When you move to Spain, there’s an unbelievable amount of bureaucracy to deal with — and even more so if you’re self-employed and holding the Spain digital nomad visa, like we are. While we’re figuring it out little by little, and I’m working on a checklist for new digital nomads in Spain, one thing that inevitably brings up a lot of questions is the topic of health care.
On the digital nomad visa, my understanding is that we are eligible for Spain’s public health system due to the fact that we’re paying Social Security. However, we still haven’t registered for it. There’s a certain order you need to do things in, and I’m not sure we’ve completed all the steps yet. I wasn’t planning to get a private plan, and I just figured we’d get the public health insurance as soon as we could, but there was one more thing that I was a little concerned about.
What health insurance would we use when we went home to the U.S. for a visit?
The Fun of Health Insurance
When I lived in Madrid and worked as a language assistant with the NALCAP program, program participants had private insurance, but it expired at the end of the school year. When I’d go home to the U.S. for the summer, I would typically apply for a cheap Health Insurance Marketplace (Obamacare) plan which would only cost me about $30 per month. That’s because HIM/Obamacare plans are based on your income, and I was hardly making any money at the time. I’d sign up through a special enrollment period, as I classified myself as “moving” back to the U.S., and then I was set.
Unfortunately, I knew that this plan wouldn’t work this time. First of all, I make way more money now, which would make insurance much more expensive; and second, we’ll be home twice instead of just once this year.
I feel that I should also explain a little about what our insurance situation in the U.S. has been like for the past couple of years, since I moved home in mid-2020. As self-employed contractors, Matt and I weren’t eligible for any workplace health insurance plan. Rather than pay a $500 monthly premium for a Health Insurance Marketplace plan (which is guaranteed-issue, hence the high cost), we opted for private plans that ran about $275 per month.
The day I got to cancel that plan — because we were moving to Spain — couldn’t come soon enough. Despite a “low” premium, coverage was absolutely terrible. Among a long list of things, our plan wouldn’t even cover an annual flu shot, much to the confusion of the CVS pharmacists every single year. So yeah, good riddance to USHealthGroup. I don’t miss you at all.
In the past two months, since arriving in Spain, we have had no health insurance. This would freak me out in the U.S., but I feel like I can trust Spain to not saddle me with millions of euros in medical debt in the worst-case scenario. We are still working through the process to get public insurance, like I mentioned, but that won’t help us when Matt and I go back to the U.S. for six weeks in May/June. And then again for a couple months this fall.
My research led me to two options:
1. Buy a Short-Term Travel Insurance Plan
Travel insurance can come in handy in so many ways. We’ve personally bought travel insurance plans for several trips, and we’ve had to use it to help us make claims once. When we went to Ecuador for two months in 2022, our travel insurance plan paid off when Matt got sick in the Galapagos Islands, and he had to see a doctor both on the islands and again when we got back to Quito.
There are plenty of travel insurance companies that would be great options for traveling back home to the United States. Nomad Insurance by SafetyWing, for example, seems to cover American citizens who are primarily living abroad. However, it looks like the current coverage length is only for trips of 15 days or less. I know it’s a newer company, but they’ve got big plans to be the first truly borderless health insurance company for digital nomads and remote workers all around the world. With that in mind, I wouldn’t be surprised if their offerings continue to expand over the coming years.
Additionally, it shouldn’t be hard to find other types of short-term insurance plans that can cover you for the duration of your trip — whether it’s a couple of weeks or a couple of months. Based on the quotes I was getting, for about 3-4 months total of time in the U.S. this year, I would expect to pay about $350-$400 total. About $100 a month, I guess you could say.
I feel like $100 per month is really not too bad, especially considering I was paying nearly 3x that per month in the U.S. when I was living there. 🙃
2. Buy a Private Insurance Plan in Spain With U.S. Coverage
While the short-term plan might be the better option if you’re only spending a week or two a year in the U.S. per year (working toward that permanent residency, huh?), it wasn’t the best deal for our situation.
I decided to get some private health insurance quotes here in Spain, and the prices truly astounded me. With Sanitas, for example, which is one of Spain’s biggest health insurance providers, we could get a special plan for self-employed workers that is about $35/month/person. Not only would it provide us access to the whole private health network of providers and services, much quicker than we could access the public ones, but including the USA Assistance Add-on also covers us when we go home to the U.S.!
If I multiply that monthly price by 12, I get a yearly cost of $420. Just barely more than what I would pay for four months of U.S. travel insurance. And I’d get a whole lot more out of it, like some of the benefits I mentioned above. So, for us, getting a private insurance plan in Spain is 100% the better deal. And if you find yourself in a similar type of situation, it might also be right for you!
It’s still kind of astonishing how little a private health insurance plan costs here, and I will forever wonder why the U.S. can’t figure out how to provide public health coverage or even private health insurance for a reasonable price… but it make me really glad I’m here in Spain, now.
Did any of this surprise you? Would a short-term travel insurance plan be better for you, or are you considering a private plan in Spain? Let me know in the comments!
-Cathy
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