One of the biggest worries for British and other non-EU retirees in Spain is:
“If I live in Spain on a Non-Lucrative Visa (NLV), can I use the public health system?”
After a few years, people start hearing totally different versions of the “rules”:
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“You’re never eligible, you haven’t paid into the system.”
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“After 5 years’ residency you can join.”
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“You need 10 years.”
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“You can join now if you pay a monthly fee.”
No wonder everyone is confused.
In this article I’ll explain, in plain English, how public healthcare access really works for NLV holders, especially long-term residents in Andalucía (Málaga, Costa del Sol, etc.).
1. NLV ≠ automatic access to public healthcare
The Non-Lucrative Visa is for people who live in Spain with sufficient resources but do not work in Spain and don’t pay into Spanish Social Security.
That means:
So where does the confusion come from?
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The 5-year mark is relevant for long-term residence, not healthcare rights.
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There is no 10-year rule for healthcare access.
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But there is a way into the public system for people who haven’t paid in: the Convenio Especial.
If you want to refresh the basics of the visa itself, you can see our full guide to the Non-Lucrative Visa in Spain (requirements, renewals, etc.).
2. What is the Convenio Especial?
The Convenio Especial de prestación de asistencia sanitaria is a scheme that allows legal residents who haven’t contributed to Social Security to join the public health system by paying a monthly fee.
To qualify, you generally must:
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Be a legal resident in Spain (with a valid TIE).
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Be registered on your local padrón (town hall register).
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Not already have entitlement to Spanish public healthcare (for example, through employment, an S1 form, etc.).
Once accepted, you access the SNS (national health system) like any other resident in your region.
3. Costs in Andalucía (Málaga, Costa del Sol, etc.)
In Andalucía, the typical monthly fees for the Convenio Especial are approximately:
(These figures can change over time, so always check the latest amounts when you apply.)
Once you’re in the system, you use healthcare in your area as any other insured resident would.
4. What is covered?
The Convenio Especial is not a “cut-down” version of public healthcare. It typically includes:
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GP (family doctor) and specialist care
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Emergency care
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Hospitalisation
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Chronic illness and ongoing treatment
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Medication with the usual co-pay system
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No exclusions for pre-existing conditions
For many long-term NLV residents, this is the first time they feel truly integrated into the Spanish healthcare system.
5. Common myths (and what really happens)
Let’s clear up the most frequent myths we hear from NLV retirees:
“After five years we get healthcare automatically.”
❌ False.
Five years’ residence is important for long-term residence status, but it does not automatically give you public healthcare if you haven’t contributed.
“We must wait ten years.”
❌ False.
There is no 10-year rule for joining the public system via the Convenio Especial.
“We will never be eligible because we haven’t paid in.”
❌ Not correct.
The whole point of the Convenio Especial is to include legal residents who have not paid into Social Security.
“We can join now for under 200 € a month.”
✅ Largely true.
Most residents will fall into one of the two age bands mentioned above, so many can access Spanish public healthcare for less than 200 € per month, depending on age.
6. How the Convenio Especial fits into your NLV journey
When you first apply for the NLV, private medical insurance is mandatory. Many people are happy with this at the beginning.
Over time, however:
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Private policies often become more expensive with age.
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Some people worry about future exclusions or premium increases.
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Many want the stability of being inside the public health system.
A common strategy for NLV holders is:
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Start with private insurance to obtain and renew the Non-Lucrative Visa.
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As your residence becomes more stable, apply for the Convenio Especial to secure long-term public healthcare.
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Combine private and public for a while if needed (e.g. keep private cover during the application process or for extra comfort).
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Review the tax implications once you spend 183 days or more per year in Spain and become tax resident.
The key idea: your NLV journey doesn’t end with getting the visa. Over time, you can move towards long-term residence and stable public healthcare access.
7. How CostaLuz Lawyers can help NLV residents
At CostaLuz Lawyers we work daily with British and other non-EU retirees on the Costa del Sol and across Spain. For NLV holders, we typically help with:
✅ Residence & healthcare
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Reviewing your residency status and renewals.
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Checking your eligibility for the Convenio Especial.
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Preparing and submitting the application and documentation.
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Liaising with the regional health authority in Andalucía.
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Explaining how healthcare, residency category and tax residency fit together.
✅ Beyond healthcare: key areas for retirees
Most NLV residents ask for help with more than just healthcare. We also assist with:
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Initial NLV application and renewals
We review requirements, prepare and check your documents, complete forms, design a strategy for your consulate and accompany you until approval and through renewals.
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Transition to long-term residence
We analyse your years of residence and absences, prepare the file and plan a route that takes into account healthcare, tax residency and long-term stability.
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Tax advice for NLV residents
We look at when you become a Spanish tax resident (183 days, centre of vital interests, main home), coordinate with advisers in your home country and try to reduce or avoid double taxation where possible.
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Safe property purchase in Spain
Full legal support when buying property (coastal, rural, off-plan or resale): planning and land registry checks, reservation and deposit contracts, notary completion and registration.
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Wills and international estate planning
We help you sign a Spanish will that works together with your will back home, and choose the applicable law to your estate. We also support your family later when they need to execute the will before Spanish notaries, banks and authorities.
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Preventive powers of attorney (poderes preventivos)
These allow a trusted person to act for you in Spain if, one day, you cannot manage your affairs (healthcare, banking, property, administration). We help you set them up, update them and, later, help family members activate and use them.
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Changing your type of residence when life changes
If your life project shifts and you want to move from an NLV to work, self-employment, a Digital Nomad Visa, or a family route, we study the alternatives and design the safest transition.
If you’re already living in Spain on a Non-Lucrative Visa and would like to review your residence, healthcare, tax, property and long-term planning, we can study your case and propose a clear, realistic plan tailored to your age, resources and long-term goals in Spain.
About the author
Written by:
María de Castro, Abogado no. 2745, Ilustre Colegio de Abogados de Cádiz.
CostaLuz Lawyers has supported international buyers and residents in Spain since 2006, including many members of the EyeOnSpain community, with clear guidance on visas, tax, property purchases and long-term planning.
Updated: 14 November 2025.
