Medical cover for the hard of understanding?

I have done what I consider quite a lot of research on line and with ex-pats out in Spain to find a suitable solution for our query, as yet I have not been able to find an example of what to do when in circumstances such as ours. Any help would be much appreciated.

Background – My partner and I are planning to move to Spain next year where we have recently purchased a villa. We are both under 40 years old and are lucky enough to have just enough money from our investments not to have to work. We will still keep a home in the UK too and will continue to make NI contributions there to keep our UK pensions in good order. We can therefore spend as much or as little time in either country as we wish.

The additional expense of private health care is something we wish to avoid if at all possible. Can anyone offer their knowledge on what would be the best route to get adequate heath care cover whilst out in Spain.?

Should we just pose as occasional visitors to Spain and use our E111 cards? - I’m concerned this might cause us problems as we wish to spend the majority of the year there and just visit the UK for brief breaks.

Should we register as permanent residents in Spain?

Is there a way to avoid expensive health insurance given our situation?

Much obliged and thanks in advance.

 The EHIC (E111) is just for temporary visitors, ie holidaymakers etc.  It is used extensively by many as an almost permanent healthcard even though it's not supposed to be.  The problem could come if you have an existing condition which won't be covered under this scheme.

Even if you take out residency in Spain, you won't be covered for healthcare.  The Spanish system is contributions and aged based.  If you haven't paid into the system and you are over 18 and under retirement age you are not entitled to use the Spanish NHS regardless of status.  You don't say where you are living in Spain but some regions have a scheme where you can pay into the NHS after a certain time.  This can work out more expensive than private health insurance but does cover you for pre-existing conditions which the private schemes do not.  You say you and your partner are under 40 years old and, if you have no existing problems, you will probably find the private schemes work out a lot cheaper than you thought.  

Basically, if you continue to pay NI contributions in UK, you should continue to use the health system there.  You will be entitled to emergency treatment in Spain but not full access to the health system unless you pay into it (which is only fair, if you think about it.  The level of outrage towards health tourists in UK works both ways).

Babaol, 

Thanks for your quick response. We will be based in Valencia.

So, I assume only if you work and pay taxes in Spain can you be granted immediate access to the National Healthcare system there.  I quite understand the frustration of locals when watching their healthcare funds getting drained by non-nationals, heaven knows we are used to that bitter taste in ther UK.

No escape then, will have to get private cover I guess, thanks for your help.

Dan

Further to my last...

I seemed to remember something about free care if you enroll on the register at your local town hall.

I found this on an ex-pat website that seems to suggest that if you enroll, you can can receive free healthcare regardless of status.

It all seems a bit too easy to be true.

Once you get  your empadronamiento you present the form along with your empadronamiento, you take your form to the local clinic (they’ll tell you where your clinic is at the registration centre for your ( if you have those, better that you do, although you won’t be refused) to the desk after waiting the obligatory hour or more where they’ll present you with a shiny new card good for free public health care at your local doctor’s office. work permit and work contract

Any further thoughts?

 Valencia is one of the regions that has the scheme where you can pay into.  It is, however, €90 per month (€270 per quarter) per person and I am sure you could find cheaper if you went private at your age.  You will also get a provisional medical card allowing you to visit a GP provided you also have your EHIC.  Using this provisional card will allow you around 60% discount on medication with a prescription.  For example, my wife's med was €16 trade price (you can get lots of prescription medicine over the counter in Spanish pharmacies) but €6.40 with the prescription.

Valencia is one of the regions that has the scheme where you can pay into.  It is, however, €90 per month (€270 per quarter) per person and I am sure you could find cheaper if you went private at your age.  You will also get a provisional medical card allowing you to visit a GP provided you also have your EHIC.  Using this provisional card will allow you around 60% discount on medication with a prescription.  For example, my wife's med was €16 trade price (you can get lots of prescription medicine over the counter in Spanish pharmacies) but €6.40 with the prescription.

The above is also illegal under Ec law. Spain was given 2 months last november to bring Valencia & Andalucia into line withEU law which reqires all countries to provide healthcare regardless of age, working/non-working or contributions.

Here is a reply I posted recently on another forum :

The rules are EC/Spain if Andalucia have some others then it's time to straighten them out , although that'll probably happen when the elections are held & the whole lot are thrown out.
The EC implemented action against both Andalucia & Valencia last november giving the Spanish Government 2 months to get them to bring their healthcare into line with the whole EC requiring them to provide healthcare to all citizens regardless of age / under retirement age / working or not .
This is why Rajoy signed off the bill, that had already been passed , early in january .

http://www.typicallyspanish.com/news/publish/article_33211.shtml

Here is the relevant legislation , in Spanish

Artículo 12. Derecho a la asistencia sanitaria. Redacción según Ley Orgánica 2/2009, de 11 de diciembre.

1. Los extranjeros que se encuentren en España, inscritos en el padrón del municipio en el que tengan su domicilio habitual, tienen derecho a la asistencia sanitaria en las mismas condiciones que los españoles.

In English ;

Article 12. Right to healthcare.
1. Foreign citizens resident in Spain & registered on the padrón in the municipal area in which they have their permanent home , have the right to healthcare under the same conditions as Spanish nationals.

This was also in the Ley Organíco of 2000, but then mysteriously disappeared. Unfortunately whoever they employed to make it vanish failed to do a proper job & left it in the official english translation.
 

This is very useful, thank you Guslopez.

So, do you know if the new legislation was installed following the two month deadline?

Thanks,

Dan

signed off on january 3rd.

Excellent!  Thank you so much.

Thanks, Gus, this is interesting, but I fear slightly misleading.

I've been researching this problem for months and have been all over the place to try and get health cover other than by becoming autonomo (250€ a month) or buying private health care, which is expensive at my age.

Do you have the URL for the source of your quote re EU law:

"The above is also illegal under Ec law. Spain was given 2 months last november to bring Valencia & Andalucia into line withEU law which reqires all countries to provide healthcare regardless of age, working/non-working or contributions."

This could be crucial, since my research into the Spanish legislation appears to confirm what you suggest that free health cover is available for all EU citizens resident in Spain and empadronado, but I fear this is NOT THE CASE. The key wording is:

Los extranjeros que se encuentren en España, inscritos en el padrón del municipio en el que tengan su domicilio habitual, tienen derecho a la asistencia sanitaria en las mismas condiciones que los españoles.

In other words we have the same rights as Spaniards. Problem is Spaniards with resources above a certain amount who don't pay social security don't qualify for free health cover, so those of us foreigners with pensions won't either!

The article on Typically Spanish is typically ambiguous, unfortunately.

Thanks for bringing clarity to this. I was puzzled too. And so what was the change in January if any?

Guy

I'm not clear on that, Guy. Perhaps Gus can enlighten us - maybe the EU law he referred to in his earlier post could shed some light.

Hi, Johnsx

I should have said "so those of us foreigners with PRIVATE pensions won't either until we get our STATE PENSIONS“

I have spoken at length to Seguridad Social and the Pensions People in Newcastle fairly recently about all this. I fall into a kind of black hole. I'm 61 and have a private pension of more than the limit allowed, so I can't get a Spanish health card until I'm 65..

The facts are these:

If you have income of more than a certain amount (around 600 euros per month) and are not in receipt of your state pension in your EU country of origin you are not eligible for free health cover. Same rules for Spaniards.

As for the 121 form (now called the S1) that is only available for people in receipt of their state pension. Maybe it's different for younger people if they're on invalidity benefit.

Fact is, unless you lie about your resources - and I know some who do - you have to wait until your state pension comes along, which in my case means another 4 years.

Pablo, you say

If you have income of more than a certain amount (around 600 euros per month) and are not in receipt of your state pension in your EU country of origin you are not eligible for free health cover. Same rules for Spaniards.

If you have income of more than a certain amount (around 600 euros per month) and are not in receipt of your state pension in your EU country of origin you are not eligible for free health cover. Same rules for Spaniards.

May I ask you to read my post again.  I did  get free Spanish health cover at the age of 48 and  my private pension (as a former Goverment employeee) was considerably above the 600 euros a month you say is the upper limit.

 The problem with so many rules is that there are fine differences, so one need to avoid making broad stroke comments, which can be very misleading for those seeking info.

Free health care is available in Spain paid for by the UK to those under state pension age  if they are in receipt of a long term benefit such as Incapacity benefit (formerly Invalidity benefit)

http://www.nhs.uk/NHSEngland/Healthcareabroad/movingabroad/Pages/Livingabroad.aspx

That was my understanding too. But cannot anybody enlighten us on the changes resferred to earlier that were signed off by Rahoy in January. I have been on the foreign office website and can see no changes in advice. Thanks in advance.

Guy

Here is the article about the Eu instigating proceedings against Spain in relation to Andalucia & Valencia.

http://www.actasanitaria.com/noticias/actualidad/articulo-espana-emplazada-a-otorgar-la-tarjeta-sanitaria-europea-a-ciudadanos-comunitarios-no-espanoles.html

Before any spaniards that had exhausted their unemployment , plus the 3 months grace period, had no healthcare except if they were able to piggy back off of their parents, grand parents , wife, husband , etc. Resident foreigners with no income , or less than the minimum, fell into this as well & were/are still being denied it in both these regions. If you have no income or income under the 8k minimum , then you are entitled to free healthcare.

Children under the age of 18 & pregnant women have always been entitled to free healthcare & this had been denied as well.

The relevant legislation that was passed into law  was this ;

http://www.tt.mtin.es/periodico/LEY_EXTRANJERiA%28BOE12-12-2009%29.pdf

which re-instated Article 12 which had mysteriously disappeared from the Ley de Organico /2000 , but unfortunately they failed to delete it from the official english version.

If you are under retirement age & have an income over 8k then you are not going to get it.

We've always had it in the Murcia region.

Johnsx

I think, and it has been confirmed by Poppyseed and Guy, that you got cover at the age of 48 because you were receiving UK invalidity benefit.

If you're not receiving a long-term UK benefit, what I posted yesterday is correct based on a close reading of the legislation in Spanish and my conversations with the appropriate authorities in the UK and here. This is confirmed by Gus.

If anybody finds out different, I for one will be very grateful.

  Article 12. Right to healthcare.
1. Foreign citizens resident in Spain & registered on the padrón in the municipal area in which they have their permanent home , have the right to healthcare under the same conditions as Spanish nationals.

So that's correct then and it is the way it works in the Valencia region.  If you've paid in, or you are on incapacity benefits, or you are under 18, or you are over retirement age or you are part of the household of someone in those categories then you will get free healthcare.  Exactly the same as a Spanish national.  It used to be that all expats, regardless of age and status, got free healthcare but that changed some time ago.  I wonder if that was to bring them in line with the system for nationals?

And other EU countries operate the same, EU citizens have the same right to healthcare as their nationals.  In Germany, you have to have part insurance depending on income.  In UK, everyone living in UK has the right to healthcare regardless of paying in or not as it is resident based, in France it is exactly the same as Spain except that those under retirement age or not on incapacity benefit have to pay 30% of the cost of treatment through insurance, the same as a French national.  

It would be marvellous to think every EU citizen would receive comptetely free healthcare when resident, just like UK, but each country has its own system.  

From my own point of view, my wife gets a UK state pension and I don't (4 years to go yet) but I get free healthcare as I am classed as her beneficiary.  Although I was entitled to 2 years based on my UK NI Payments, this was not taken into account on the S1 form.  If you are married and have been working in UK, you can receive up to 2 years free healthcare in Spain depending on the amount of NI contributions you paid in UK in the last 2 years, handy if you are coming up to retirement age but not quite there.  As soon as you reach retirement age, you can get another S1 to update this.