Health Insurance for the Spain Digital Nomad Visa: What Remote Workers Need to Know

Spain has spent the past few years positioning itself as the top destination in the world for remote workers, and the numbers back it up. The Spain Digital Nomad Visa — introduced under the Startup Act (Ley de Startups) in 2023 — is now one of the most sought-after options for Americans who want to live in Spain while continuing to work for a US employer or client base.

But the visa comes with specific requirements, and health insurance is one of the areas where applicants most frequently run into problems. Your existing US health plan will not be accepted. Your travel insurance will not be accepted. Even some well-known international expat plans are rejected if they are not issued by an insurer authorised to operate in Spain.

Here is what you need to know before you apply.

What Is the Spain Digital Nomad Visa?

The Digital Nomad Visa — formally the Visado para Teletrabajo de Caracter Internacional — is a long-stay residency route for remote workers and freelancers who work primarily for employers or clients based outside Spain. Unlike the Non-Lucrative Visa (NLV), which prohibits any active work, the Digital Nomad Visa is specifically designed for people who earn an income while they live in Spain.

You are permitted to earn up to 20% of your income from Spanish clients, with the remainder coming from abroad. The visa is initially valid for one year (if applied for at a Spanish consulate) or up to three years (if applied for from within Spain). It is renewable, and after five years of legal residence it provides a pathway to permanent residency.

For 2026, the income threshold is approximately EUR 2,850 per month for a single applicant — equal to 200% of Spain’s Minimum Interprofessional Salary (SMI). Dependent family members can be added to the application with additional income requirements.

Tax note: Employed Digital Nomad Visa holders may qualify for Spain’s Beckham Law — a special tax regime that allows eligible foreign workers to pay a flat 24% tax on Spanish-source income for up to six years, rather than Spain’s standard progressive rates of up to 47%. Freelancers are generally excluded from the Beckham Law. Verify your eligibility with a tax adviser before applying.

Health Insurance Requirements for the Spain Digital Nomad Visa

Health insurance is a mandatory requirement for the Digital Nomad Visa application and shares the same core principles as other Spanish residency visas. The rules are strict, and getting the policy wrong is one of the most common reasons applications are refused.

Your policy must:

• Come from an insurer authorised to operate in Spain — a policy from a foreign provider, however reputable, will be rejected
• Provide full comprehensive coverage equivalent to Spain’s public healthcare system (the Sistema Nacional de Salud)
• Have no co-payments (sin copago) and no deductibles
• Have no waiting periods — coverage must start immediately
• Be valid for the full duration of the visa — at least one year
• Come with an official certificate in Spanish, ready to submit at the consulate

Travel insurance is explicitly rejected, even if it includes medical cover. Standard international expat policies are also rejected unless the issuing insurer holds authorisation from Spain’s Directorate-General of Insurance and Pension Funds (DGSFP). This rules out many plans that American remote workers might already have in place.

How the Digital Nomad Visa Insurance Requirements Differ from the NLV

The core insurance requirements — no co-payments, no deductibles, authorised insurer, nationwide coverage — are the same across both visas. But there are some nuances worth knowing.

Because Digital Nomad Visa applicants are actively employed (rather than living on passive income like NLV holders), your employment situation may affect your Social Security obligations in Spain. If your employer is based in the US and you hold a Digital Nomad Visa, your position under the US-Spain Social Security agreement may mean you contribute to either the Spanish or American system — but not both. This can affect whether you ever become eligible for Spain’s public healthcare system (the SNS).

In practice, most Digital Nomad Visa holders rely entirely on private health insurance for the duration of their visa — which makes getting the right policy from the start even more important.

Does Medicare Cover You in Spain on a Digital Nomad Visa?

No. Medicare does not cover healthcare outside the United States in almost all circumstances, and Spain is not an exception. It does not matter whether you are on a Digital Nomad Visa, a Non-Lucrative Visa, or any other residency status. If you are receiving care in Spain, Medicare will not pay for it.

If you are approaching 65 and considering a move to Spain, you will need to think carefully about whether to maintain Medicare Part B (which costs around $185 per month in 2025) while living abroad. Part B will not cover you in Spain, but dropping it permanently means a 10% re-enrolment penalty for every year you were not enrolled if you later return to the US. This is a financial planning decision worth taking professional advice on before you commit to a move.

Where to Apply and What the Consulate Looks For

You can apply for the Digital Nomad Visa at a Spanish consulate in the US before you travel, or from within Spain if you are already there legally (for example, on a tourist visa). The two routes produce different visa lengths — one year vs. up to three years — so the route you choose matters.

When it comes to health insurance, consulates pay close attention to the certificate rather than the full policy document. The certificate must explicitly state:

• The insurer is authorised to operate in Spain
• There are no co-payments or deductibles
• There are no waiting periods
• Coverage is nationwide and comprehensive

In 2025 and 2026, refusals on insurance grounds have been documented specifically where the certificate contained co-payment language buried in the small print — even where the applicant believed their policy was compliant. Use a broker or insurer with direct experience in Spanish visa applications, not simply the cheapest policy that looks broadly suitable.

Popular cities for American digital nomads in Spain include Barcelona, Madrid, Valencia and Malaga — all of which have well-established networks of private clinics with English-speaking staff. Wherever you plan to base yourself, check that your policy provides access to providers in that region.

ExpatInsure can help you identify the right health insurance for your Digital Nomad Visa application and your life in Spain.

Frequently Asked Questions