The quality of health care facilities in Andalusia is very good with highly trained doctors and nurses. For people who retire to live on the Costa del Sol it is important to know how to access health care. This can be obtained in two ways. First, for retirees not in receipt of a UK State pension it will be necessary to take out private medical insurance (unless you pay cash for services!) which it is recommended should be obtained before relocating to Spain. It is suggested that you consult the Foreign and Commonwealth Office (FCO) telephone 0845 850 2829, or www.fco.gov.uk for travel advice. When you decide to move to Spain it is advisable to collect as much information as possible from such sources as Age Concern/Help the Aged and the Department of Health at www.dh.gov.uk. Before you buy private medical cover, and as an interim measure, obtain the European Health Insurance Card (EHIC) that replaced form E111. This also applies to those individuals who are receiving British State pensions and are entitled to reciprocal health benefits. The EHIC is free of charge through the Department of Health web site noted above. Probably the easiest way to access this card is by collecting the leaflet ‘Health Advice for Travellers’ available from most UK post offices. But be aware the EHIC is only for emergency care and is not a substitute for travel insurance.
Second, for British retirees in receipt of a State retirement pension – 60 for most women and 65 for men (although the government has plans to alter the age at which this pension becomes available) there are certain procedures that should be adopted to register for health care. You must notify your Spanish address to the Overseas Benefits Directorate of the Department of Social Security (address follows). The DSS will send you form 121. After completing this, send it to the office of Instituto Nacional de la Seguridad Social (INSS). It is suggested that you contact your local Centro de Salud (Health Centre). They will help with information of exactly where to send the form. The INSS will send you a Tarjeta Sanitaria (health care card). Allow a couple of months before it is issued – hence the need for EHIC.
If a women is aged 60 and in receipt of a UK State pension and her partner is not yet 65, he may also be entitled to health care as her dependant. However, when the partner reaches 65 he should register using form 121 so that he is entitled as of right to appropriate care. There have been cases of older people over the age of 65 not registering and then they later find they are denied access to medical treatment (except for emergencies); therefore, the maxim is register when you reach the age to draw a UK State pension.
So, if health care in Andalusia is good to what are retirees entitled? A family doctor (Medico de Cabecera) at a local Centro de Salud (Health Centre) will be allocated to you. You will also have the services of a nurse (Practicante) working with a doctor. The nurse can carry out certain tests including blood and urine tests and take blood pressure. They can also treat minor cuts and sores plus dressings and test for diabetes. The Health Centre doctor can arrange for X-rays and any other diagnostic tests. If necessary, a doctor can arrange a consultation with a specialist. Note, it is also possible to arrange an appointment with your doctor by phone, text message or internet. Ask at your local Health Centre for details. Many Health Centres in Andalusia are attempting to cope with increasing numbers of older people from the EU and wider afield and are under strain. We suggest that you should make appointments to see a doctor or nurse a week or so before it is actually needed. If you cannot keep an appointment cancel it so that it can be allocated to another person.
For health emergencies ring 902 505 061. You can ring Salud Responde on 902 505 060 for information in English about appointments.
As communication between medical personnel and patients without adequate Spanish can be problematical, some Health Centres in Andalusia have organised interpreter services, for example, Arroyo de la Miel. Torrequebrada, Estepona, Fuengirola and Nerja. For more information ask for the relevant fact sheet. At the time of writing there is also a special medical interpreting service available over the telephone. The idea is to hand the telephone back and forth between the patient and the doctor, whilst the interpreter translates over the telephone as necessary. The number of the translation service (for the price of a local call) is 902471111.
A Farmacia (chemist) will provide all the prescribed medicines free to pensioners. They will also supply general health advice about drugs and over the counter medicine. Ask for the relevant fact sheet about chemists.
There are excellent hospitals in the province of Malaga. Many people will be familiar with the Costa del Sol hospital near Marbella, Hospital Clinico, Carlos Haya in Malaga, and in recent times a number of specialised local hospitals known as CHARE Hospitals, have opened in the Province of Malaga. There are also private hospitals in the province. Ask for the hospital fact sheet for more information. Treatment in all these hospitals is often reported to be extremely good by ex-patients and research workers. However, there is a dearth of available after care facilities as Spaniards very often have a family network providing necessary support. However, because older British expatriates and other European retirees do not usually have this kind of help, home care services and Care Homes have been set up (more details elsewhere in this brochure).
As expatriates age and become less mobile there may be a problem for single retirees, particularly without adequate financial means if aftercare is needed. For example, when a doctor recommends a period of convalescence, who will help? Reliance may have to be placed on friends and neighbours. Age Care Association can be contacted for extra help depending on needs and resources – contact our help lines 691761088 or 655903182.
When a patient under a GP’s care requires urgent treatment the ambulance service will be called upon to transport the individual to a suitable hospital. This service is free for patients registered with the INSS. The Spanish Red Cross (Cruz Roja) also transports patients to hospitals, and some private hospitals have their own ambulances. If you need further information about ambulance services, ask for the relevant fact sheet.
In addition to state and private health provision there is a number of non-governmental organisations (NGO’s) on the Costa del Sol. They rely on voluntary help with, in some cases, paid professional medical staff, for example CUDECA for cancer care. For people with Alzheimer’s disease a number of support groups meet regularly to give advice and friendship (see relevant fact sheet).
As people age and become more infirm and possibly housebound the Junta de Andalucia can provide Teleasistencia (colloquially known as a ‘panic button’) to those who qualify by age. This is an essential form of communication between people needing urgent help. For a fuller description of what is required to access this service please ask for relevant fact sheet.
Most retired resident expatriates will have registered with the local Health Authority using form E 121 (See appropriate fact sheet on health care). There are two further forms that some people may need. Form E 112 is required specifically for medical care in a country in the EU. E 112s are not issued automatically or on a ‘just in case’ basis. There must be a clear need for medical treatment abroad. After a full clinical assessment has been carried out a decision is made whether treatment abroad will meet your needs.
For people under State pension age who take up residence in Spain and are not working, form E 106 can be used to access health care benefits. This form should be applied for some weeks before migrating to Spain. As the conditions for its use and length of validity may change it is advisable to check thoroughly before leaving the UK.
It is important to bear in mind that if you come to live in Spain you may lose your right to some UK health benefits. Please see our section on “Return Migration.”
Assistance with mobility Problems
For people with mobility problems you can obtain assistance at airports throughout the EU. From July 2008 a new law came into force. Anyone who is disabled, or has difficulty moving around can now ask for the right service when they book. At Malaga airport the service is called Sin Barreras; for information ring 902404704. Give them your requirements, dates of travel etc. From the UK ring 00 34 952974563 (if possible 48 hours or so before you are returning to the UK) where you will be connected to someone speaking English. Give details of the date you intend returning to Spain and arrangements will be made to cater for your mobility problems.
Habitual Residence Test
Although increasing numbers of retirees from the UK are relocating to Spain many thousands each year return to their country of origin (see ‘Brits Abroad’ published by the Institute for Public Policy Research). There are many reasons why older people return to the UK. These include the need to access domiciliary care, care home provision, and entitlement to a range of certain non-exportable health and other benefits. For individuals intending to return permanently to the UK, it is necessary to be aware of what is termed the Habitual Residence Test (HRT). It is not possible to give a full explanation of what is required to establish residence in the UK. For a comprehensive overview of HRT, log on to www.cpag.org.uk/cro/wrb155/habitual.htm. The Department of Work and Pensions and the local British Consulate in Malaga may also be able to help with information. It is crucial for intending returnees to obtain as much information as possible about the conditions needed to qualify as Habitually Resident in the UK.
Important
We suggest that it is in your interest to carry with you at all times details of any medication you are taking and some sort of identification, e.g., photocopy of your passport or residents’ certificate. Also, have details of a keyholder’s name and telephone number, to be used in an emergency.
