How to Get a Health Card in Madrid: Who Qualifies and Where to Apply
The tarjeta sanitaria links you to a family doctor in the Comunidad de Madrid. Here is who is entitled, what to sort out first and how the app works.
To get a health card in Madrid, you need to be registered on the padrón of a town in the Comunidad de Madrid and have your right to public healthcare recognized by the Social Security (INSS). You then apply at your local centro de salud (public health center), and the card arrives there in about 3 to 4 weeks, as of November 2026.
What is the tarjeta sanitaria individual?
The tarjeta sanitaria individual (TSI) is the plastic card of the Servicio Madrileño de Salud (SERMAS), the regional public health service. It links you to a family doctor (médico de familia), a nurse and a health center, and it is what pharmacies and hospitals scan to see your records and your prescriptions.
The card is issued by the Comunidad de Madrid, not by the national government. If you move from another Spanish region, you request a new Madrid card once you are registered here.
Who is entitled to public healthcare in Madrid?
The rule is two-sided: the Social Security decides whether you have the right to care, and the Comunidad de Madrid issues the card. According to the Comunidad de Madrid’s health card page, the first card requires all of the following, as of November 2026:
- Registration on the padrón of a municipality in the Comunidad de Madrid.
- A right to healthcare recognized by the INSS.
- For foreign nationals, a valid residence permit or one being renewed, or the EU registration certificate for EU citizens.
The most common situations look like this:
| Your situation | How the right to care is recognized |
|---|---|
| Employee or self-employed (autónomo) paying into Spanish Social Security | Automatically through your affiliation. The INSS record is usually already there when you visit the health center. |
| Spouse, partner or child of an insured person | As a beneficiary (beneficiario) linked to the insured person’s record. |
| Pensioner from another EU country living in Madrid | Register the S1 form, issued by the pension country, with the INSS. Spain then provides care and bills your home country. |
| Legal resident with no Spanish contributions and no S1 | Possible recognition as a resident without other coverage. The INSS decides case by case; ask at a Social Security office. |
| Foreigner without a residence permit, in Spain more than 90 days | Not a TSI. The Comunidad issues a separate document, the DASE (see below). |
People who do not qualify on any of these grounds and have lived in Madrid for at least a year can pay a monthly fee for public care. That route is explained in our guide to the convenio especial for public healthcare in Madrid.
What do you need before you go to the health center?
Sort out two things first: your padrón registration and your identity number. Without them the health center cannot process the request.
- Register your address. Your empadronamiento (registering your address with the city) decides which health center you are assigned to. Our guide to registering on the Madrid padrón covers the appointment and documents.
- Get your NIE or residence document. The administration checks your NIE electronically. If you do not have one yet, see how to get an NIE in Madrid.
- Check your INSS status. Workers are normally recorded through their employer’s or their own Social Security registration. S1 holders and residents without contributions must first get a decision from the INSS.
How do you apply for the health card?
Most people apply in person at the administrative desk (unidad administrativa) of the health center that matches their address. The Comunidad says you do not need to bring the application form if you apply there: staff tell you what documents apply to your case.
- Find the health center for your address. If you are unsure which one covers your street, ask the 012 information line.
- Go to the desk during opening hours, 8:30 a.m. to 8:30 p.m. on weekdays, as of November 2026.
- Bring your passport, NIE or TIE, and any INSS document you have (for example, the S1 registration). Children under 14 without an ID card need a birth certificate.
- Staff validate the request and assign you a family doctor and a nurse. Children get a pediatrician.
- The card is posted to the health center in about 3 to 4 weeks. Pick it up at the same desk.
The Comunidad also offers an online application on its electronic office, but in November 2026 the page says online filing is temporarily suspended for maintenance, so the in-person route is the reliable one for now. A relative or representative can apply on your behalf with written authorization and proof of the relationship or power of attorney.
Can you see a doctor before the card arrives?
Yes. The Comunidad’s guidance says that if you need care before the card is ready, your health center will give you access to treatment. Once the request is validated you already appear in the system, and the health center can book you with your assigned doctor.
Emergency care in a public hospital is available to everyone, card or no card. Our guide to emergencies in Madrid explains when to call 112 and where the main emergency departments are.
What about foreigners without a residence permit?
Foreign nationals who live in Madrid without a residence permit can request the DASE (Documento de Asistencia Sanitaria para Ciudadanos Extranjeros sin residencia legal en España). It is a health document rather than a TSI, valid for two years and renewable, as of November 2026.
According to the Comunidad de Madrid, applicants must have been in Spain for more than 90 days and registered on a padrón for at least three months, with current registration in the Comunidad de Madrid. You can apply online with an electronic signature or in person. After the request is checked, you get an appointment at one of the regional processing units (Unidades de Tramitación) to present the documents. If you have trouble getting the padrón, the Comunidad accepts a report explaining the delay and your date of entry.
How does the Tarjeta Sanitaria Virtual app work?
The Tarjeta Sanitaria app is the Comunidad de Madrid’s digital version of the card. It shows your card on screen and lets you book appointments with your family doctor, nurse or hospital, see your medication and download reports and test results. It also holds the profiles of children or dependants you add to your account.
The app is for SERMAS patients aged 16 and over. To activate it you need a digital certificate, an electronic DNI, Cl@ve Permanente or the Comunidad’s own identification system, or you can activate it at the health center with a QR code. Newcomers without a certificate usually find the QR activation at the desk the quickest.
Bottom line
Ask for your padrón certificate and your INSS paperwork before you queue at the health center, because missing either one means a second visit. Once your card is processed, activate the app at the same desk: you can book appointments from it the same day.
FAQ
Does the Madrid health card cost anything?
No. The first card is free. You may pay a share of prescription costs at the pharmacy, depending on income, but not for the card itself.
Can I use my European Health Insurance Card instead?
The EHIC covers necessary care during a temporary stay. Once you live in Madrid, you need to register your residence and get a local card through the INSS route that fits your case.
What if I move to another town in the Comunidad de Madrid?
Update your padrón in the new town, then ask at your new health center or change center online. Your card stays valid, but your assigned doctor and center change.
Who do I call with questions about my card?
The Comunidad’s 012 information line handles health card questions, and your health center’s desk can check the status of your request.
