Convenio especial: paying into Spanish public healthcare on the Costa del Sol

If you live in Málaga, don't work and don't have an S1, Spain lets you pay a flat monthly fee to use the public health service, once you've been here a year.

The short version

• The convenio especial is a national scheme that lets people with no other right to Spanish public healthcare pay to join it. In Andalusia you sign up with the Andalusian Health Service (SAS) [1].
• It costs EUR 60 a month (about £50) if you're under 65 and EUR 157 a month (about £131) if you're 65 or over [1].
• You need at least one year's residence in Spain, to be on the padrón, and to have no access to public healthcare by any other route [1].
• It covers GP, hospital and specialist care with no waiting periods, but you pay the full price of prescriptions [1].
• UK State Pensioners living in Spain should normally use an S1 instead: the UK pays for their Spanish state healthcare, so there's no monthly fee [3].

Pound conversions use the Bank of England spot rate of 5 November 2026 (£1 = EUR 1.20).

Who the convenio especial is for

In Spain you get public healthcare mainly by working and paying social security, by being a pensioner, or as the dependant of someone who does. The S1 slots UK State Pensioners into that system, with the UK footing the bill [3].

That leaves a gap. Picture an early retiree from Basingstoke who moved to Rincón de la Victoria at 58 on a non-lucrative visa. They don't work in Spain, they aren't old enough for the UK State Pension, so there's no S1, and they're paying for private insurance year after year. The convenio especial is designed for people like them.

Typical members on the Costa del Sol:

• Early retirees living on savings, a UK workplace pension or rental income, before State Pension age.
• Non-working partners of people with private cover only.
• People whose private insurer has excluded a condition, or whose premiums have climbed with age.
• Long-term residents who fall between two stools, for example after a job ends.

It isn't for visitors or second-home owners. You have to be properly resident.

Who can join: the rules

The Ministry of Health's rules, set out under Royal Decree 576/2013, say you must [1]:

1. Have lived in Spain for at least one continuous year immediately before you apply. Time living in another EU or EEA country, Switzerland or the UK can count towards this.
2. Be on the padrón (registered at the town hall) in a Spanish municipality when you apply. Our guide to the padrón explains how.
3. Have no access to public healthcare by any other means, whether through Spanish rules, EU social security rules or a bilateral agreement.

That last point is why the scheme isn't for S1 holders. The Ministry says pensioners who can prove their right to healthcare from their pension country, such as with an S1, don't need it [1].

Practically speaking, the one-year rule means nobody arriving fresh from the UK can join on day one. For a non-lucrative visa, the Spanish consulate in London asks for public or private health insurance with a company authorised in Spain, or a registered S1 [4]. So most early retirees start with private cover and look at the convenio especial once they've done their year. Check with Extranjería before relying on it for a visa renewal.

What it costs

Fees from the Ministry of Health, checked on 7 November 2026 [1].

There are no co-payments for the services it covers and no waiting periods [1]. The fee is per person, so a couple both under 65 would pay EUR 120 a month (about £100) between them.

The 65-and-over rate is the one to watch. A Brit who turns 65 a year or two before reaching UK State Pension age (which is rising to 67) would pay the higher rate until their S1 kicks in.

What it covers, and the prescriptions catch

The convenio especial gives you the national health service's common basic package: prevention, diagnosis, treatment and rehabilitation, in primary care and in hospital, as an outpatient or inpatient, plus urgent medical transport [1]. In Málaga that means your local centro de salud, a GP (médico de cabecera), and referrals to hospitals such as the Hospital Regional or the Clínico.

The catch is in what you pay for in full [1]:

• Outpatient prescriptions, at 100% of the price
• Outpatient orthopaedic products such as braces and some prostheses
• Special dietary products
• Non-urgent medical transport

Back home in Blighty, prescriptions are free in Scotland, Wales and Northern Ireland and capped in England. Here, if you're on several regular medicines, the full chemist's price can add up quickly. Do the sums with your actual prescriptions before you sign up. Many Spanish medicines are cheaper than you'd expect, but it varies a lot.

How to apply in Andalusia

You apply to the regional health service where you live. In Málaga province that's the Servicio Andaluz de Salud (SAS); the Ministry of Health links to the Junta de Andalucía's procedure page [1].

The Ministry lists these documents [1]:

1. Proof of identity: passport, NIE certificate or TIE.
2. Proof of a year's residence: for example a residence certificate from the police or a padrón certificate showing your registration date.
3. A current padrón certificate from your town hall.
4. A statement that your home country doesn't cover you: for UK nationals, a certificate or sworn statement that you aren't covered in Spain by UK healthcare.

Then:

5. Sign the agreement and set up the direct debit from a Spanish bank account. See banking in Spain as a Brit.
6. Register at your centro de salud and get your Andalusian health card (tarjeta sanitaria).

Keep the direct debit going: your cover depends on paying the monthly fee.

Expect some paperwork faff and a few trips. It's worth asking in our community group for Brits in Spain how long it's currently taking in your town.

Convenio especial vs the S1 vs private cover

When the S1 wins

If you get a UK State Pension and live in Spain, apply for the S1. It costs you nothing, and you're treated like a Spanish pensioner, prescriptions included. Remember you can't get a UK S1 if you also get a Spanish state pension, because Spain then becomes responsible for your healthcare [3]. And register the S1 promptly: until it's registered, you're responsible for your own cover [3]. Our guide to the NHS when you live abroad and the S1 covers who qualifies.

When the convenio especial wins

• You're under 65, healthy apart from a condition your insurer won't cover, and not yet on the UK State Pension.
• You'd like to stop paying private premiums that rise every birthday.
• You're happy with the public system's waiting lists and Spanish-speaking GPs (bring a friend or an app if your Spanish is shaky).

When private cover wins

• You've just arrived and haven't done your year.
• You want English-speaking doctors, private rooms and shorter waits, and the premium doesn't hurt.
• You take expensive regular medicines that your policy covers.

Plenty of Brits on the coast end up with both: the convenio especial as a safety net for the big stuff, and a cheaper private policy, or simply paying privately, for quick appointments.

Don't forget the UK side

Moving to Spain usually ends your right to free NHS care in the UK, except in limited cases such as with an S1. The GHIC is for visits, not for living abroad. If you go back to the UK, tell the NHS Overseas Healthcare team so any S1 can be cancelled [2]. Our guide to healthcare in Málaga has the bigger picture.

Sources

1. Spanish Ministry of Health: Special agreement on healthcare provision (convenio especial)
2. GOV.UK (FCDO): Living in Spain (updated 3 July 2026)
3. NHS: Planning your healthcare when living abroad
4. Spanish Consulate General in London: Non-lucrative residence visa (page dated 6 July 2026)

Keep reading

• Healthcare in Málaga
• Spain's non-lucrative visa for British retirees
• The NHS when you live abroad (and the S1 for pensioners in the EU)
• Health insurance between countries and the NHS on your return