Spain has one of the best healthcare systems in the world (consistently top 10 in WHO and Bloomberg rankings) and one of the cheapest for residents. Most American expats end up using a mix of the public Sistema Nacional de Salud (SNS) and a private policy — public for serious or chronic care, private for fast specialist access.
If you're on a Digital Nomad Visa, Non-Lucrative Visa, or any first-year visa, you legally need full private health insurance with no copays and no waiting periods. After your first renewal or once you're contributing to Social Security, you can switch to or supplement with the public system.
The SNS is universal and tax-funded. Care is free at the point of use for residents — no copays for GP visits, hospital stays, surgeries, or maternity. Prescription medications have a small income-scaled copay (most working-age expats pay 40% of a heavily discounted price).
Each Autonomous Community runs its own health service: CatSalut in Catalonia, SERMAS in Madrid, SAS in Andalusia, etc. Quality is high everywhere; the differences are in wait times for non-urgent specialist appointments and the availability of English-speaking GPs.
You get assigned a centro de salud (local clinic) and a médico de cabecera (your GP) based on where you're empadronado. To register, bring your TIE, empadronamiento, and Social Security number to the centro and ask for your tarjeta sanitaria individual.
Emergency care (Urgencias) is free for anyone in Spain regardless of residency status — including tourists. You will be treated first and billed (or not) afterward.