Sanitas vs International Health Insurance in Spain: Which Is Better for Expats?

It depends on the specific plan and its terms, and the answer is often no. To qualify for Spanish immigration purposes — whether for the Non-Lucrative Visa, Digital Nomad Visa, Student Visa, or any work residency permit — the insurer must be authorized to operate in Spain (registered with the DGSFP, Spain's insurance regulator), and the policy must have no copays, no waiting periods, and cover the full Spanish territory. Many Cigna Global and Bupa Global plans are excellent international health policies, but they're issued by UK or US-regulated entities rather than Spanish-authorized insurers, or they include copays and deductibles that Spanish consulates specifically prohibit. If you already have an international plan and plan to use it for a Spanish visa application, our office will review its conditions against the official consulate checklist for your visa type at no charge before you submit anything. The risk of submitting a non-qualifying policy is having your entire application rejected after paying consulate fees and waiting months for an appointment.

No. SafetyWing and similar digital nomad travel insurance products — as well as standard annual travel insurance plans — are not accepted by Spanish consulates or the immigration office for any residency visa or permit. They're designed for temporary emergency coverage during travel, not as comprehensive health insurance for residents. They typically exclude or limit pre-existing conditions, don't cover routine specialist care, have reimbursement-based claims processes that don't match how Spanish healthcare works, and are not issued by Spanish-authorized insurers. They work well for short-term travel within 90-day tourist stays, but if you plan to apply for any Spanish visa allowing residency beyond 90 days, you'll need a proper Spanish private health policy. Many digital nomads and remote workers arrive in Spain with SafetyWing and assume it covers them for their visa application — this assumption is consistently wrong.

Three things that specifically matter for life in Spain. First, visa compliance: Sanitas is a Spanish-authorized insurer whose certificate is accepted by all Spanish consulates and the immigration office, with explicit statement of all required conditions (no copays, no waiting periods, complete coverage, DGSFP authorization). Second, a Spain-native medical network: Sanitas operates its own hospitals, own Milenium medical centers, and a network of over 50,000 professionals and 4,500 centers across Spain — direct booking, no claims process, no reimbursement waits. In practice this means you call or use the app, book a specialist for next week, go, and pay nothing. With an international insurer, you typically pay out of pocket and submit for reimbursement, which is a fundamentally different experience. Third, a local English-speaking office that handles renewals, certificate updates, and coverage questions in person or by WhatsApp — relevant every time you renew your TIE.

Two things: worldwide coverage and reimbursement flexibility. If you travel frequently outside Spain or split your year between Spain and the US, Cigna Global or Bupa Global give you comprehensive worldwide coverage in a single policy, while Sanitas covers Spanish territory only (with limited emergency coverage abroad). Sanitas's Más Salud with Reimbursement option adds 80% reimbursement for out-of-network care in Spain and abroad, up to €90,000–€150,000, which partially bridges this gap. If you spend more than 3–4 months per year outside Spain, an international plan for worldwide coverage combined with a Spanish policy for visa compliance may actually be the most practical combination — something our office advises on directly, since we know which situations genuinely warrant the added cost.

For a 55-year-old adult in the Madrid province, Sanitas Más Salud (no copay, with hospitalization) costs from approximately €120–€140 per month based on the official April 2026 rate card — the exact figure depends on your specific postal code. Cigna Global and Bupa Global plans for the same age bracket with comprehensive coverage including hospitalization typically range from €200–€500 per month depending on the plan tier and worldwide vs. Spain-only coverage. SafetyWing Remote Health starts significantly cheaper but is not Spain-visa-compliant and has different coverage terms. The price gap reflects that Sanitas is priced for the Spanish domestic market — where it competes against other Spanish insurers — rather than for a premium international expat market. For most Americans moving to Spain permanently or long-term, Sanitas offers significantly better value for the coverage that actually matters in daily Spanish life, at a fraction of comparable US or UK international plan costs.

No. You can hold both simultaneously, and many of our clients do during a transition period or if they maintain ties to other countries. There's no legal or contractual reason you can't have an international plan for worldwide coverage alongside a Sanitas policy that serves as your official Spanish residency insurance. In practice, once people are settled in Spain and using the Sanitas network for their daily healthcare, most find they're not using the international plan enough to justify the additional premium — but that's a decision you can make after a year, not before you arrive.

Within 24 hours of taking out the policy, guaranteed. In practice, for clients who reach our office during business hours and can provide the required information quickly (name, date of birth, effective date in Spain, and postal code), we often issue the certificate the same day. The certificate arrives as a PDF by email, signed by Sanitas, and is accepted by all Spanish consulates in the United States. If your consulate requires it in English, in Spanish, or with a specific additional attachment, we prepare the exact format you need. Our office handles this process entirely by WhatsApp or email for clients still in the US — no in-person visit is needed at any stage.

Yes. Our Majadahonda office (Calle Santiago Apóstol, 5, 28220 Madrid) handles all communication in English — by WhatsApp, email, video call, or in person — with no language barrier at any stage of the process. This includes the initial quote, signing up for the policy, preparing the consulate certificate, annual renewals, and any coverage or claims questions that come up while you're living in Spain. A significant portion of our clients are English-speaking Americans and other internationals, and the practice of handling the entire process remotely from the US before traveling is the norm, not the exception. Unlike calling a general Sanitas phone line where English support isn't guaranteed, our office is the dedicated point of contact for the whole relationship.