in search of Health Insurance Consultant - Both National and Private

A bit of background on Spanish private healthcare ....  hope it helps

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My wife and I use DKV private health insurance (PHI). Our annual combined cost is around 2200 Eu (ages 63/61). Our maximum (capped) annual co-pay is 1200 Eu (600 each). This seems to be about the going rate. As you are coming from the USA, this might sound too good to be true - but it is not (although you will need to pay for prescription drugs).

You should bear in mind ....

It isn't just about cost. Don't just choose the cheapest policy. When you gain Residency/Visa/TIE, your PHI will, at least for a while, become your only source of healthcare. So accessibility and quality are the important factors.

My wife became seriously ill in 2019, and DKV have been absolutely fantastic; our co-pay was 600 Eu that year. She had chemotherapy, surgery and radiotherapy. She continues to receive regular scans/checkups. 

BUT we had to travel to obtain treatment and tests, mostly to the Quiron Hospital in Murcia. We have also used (I think) 8 or 9 other medical facilities in Murcia, Elche and Torrevieja. 

This seems to be quite normal. We have met numerous other people "doing the rounds" - each having different insurers.

Into the detail .... insurers may quote the various clinics and hospitals that they use, but in reality, they pick and choose exactly what services they contract for at which hospital. So if your insurer's brochure says that they use (say) Quiron or IMED hospitals/clinics, the city you have to go to depends on the medical service you need. Given my wife's illness, we aren't in any rush to give up our private healthcare. 

We use a private GP (General Practitioner - first line Doctor) in our village (not the state-run health centre) and she acts as the gateway into the DKV system - and she is very good at it. 

Our local GP works with DKV (which may be why our local insurance broker recommended DKV). So it seems that the most important thing is to have an insurer who works with your local GP.

We have a neighbour who uses a different insurer. Her nearest insurer-affiliated GP is 50 minutes away by car. 

Here is the DKV website (with an English language option). They have several "levels" of insurance. You generally need the top level of cover (zero co-pays) for Residency nowadays.

https://eng.dkv.es/particulares

As we get older, we generally need more healthcare, not less. So it might be an idea to consider medical access/private hospital locations when choosing where to live. Ideally get your insurer, GP and hospitals lined up.

There are a few insurers (not just DKV) that seem to give good service - users of this forum recommend other providers quite regularly. For balance, I have seen one or two critical comments on this forum regarding DKV.

Most insurers will charge extra for pre-existing conditions. Some pre-existing conditions will not be acceptable to PHI providers.

Once you have held Residency for a year, you can apply to join the Convenio Especiale (effectively, you pay into the Spanish State healthcare system). Others may be able to comment on this option, as I have no experience of it. At age 65+ the costs aren't too different from private health insurance. The Convenio Especiale does not discriminate against pre-existing conditions, so some people buy PHI for the purposes of gaining Residency, then switch to the Convenio Especiale a year or so later.

After 12 months residency you'll qualify for the Convenio Especial which, as the above poster mentioned, is the state healthcare system. The cost is 60 euro per month until 65 years old, at which point it rises to 157 euro per month (per person).

We used ASSA PHI for our residency application which was under 1000 euro, with no co pay, for a 63 yo.

Thank you for the information.  It sounds like we have similar health insurance needs and observations regarding the low insurance and copay costs in Spain relative to the US.  I am primarily interested in coverage limitations on pre-existing conditions as I have one that is not currently and may never become life threatening but requires continued monitoring.  I am hoping that there will be private insurance carriers that will cover this until I can get on the national insurance coverage, which I understand does not limit care for pre-existing conditions.  I am also hoping to gain some information regarding quality of care provided by the national insurance coverage and level of Spanish language fluency required to use it.   Thanks again.

To get a view of what the PHI market can offer ... these two contacts are frequently recommended on this forum.

GRAN ALACANT INSURANCES

Jennifer Cunningham Insurances in Orihuela Costa: address, telephone number and opening hours and times (costablancaforum.com)

Best Wishes

K

Thanks :)

Would just advise you to use an agent, especially if your Spanish not fluent, and query every condition and demand details of all clauses. I say this because we have some American friends who obviously have what they assumed to be top level cover, they were not trying to penny pinch. They declared all previous conditions etc etc. Unfortunately, last year, the husband suffered various events, requiring serious hospitalization and treatment, which they said was excellent. However, the insurers refused to pay, claiming that a minor event some ten years earlier, which had been declared, was contributory and continued to refuse. They had to pay several extremely large bills and thought they would have to sell their house, although it didn’t come to that. The only thing they could say was that it was very much less costly than the same treatments would have been in USA.