurer such as Sanitas, which issues an official certificate explicitly stating each requirement the consulate checks. If you already have an international plan and are unsure whether it qualifies, bring the policy conditions to our office and we'll review it against the official checklist for your specific visa type at no charge.

Americans moving to Spain typically use one of three visa types, depending on their situation. The Non-Lucrative Visa (NLV) is the most common for retirees and anyone with passive income — dividends, rental income, savings — who won't be working in Spain. The Digital Nomad Visa (DNV), introduced in 2023 under Spain's Startup Law, is designed for remote workers employed by or providing services to companies outside Spain. The Type D Student Visa covers enrollment in a Spanish university, language school, or accredited study program lasting more than 90 days. Each of these requires health insurance with no copays and no waiting periods, issued by a Spanish-authorized insurer. The Golden Visa (investment visa) and family reunification routes also require equivalent health coverage. A smaller group enters as EU citizens' family members or transitions from a tourist stay — if you're unsure which category fits your situation, describe it to our office and we'll confirm which insurance document your specific process requires.

The Spanish consulate checklist — which varies slightly by consulate but follows the same core requirements — looks for six things in the certificate: the insurer must be authorized to operate in Spain (registered with the Directorate General of Insurance, DGSFP), coverage must be valid across all Spanish territory, there must be no copays (copagos) and no waiting periods (carencias) for the duration of coverage, medical repatriation must be included, and the annual premium must be paid in advance. A seventh detail that trips many people up: it's not enough for the policy to meet these requirements, the certificate must state them explicitly, using the exact language officials look for. The official certificate we issue for this policy lists all six points word for word, in Spanish or English as your consulate requires, and is issued within 24 hours of taking out the policy.

For the non-lucrative visa and work/digital nomad visa insurance, prices start from €67.76 per month per adult, based on the official April 2026 Sanitas rate card for the province of Madrid. This translates to approximately €813 per year, which is the full annual premium most consulates require you to pay upfront. For the student visa insurance (Type D), prices start from €42.65 per month for students up to age 29 — roughly €512 per year. Prices vary by age and postal code of residence in Spain, not by nationality. For context: many Americans are surprised to find that comprehensive private health insurance in Spain costs a fraction of what comparable coverage costs in the US. The calculator on this page gives you your exact price by age and Madrid postal code in under a minute, with no personal data required.

Yes — in fact, you must, because the Spanish consulate requires the insurance certificate as part of your visa application, which you submit in the US before traveling. The entire process is handled remotely: you contact our office by email, WhatsApp, or video call from the US, we explain the coverage, issue the policy effective from your planned arrival date in Spain, and deliver the official PDF certificate by email within 24 hours, guaranteed. No in-person visit is needed at any point before or during the application. Many of our American clients handle the whole process from New York, California, or Texas before flying to Spain. The certificate is signed by Sanitas and accepted by all Spanish consulates in the United States. If your consulate has specific additional requirements — some US consulates ask for the certificate in English, others want an apostille — let us know your consulate location and we'll confirm exactly what version to prepare.

Yes. Spanish residency permits (TIE — Tarjeta de Identidad de Extranjero) are renewed annually or every two years depending on your permit type, and each renewal requires proof that your health insurance is still in force on the date of your appointment at the Immigration Office. The original certificate from your initial visa application is not enough for renewals. Our office tracks renewal dates for every client and sends advance notice before the policy expires, so you're never caught without a valid certificate when your TIE appointment arrives. This is one of the practical advantages Americans moving to Spain mention most: having a local English-speaking office that stays on top of the paperwork instead of having to monitor it yourself from abroad.

Travel insurance — including annual Schengen travel insurance policies sold in the US by companies like Allianz Travel, World Nomads, or AXA — covers temporary emergencies during travel but does not meet Spanish immigration requirements for residency visas. Travel insurance policies typically exclude pre-existing conditions, limit coverage duration, cover only acute emergencies rather than routine care, and are not issued by Spanish-authorized insurers. Spanish consulates and the immigration office require a comprehensive health policy equivalent to Spain's public healthcare system, from an insurer registered with Spain's DGSFP. If you submit travel insurance as your health coverage document in a non-lucrative visa or digital nomad visa application, it will be rejected. The policies we arrange at our Majadahonda office meet every immigration requirement and include a certificate that explicitly states all required conditions in the language your consulate requests.

Yes, but each family member being included in the visa application needs their own individual certificate meeting the same requirements — a single family travel policy won't work. What our office does is arrange all family members under the same Sanitas contract, with an individual certificate issued for each person, and a multi-insured discount of 5–8% applied to the overall premium depending on the number of people. This keeps all renewal dates aligned, simplifies annual renewals, and means the whole family gets notified at once when TIE renewals are approaching. Bring us the name, date of birth, and passport number for each family member and we'll prepare a combined quote with individual certificates ready within 24 hours.

Yes. Our office handles the full insurance process in English — quotes, policy sign-up, consulate certificate preparation, annual renewals, and any ongoing coverage questions — by WhatsApp, email, video call, or in person at our office in Majadahonda (Calle Santiago Apóstol, 5, 28220 Madrid). A large share of our clients are English-speaking Americans, Britons, and other internationals processing Spanish visas or already resident in Spain, and the entire process is conducted in English from start to finish at no extra cost. If you prefer to handle everything remotely from the US, that's the norm rather than the exception: most Americans take out the policy and receive their consulate certificate without ever visiting the office in person.

From first contact to receiving the official PDF certificate: typically 24 to 48 hours, depending on when you reach out and how quickly you can provide the information needed for the policy (name, date of birth, planned arrival date or effective date in Spain, and postal code of residence or intended address). The certificate is issued within 24 hours of taking out the policy, guaranteed. In urgent cases — a consulate appointment the next day, for example — we can usually expedite the process even further. One tip from our office: don't leave the insurance until the last week before your consulate appointment. Spanish consulates in the US can have appointment wait times of several weeks, and you want to have the insurance sorted before you lock in your appointment date so you're not rushing the certificate at the end.