Private health insurance in Madrid for Americans: options and comparison

Your US health insurance doesn't work in Spain. Period. Some Americans arrive thinking they can use their US policy or that Spain will automatically give them public healthcare access. It doesn't work that way. You need Spanish private health insurance, and you must have it before applying for a visa.

Why you need private insurance

Spain has excellent public healthcare, but as a foreigner to access it, you have two options: work formally in Spain (after 90 days worked, you get access), or have private insurance.

If you apply for a visa (non-lucrative, digital nomad, work), the consulate requires you to prove you have private medical insurance. Without it, they reject your visa. It's non-negotiable.

Private insurance covers: doctor visits, specialists, emergencies, hospitalization, medicine, dental (some policies), optometry. The best policies cover almost everything. The cheapest cover essentials.

Main insurers in Spain

Sanitas. The largest. Wide network of hospitals and doctors. Extensive coverage. Price: €80-150 monthly depending on age and coverage.

Axa. Second largest. Good customer service. Flexible policies. Price similar to Sanitas: €80-140 monthly.

Mapfre. Multi-service insurer also does private medical. Competitive. €70-130 monthly.

Allianz. Options from very basic to premium. Price: €60-200 monthly depending on coverage.

DKV. Smaller but very reliable. Reduced network but good doctors. €80-140 monthly.

All have options for foreigners. All have customer service in English (though not always).

How to choose

Define what's important to you:

• Doctor network: Do you want to choose your doctor? Sanitas and Axa have larger networks.
• Specialists: Will you need a dermatologist, cardiologist? All cover but with co-pay.
• 24h emergencies: all offer it, but some have faster access.
• Dental included: few include it. Allianz and some Sanitas options do.
• Optometry: important if you wear glasses or contacts. Sanitas and Axa include it well.
• Maximum monthly price: if you have a budget, some plans cost €50-70, others €200+.

For American with no pre-existing conditions: I recommend mid-tier plan from Sanitas or Axa, €100-120 monthly. Covers all basics and emergencies without waiting.

The application process

You apply online or call. They ask basic questions:

• Age
• Medical history (asthma, diabetes, hypertension?)
• Smoker or non-smoker
• Where you'll live in Madrid

With that info, they give you a quote. If you accept, you send documentation (passport, proof of residence, sometimes medical certificate). Within 1-2 weeks you have your policy.

The policy starts when you want (you choose the date), normally within 30 days of purchase.

Real costs

For a single American, 30-50 years old, with no pre-existing conditions: €90-130 monthly covers almost everything. This includes: unlimited general practitioner visits, specialists with small co-pay, emergencies, hospitalization, medicines.

For a couple: ~€180-220 monthly combined.

For a family (couple + 1 child): ~€250-350 monthly.

These prices are "year 1." After that, some increase 3-5% annually, others have larger increases as you age.

Documentation for visa

When you apply for visa, the consulate requires:

• Policy in your name
• Certificate covering all Spain
• That it's in force (not future)
• That it covers emergencies and hospitalization

Some insurers issue a special coverage certificate for visa. Ask when contracting.

Things to know

Co-pay: many policies have co-pay per specialist visit (typically €20-50). Read the fine print.

Deductible: some plans have annual deductible (the first €500 of costs you pay). Others don't.

Provider network: ask if the doctor you want is in-network before contracting.

Cancellation: many policies allow cancellation without penalty after 90 days. Read terms.

Pre-existing conditions: if you have a medical condition (diabetes, hypertension), some policies have exclusions year 1. Ask.

Telemedicine: many insurers now offer video consultations. Useful if your doctor doesn't speak English.

If you arrive without insurance

If you arrived in Spain without having contracted insurance beforehand, you can do it in the first 2 weeks. Some Spanish banks offer insurance to new customers at a discount. Ask at your bank.

If you need urgent medical care before you have insurance: go to private hospital, pay out of pocket (~€300-500 for urgent visit), then claim to your insurer retroactively if you have one.

In summary

Private medical insurance is a visa requirement and necessary to live comfortably in Madrid. It costs €90-130 monthly. You have multiple options, all good. Contract before applying for visa to avoid rejection.

If your move is with Aedara, we help you choose and contract. If it's on your own, use Spanish comparison sites or call insurers directly.