Convenio Especial in Madrid: Paying for Public Healthcare
A flat monthly fee buys access to the public health system after one year in Madrid. What it covers, what it leaves out and how to apply.
The convenio especial lets Madrid residents with no other right to public healthcare pay a flat monthly fee for it: €60 a month under 65 and €157 a month from 65, as of November 2026. You need one continuous year of residence and a current padrón in the Comunidad de Madrid, and the region issues a decision within one month.
What is the convenio especial?
The Convenio Especial de Prestación de Asistencia Sanitaria is a contract between you and the Servicio Madrileño de Salud (SERMAS). It is set up under national rules, Real Decreto 576/2013, and each region runs its own version. In Madrid, it gives access to the basic common package of public healthcare: family doctor, specialists, hospital care and emergencies in the public network.
It is meant for people who live in Madrid but have no right to care through work, a pension, a family member or an EU form. Typical cases are early retirees, people living on savings and family members who do not qualify as beneficiaries.
Who qualifies in Madrid?
According to the Comunidad de Madrid’s convenio especial page, applicants must meet these conditions, as of November 2026:
- Live in the Comunidad de Madrid and be registered on the padrón of a Madrid municipality when they apply.
- Prove effective residence for at least one continuous year immediately before the application. Time in Spain, another EU or EEA country, Switzerland or the UK counts.
- Have no right to public healthcare through any other route.
Each family member needs a separate application. If you have just arrived, you cannot use the convenio during your first year; the residence requirement rules it out.
Before applying, check that you really have no other route. Workers, pensioners with an S1 form and family members of insured people get the regular card, explained in our guide to the Madrid health card.
How much does it cost?
The fee is fixed by age and does not depend on income or health history. The Comunidad says it will be reviewed in line with the cost of the public health package, so check the current amount before signing.
| Subscriber’s age | Monthly fee (as of November 2026) | Per year |
|---|---|---|
| Under 65 | €60 | €720 |
| 65 and over | €157 | €1,884 |
There is no application fee. The monthly payment is due in the first five days of each month. Failing to pay the first fee, two months in a row or three months in total ends the agreement.
What does it not cover?
The convenio covers the basic package only. The Comunidad lists these exclusions:
- Medicines bought at the pharmacy with a prescription (outpatient pharmacy). You pay the full price.
- Orthopedic and prosthetic items.
- Special dietary products.
- Non-urgent medical transport.
You also do not receive the standard health card. The region gives you a health care document instead, which you show at the health center and hospital.
How do you apply?
You can apply online with an electronic signature, or on paper at the offices listed by the Comunidad. Some offices require an appointment.
- Get your padrón history. Request a historical padrón certificate (certificado de empadronamiento histórico) for the Comunidad de Madrid showing at least one year. It must be issued within the 90 days before you apply. Our guide to registering on the Madrid padrón explains how to get it. If you have not been registered in Madrid for a full year, add certificates from other Spanish municipalities.
- Copy your passport. The Comunidad asks for a complete, legible copy of every page.
- Fill in the form. Online, use the regional electronic office with a digital certificate or Cl@ve. On paper, download the PDF, sign it and file it with your documents.
- Wait for the decision. The region issues a resolution within one month. If something is missing, you have 15 days to fix it after the request arrives.
- Sign the agreement. If approved, you attend an appointment to sign the convenio. Ask there from which date care starts and how the monthly payment is collected.
If you cancel or the agreement is ended, you must wait one year from the day after it ends before you can sign up again. Cancellation has to be made in writing.
Convenio especial or private insurance?
The two options serve different purposes. Private health insurance is often required at the start of a residence permit, when the convenio is not yet available. The convenio becomes an option after a year, once you have a padrón history.
| Point | Convenio especial | Private insurance without copays |
|---|---|---|
| Monthly cost (as of November 2026) | €60 under 65, €157 from 65 | Varies by age and insurer; rises with age |
| When you can join | After one year of residence | Any time |
| Pre-existing conditions | Not a factor | Insurers may exclude them or refuse cover |
| Network | SERMAS health centers and public hospitals | Insurer’s private clinics and doctors |
| Prescription medicines | Not covered; full price | Usually not covered either |
| Use for a residence application | Depends on the permit; confirm with the immigration office | Accepted by consulates if it meets their conditions |
For permits such as the non-lucrative residence, consulates usually ask for a policy from an insurer authorized in Spain with no copays and no waiting periods. Our comparison of private health insurance in Madrid covers what those policies include. Whether the immigration office accepts the convenio at renewal depends on the type of permit, so confirm with the office or an abogado de extranjería (immigration lawyer) before you cancel a private policy.
Bottom line
Ask for the historical padrón certificate in the same week you plan to apply, because it expires 90 days after issue. If you are close to 65, compare the two fee bands: the jump to €157 a month applies from that birthday.
FAQ
Is there a waiting period for treatment?
The Comunidad’s page does not list a waiting period after signing. The main wait is the one-year residence requirement before you can apply.
Can my spouse join on my convenio?
No. Each person, including family members, needs a separate application and pays their own fee.
Do I get a health card with the convenio?
No. You receive a health care document instead of the standard tarjeta sanitaria individual, and you show it at the health center and hospital.
Can I see private doctors under the convenio?
No. Care is provided in the public SERMAS network: health centers and public hospitals.
