Living there · 1 October 2026 · 4 min read
Healthcare in Spain on a UK State Pension.
A lot of the people we talk to have a UK pension somewhere in the household: years worked in England, a spouse who grew up there, a life in Northern Ireland. If you draw a UK State Pension and move to Spain, the UK can pay for your Spanish public healthcare through a form called the S1. For anyone on regular medication it's the most useful piece of paper in the whole move. The Irish version is in our healthcare guide.
How the S1 works
If you live in Spain and receive a UK State Pension, you may be entitled to Spanish state healthcare paid for by the UK. You use the Spanish system on the same footing as anyone else living there, and the UK settles the bill between governments. The S1 can also cover dependants, such as a husband or wife who isn't drawing a pension yet. When they start claiming their own UK State Pension, their cover moves to an S1 of their own.
Getting one, step by step
You ask NHS Overseas Healthcare Services for the application by phone, on +44 191 218 1999. Once you're living in Spain, you register the S1 with the INSS, the Spanish social security office, in person or online. The INSS posts you a Spanish social security number, you take that to your local health centre to register, and you get the medical card you use at the doctor, the hospital and the pharmacy. You also get a UK-issued GHIC or EHIC for trips to other countries.
What prescriptions cost
Spain doesn't make medicine free, but for pensioners the cost is small and capped. Pensioners pay 10% of the price of their prescriptions, with a monthly ceiling that depends on income. Below €18,000 a year that ceiling is €8.23 a month, however much medication you're on. That's worth knowing if your medication is part of the reason you're weighing the move up.
Your EHIC isn't enough once you live there
The EHIC and GHIC are for visits. They cover care that can't wait until you get home, not life as a resident. Once you move, it's the S1 that counts, so start the application before you go, not after.
Not drawing a State Pension yet
Before pension age there's no S1 from a pension. For your first year living in Spain you'd need private health insurance, and after a year you can join the Spanish public system by paying in monthly, under what's called the convenio especial. If one of you draws a UK State Pension, the other may be covered as a dependant, so check that first. Residency itself needs proof of health cover too, which is in Spanish residency for Irish citizens.
Going back to the UK for treatment
Moving abroad for good can end your right to free NHS care on visits. People who were already living in the EU by 31 December 2020 and hold a UK-issued S1 keep some access. If you're moving now, assume you'll be treated in Spain and check what applies to you before you rely on going back.
Spending part of the year here?
Our free Wintering in Spain guide covers the tax days, pensions, healthcare, running costs and the car, checked against the official sources.