Getting a health card is a necessary step to access public medical services in Spain. This guide explains how to get a health card in Madrid.
You will learn about eligibility rules, registration offices, and required documents. Standard steps to obtain your card are detailed below.
What is the Madrid public health card?
The public health card grants access to free primary care, hospital treatment, and subsidised prescriptions.
The Spanish term for the public health card is tarjeta sanitaria (health card).
It is also referred to as the tarjeta sanitaria individual (individual health card).
The card is issued by the Community of Madrid’s public health service. The Spanish term for this service is Servicio Madrileño de Salud (Madrid Health Service).
The service is commonly known by its abbreviation, SERMAS. You will see this acronym on clinics and official medical forms.
How to find English-speaking doctors in Madrid
Who can get a public health card?
Public health cards are available to all residents who pay social security taxes in Spain.
Employed workers, self-employed freelancers, and state pensioners are eligible. Their registered dependents are also covered.
State-funded coverage is also granted to pregnant women, children under 18, and students under 28.
If you do not fit these categories, you must buy private health insurance or pay a voluntary monthly fee.
The social security registration document
Before visiting the health center, you must get a document proving your entitlement to healthcare.
First, you must register at the social security office. The Spanish term for this office is Tesorería General de la Seguridad Social (General Treasury of the Social Security).
They will issue your social security number. You must then request a document confirming your right to healthcare.
The Spanish term for this registration document is documento de afiliación (affiliation document).
It is also called the documento de derecho a asistencia sanitaria (document of entitlement to healthcare).
Step-by-step: How to get your health card
Follow these steps to obtain your public health card in Madrid.
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Locate the nearest public health center that corresponds to your residential area.
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Book an appointment with the administrative office at the health center.
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Prepare your identification documents, padrón certificate, and social security paper.
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Attend the appointment and present your documents to the administrator.
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Receive your temporary paper health card showing your assigned doctor’s name.
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Use your temporary card immediately to access services and buy subsidised medicine.
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Collect your permanent plastic health card from the health center or receive it by post.
The Spanish term for a health center is centro de salud (health center).
The Spanish term for the booking system is cita previa (prior appointment).
Checklist: What to bring to the health center
Prepare these items before you visit the health center administrative office:
- Passport : Your valid national identity document.
- TIE or visa certificate : Your foreign identity card or registration certificate.
- Entitlement document : The social security document confirming your right to healthcare.
- Padrón certificate : The Spanish term for this registration certificate is volante de empadronamiento (registration certificate).
- Application form : The completed health card application form.
Most health centers provide the application form at the reception desk.
Costs, fees, and validity
There are no fees for obtaining your first public health card. It is funded by your monthly social security contributions.
| Card status | Cost | Validity period |
|---|---|---|
| New card | Free | Valid indefinitely (residents) |
| Renewal card | Free | Valid for duration of visa |
| Replacement (lost/stolen) | Free | Matches original validity |
The health card remains valid as long as you continue paying social security taxes. If you change jobs, your coverage continues automatically.
Private health insurance is an alternative option for expats who prefer faster access. The Spanish term for private insurance is seguro de salud privado (private health insurance).
Private insurance does not require social security contributions. However, you must pay monthly premiums instead.
Example: A doctor prescribes a drug that costs €15. At the pharmacy, you present your public health card. Because your copayment rate is 40%, you only pay €6. The card saves you €9 on the prescription.
The Spanish term for this copayment is copago (copayment).
The Spanish term for an insurance refund is reembolso (reimbursement).
Health insurance in Spain: public vs private
Public health card versus private insurance cards
This table compares using the public health card with holding a private health insurance card.
| Pathway step | Public health card | Private health insurance |
|---|---|---|
| Base cost | Free (funded via social security) | Monthly premiums (€30 to €100) |
| GP appointment | Assigned doctor at local center | Free choice from medical directory |
| Bilingual support | Low (mostly Spanish) | High (many bilingual doctors) |
| Medication cost | Subsidised (pay 10% to 60%) | Full price paid out of pocket |
The public health card is excellent for standard prescriptions and emergency hospital treatments. Private insurance is better for fast, English-speaking specialist care.
Questions and answers
How much does a public health card cost?
It is free. There is no charge for the card itself, as it is funded by social security taxes.
Can I get a health card if I do not work?
Yes, under certain conditions. You can register if you receive benefits, have a pension, or pay a voluntary monthly contribution.
What is the validity of the public health card?
Indefinite for permanent residents. For temporary residents or students, it is valid for the duration of your visa.
Can I use my Madrid health card in other Spanish regions?
Yes, for emergencies. If you move temporarily, you must register as a temporary resident at the local center.
The Spanish term for this temporary status is desplazado (displaced resident).
What should I do if my health card is lost or stolen?
Request a replacement. Visit your local health center reception desk to ask for a duplicate card.
Can students get a public health card in Spain?
Only under certain visa schemes. Non-EU students usually require private insurance, but EU students can use their EHIC.
Can I choose my public family doctor when I get the card?
Yes, within your local center. You can request a change if they have open slots.
The Spanish term for your family doctor is médico de cabecera (family doctor).
How long does the health card take to arrive?
Between two and four weeks. You will use your paper document to access services while waiting.
Does the health card cover private clinics?
No. The public health card can only be used at public health centers and public hospitals.
Can I register for a health card online?
Yes, if you have a digital certificate. Otherwise, you must submit your application in person at the health center.
