Employed
Registration as an employee generates the right automatically. Your employer handles the Social Security alta; you then take the INSS recognition to a health centre.
Healthcare in Málaga: how to actually get covered
Spain splits this in two, and the split is where people get stuck. The State decides whether you have the right to care; Andalucía issues the card that gives you access. You need both.
The two-step structure
The national Social Security system recognises your right to healthcare. The Servicio Andaluz de Salud then uses that recognition to issue your individual health card and assign your doctor.
So the question is never just "am I covered" — it is "which route gives me the right, and have I turned that right into a card". Almost everyone who tells us they cannot see a doctor has a right they have not converted.
The five routes to entitlement
Self-employed
Registering in RETA as an autónomo works the same way. Officially both employed and self-employed sit under "registered with Social Security".
Pensioner with an S1
If you draw a state pension from another EU or EEA country, you register an S1 form with the INSS. Your home state then reimburses Spain for your care.
Temporary stay on an EHIC
The European Health Insurance Card covers medically necessary care during a temporary stay — and becomes invalid the moment you change residence to Spain. It is not a route for residents.
Convenio especial
The paid opt-in for people with no other coverage. Requires a continuous year of effective residence in Spain, proof of empadronamiento, and a declaration that you have no other entitlement.
Getting the card
You apply in person at your local centro de atención primaria. They process the application and assign your doctor, and a paediatrician for children.
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Collect the four things they will ask for
Bring originals and photocopies of each. Beneficiaries over fourteen need their own identity document.
- Your identity document — DNI, or your TIE or NIE documentation
- Family documentation, such as the Libro de Familia, for dependent children
- The INSS document recognising your right to healthcare
- A padrón certificate proving residence in Andalucía
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Get the INSS document first if you do not have it
It is downloadable from the INSS electronic office or Tu Seguridad Social using a digital certificate, Cl@ve or SMS verification, or obtainable in person by appointment.
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Use the provisional receipt
You do not have to wait for the plastic card to see a doctor. The health centre issues a provisional receipt you can use immediately; existing SAS users applying online through Inters@s receive the card in roughly fifteen days.
Public, private, or both
Andalusian public healthcare is good, and once you are entitled it is essentially free at the point of use. The standard complaint is waiting times for non-urgent specialists, which is why a large share of residents keep a private policy alongside it rather than instead of it.
Private insurance is also a hard requirement rather than a preference for several residency routes — EU citizens registering as not working must show cover meeting Spanish standards, and the international telework visa requires a policy from an insurer authorised to operate in Spain.
If you are arriving with a condition that needs continuity of treatment, get the private policy in place before you travel. Pre-existing conditions are the usual exclusion, and waiting periods are counted from the policy start date.
Common questions
I have just arrived and have no cover at all. What now?
Private insurance for the first months, while your Social Security position is settled. The convenio especial is not available to you yet — it requires a continuous year of effective residence in Spain, although time in other EU or EEA states, Switzerland or the UK can count toward that year.
Do I need to speak Spanish at the health centre?
In the public system, generally yes — English is not reliably available at primary care level, though it is more common in the private hospitals and in the coastal towns. Salud Responde is on 955 54 50 60, staffed around the clock.
Can undocumented residents get care in Andalucía?
Andalucía does provide a route for foreign nationals who are not registered or authorised as residents. The specific procedure is handled by the SAS — do not assume no papers means no care, and do not assume it is automatic either.
Does my padrón certificate expire?
The certificate itself is a point-in-time document, and health centres generally want a recent one. Separately, a non-EU resident's padrón registration lapses after two years unless renewed — which will break your card.
Want us to handle the registration?
We deal with the INSS, the padrón certificate and the health centre, and come with you if the appointment is in Spanish.