Non-Lucrative Visa Health Insurance for Americans in Spain

The Non-Lucrative Visa is designed for people who want to live in Spain without working locally, and applicants must show they can support themselves — including private health cover. For US citizens, this means holding a Spanish private health insurance policy that provides full cover within Spain, with no copayments, from an insurer authorised to operate in the country.

Because the requirement is specific, it is worth arranging the right policy from the start rather than discovering at your appointment that the cover does not qualify.

Original Medicare (Parts A & B)

Original Medicare generally does not pay for care received outside the United States, so it does not provide health cover in Spain and is not accepted for the Non-Lucrative Visa. It also does not produce the Spanish-format certificate a consulate needs.

Medicare Advantage (Part C)

Medicare Advantage plans are built around US provider networks and typically offer little or no coverage outside the United States beyond limited emergencies. They are not designed for residence in Spain and will not meet the NLV requirement or produce the required certificate.

Medigap / Medicare Supplement

Some Medigap / Medicare Supplement policies may include limited foreign-travel emergency benefits, but this is not the same as full private health insurance for residence in Spain. It is normally emergency/trip-based, limited in scope, and does not produce the Spanish-format NLV certificate. It should not be relied on for the Non-Lucrative Visa.

Medicaid

Medicaid is a state-based program for care within the United States. It does not provide cover in Spain and is not accepted for the NLV.

ACA / Obamacare marketplace plans

ACA / marketplace plans are built around US residency, US provider networks and US service areas. They are not designed to provide full private health insurance for residence in Spain and will not produce the Spanish-format certificate required for the NLV.

COBRA

COBRA continues an employer plan for a limited time, but it is still US-network coverage. It does not provide full private cover in Spain or the certificate the visa requires.

US employer / group health insurance

Employer or group plans are designed around care in the United States. They generally will not cover routine treatment in Spain or produce a Spanish certificate, so they are not suitable for the NLV on their own.

International private medical insurance

Some Americans hold international or expat private medical insurance. Occasionally this can be adapted, but it must be checked carefully against the NLV rules first — many international plans still fall short on copayments, on Spanish authorisation, or on the certificate wording.

Travel insurance

Travel and trip insurance is short-term, emergency-focused visitor cover. It is routinely rejected for the NLV, which is a residence visa that needs ongoing residency-grade cover.

The document your consulate actually reads is the insurance certificate, so the wording matters. It should confirm a full private health policy with a Spanish-authorised insurer, valid in Spain, with no copayments and no waiting period on the required cover, and it should name each insured person.

NLV policies are usually paid annually in advance, and consulates often want to see that the first year is paid — so keep your proof of payment with the certificate. If anything on the certificate is ambiguous it can cause a delay, which is why we prepare it specifically for NLV use rather than issuing a generic schedule. You can read more on our NLV insurance certificate guide.

Couples and families can apply together, but each person included in the application needs cover in their own name. A family application does not remove the insurance requirement for individual applicants, and each name should appear on the certificate documentation. See our pages on NLV cover for couples, NLV cover for families and health insurance for American families moving to Spain.

Pre-existing conditions are assessed case by case rather than being an automatic barrier. Insurers underwrite new applications based on age and medical history, so the terms, any conditions and the premium depend on that assessment, and acceptance is never guaranteed. It is best to be accurate and complete about your medical history from the start, so the certificate you receive is one you can rely on.

If you have already been declined elsewhere, or are unsure whether you can be covered, tell us the details when you request a quote and we will explain the realistic options for your situation.

247 Expat Insurance is a registered insurance distributor in Spain, regulated by the DGSFP. We provide insurance information only; NLV decisions rest with the relevant Spanish consulate or authority.