Americans are one of the fastest-growing groups moving to Spain on the Non-Lucrative Visa, often to retire or semi-retire. US applicants tend to arrive with a specific set of questions — about Medicare, their existing US plan, and the deductibles and copays they are used to — because the Spanish requirement is built around exactly the opposite of a typical US policy.
US citizens applying for the NLV normally need private Spanish health insurance — comprehensive, from an insurer authorised in Spain, with no copayments, no deductible and no waiting periods where required, valid for one year, with a certificate and proof of payment. Medicare generally does not work for living in Spain, and US domestic plans are usually unsuitable. The no-deductible point is especially important for Americans, because US plans almost always include one. Requirements can vary slightly by consulate, so always check the latest instructions for where you are applying.
This page covers what Americans need, why Medicare and US plans usually fall short, the deductible problem specifically, when international cover might work, and the mistakes to avoid. If you would rather we simply arrange suitable cover, request a quote.
What Americans normally need
The requirement is the same for US applicants as for anyone: cover that behaves like proper Spanish resident healthcare. For an American used to US-style plans, the shape of it is worth reading carefully, because several defaults you may be used to are exactly what the NLV expects to be absent:
- From an insurer authorised to operate in Spain — not a US carrier
- Comprehensive — primary care, specialists, hospital, surgery, diagnostics, emergencies
- No copayments — no per-visit charge
- No deductible (sin franquicia) — no amount to meet before cover pays
- No waiting periods where required
- Valid for the visa period, usually one year
- Documented with a certificate (often in Spanish) and proof of payment
The full detail is on the requirements hub.
Why Medicare is not normally enough
This is the first question almost every American retiree asks. Medicare is designed to cover healthcare in the United States. It generally does not provide cover for routine healthcare while you are living in Spain, so it does not function as residence health insurance for the Non-Lucrative Visa. Whatever your Medicare situation at home, it is not the basis for your NLV insurance.
Many US retirees keep their Medicare for visits back to the States and arrange a separate Spanish private policy for living in Spain — the two do different jobs. For the visa, it is the Spanish policy that matters. Do not plan your application around Medicare covering you in Spain.
US health insurance vs Spanish NLV cover
Your existing US employer or marketplace plan is built for care in the US, through US networks, and it is not usually from an insurer authorised to operate in Spain. Even setting aside the deductibles and copays, that authorisation gap alone often makes a US domestic plan unsuitable for the NLV. It could only work if it clearly met every requirement — authorised in Spain, comprehensive residence cover, no copay, no deductible, no waiting periods — and could be documented accordingly, which US plans rarely can.
So for most Americans, the practical answer is a dedicated Spanish policy designed for the visa. It settles the authorised-insurer question automatically and is structured, from the ground up, to be no-copay and no-deductible — the reverse of a typical US plan. This is the same reasoning we set out on the international insurance vs NLV insurance page, applied to US cover specifically.
The deductible problem for US applicants
If there is one concept for Americans to understand, it is this. In the US, a deductible — the amount you pay out of pocket before your insurer starts paying — is a normal, expected feature of almost every plan. A "$2,000 deductible" or "$5,000 deductible" is routine.
For the Non-Lucrative Visa, that is exactly the problem. NLV cover is normally expected to have no deductible — in Spanish, sin franquicia — so the insurer covers eligible costs from the first euro. (UK applicants call this an "excess"; it is the same idea.) A US-style deductible, however modest by American standards, is one of the most common reasons an American's existing or instinctively-chosen cover is unsuitable for the NLV. It is a genuine mindset shift: for the visa, you are looking for a plan with no deductible and no copay, which can feel unfamiliar coming from the US market.
Do not choose a plan with a deductible to lower the premium, as you might at home. For the NLV, a deductible can cause a document issue. Look for sin franquicia, no-copay cover. See no deductible and no copay.
International insurance: when it might work, when it's risky
Many Americans already hold, or are offered, an international or expat health plan, and ask whether it can be reused. Sometimes it can — but it needs checking on four points, each of which is a place it can fall short: is the insurer authorised to operate in Spain; does it avoid copays, deductibles and waiting periods; can it issue a certificate in the form the consulate expects; and can you produce proof of payment? International plans very often carry a deductible or co-insurance, which brings us straight back to the problem above.
If your international policy genuinely clears all four, it may be suitable, and we are happy to check it. If any is uncertain — and with US-linked international plans the deductible usually is — a Spanish policy is the lower-risk route. Send us the policy and we will give you an honest assessment. See no waiting periods for another point international plans can miss.
US retirees and couples
Most American NLV applicants are retirees or early retirees, and many apply as a couple. Two points follow. First, age affects price and underwriting, so if you are older, read the retiree guidance and start early. Second, the requirement normally applies to each applicant, so both partners in a couple need suitable cover and their own certificate, ideally with matching start dates — see couples. It is a common mistake to arrange cover for one spouse and assume the other is covered.
Certificate and proof of payment for US applicants
For the application you will usually want a clear insurance certificate — often in Spanish — naming each applicant, showing the cover dates, and stating the key conditions (no copay, no deductible, no waiting periods where required), together with proof of payment showing the policy is paid and active. A certificate from a US carrier in its own format, in English only, is one of the things that can trip up an American application, which is another reason a Spanish policy tends to be smoother. See the certificate page, certificate language and proof of payment — and note that payment can usually be made by card or transfer from the US, with no Spanish bank account needed. Before your appointment, run the full insurance checklist and the last-minute check.
Common US mistakes
- Assuming Medicare covers you in Spain. It generally does not.
- Reusing a US domestic plan. Usually not authorised in Spain and built around deductibles/copays.
- Choosing a plan with a deductible out of habit. For the NLV you want sin franquicia.
- Accepting copays. No-copay cover is normally expected.
- Relying on an international policy without checking authorisation, deductible and certificate.
- Insuring only one spouse. Each applicant normally needs cover and a certificate.
US applicant checklist
- Don't rely on Medicare or a US domestic plan
- Look for no-deductible (sin franquicia) and no-copay cover
- Make sure the insurer is authorised in Spain
- If using an international plan, check all four points (authorisation, deductible/copay, waiting periods, certificate)
- Cover each applicant; match dates for couples
- Get a certificate (often in Spanish) and keep the proof of payment
- If older, read the retiree/age guidance and start early
Example scenarios
The Medicare assumption
A US retiree assumes Medicare covers them in Spain. It doesn't for residence, so they keep Medicare for US visits and arrange a Spanish policy for the NLV.
The deductible habit
An applicant instinctively picks a plan with a deductible to lower the cost. For the NLV they switch to sin franquicia cover, which is the reverse of the US default.
The international plan with a deductible
An applicant's global plan is comprehensive but carries a $2,000 deductible. Because that is unsuitable, they arrange a Spanish no-deductible policy.
The US couple
A couple assume one policy covers both. Because each needs cover, they arrange two policies with matching dates and a certificate each.
American applicant? Get certificate-ready NLV cover
Tell us your situation and we will arrange NLV-suitable Spanish cover — no copay, no deductible, no waiting periods where required — with the certificate you need, or check whether an existing international policy will pass.
US applicant FAQs
Do Americans need Spanish health insurance for the NLV?
Usually, yes. US citizens applying for the Non-Lucrative Visa normally need private medical cover suitable for residence in Spain: comprehensive, from an insurer authorised in Spain, with no copayments, no deductible and no waiting periods where required, valid for the visa period, with a certificate and proof of payment. US domestic plans and Medicare generally do not meet this.
Can I use Medicare for the Spain NLV?
Generally, no. Medicare is designed for healthcare in the United States and does not usually provide cover for living in Spain, so it is not normally suitable as NLV health insurance. US applicants typically arrange a Spanish private policy instead.
Can I use my US health insurance?
Usually not, unless it clearly meets all the NLV requirements and can be documented properly. US domestic plans are built for care in the US, often with deductibles and copays, and are typically not from an insurer authorised in Spain. That combination usually makes them unsuitable for the NLV.
Can I use international health insurance?
Sometimes, but it must be checked carefully. An international or expat policy has to be from an insurer authorised to operate in Spain, with no copay, no deductible and no waiting periods where required, and able to produce a suitable certificate and proof of payment. If any of those is uncertain, a Spanish policy is the lower-risk route. See international vs NLV insurance.
Why are deductibles a problem for US applicants?
US plans very often include a deductible — an amount you pay before the insurer contributes. For the Non-Lucrative Visa, cover is normally expected to have no deductible (sin franquicia), so a US-style deductible is usually not suitable. It is one of the most common reasons a US applicant's existing cover falls short. See no deductible.
Does the policy need to have no copay?
Yes, usually. No-copay (sin copago) cover is normally expected for the NLV, which can feel unfamiliar to Americans used to copays. Make sure the certificate states no copay. See no-copay cover.
Do US retirees need one year of cover?
For the first application, cover normally needs to be valid for one year, with a start date that fits your appointment and move. Paying annually up front gives the clearest proof of payment. See one-year policy.
Do American couples each need cover?
Usually, yes. The requirement normally applies to each applicant, so both partners need suitable cover and their own certificate, ideally with matching start dates. See couples.
Should the certificate be in Spanish?
Often, yes. Certificates are commonly provided in Spanish, because the consulate reviews them. A US carrier's English-only certificate can be a sticking point, which is another reason a Spanish policy tends to be smoother. See the certificate page.
When should US applicants arrange cover?
Early — request a quote while preparing other documents, and set the start date to your appointment and move. If your appointment is close, see urgent NLV health insurance.
More questions? See the full FAQ hub.