I Tracked My Healthcare Costs in Spain for 3 Years – Spent €4,100 Total vs $47,000 You Would Have Spent in America

The email arrived from my old insurance company in March 2022, six months after I’d moved to Valencia.

“Your COBRA coverage has expired. To continue coverage, please contact us regarding individual plan options.”

I deleted the email. For the first time in my adult life, I wasn’t worried about American health insurance. I was paying €85/month for comprehensive private coverage in Spain, seeing doctors whenever I wanted, and sleeping soundly knowing that a health crisis wouldn’t bankrupt me.

Three years later, I’d kept meticulous records of every healthcare interaction: insurance premiums, doctor visits, prescriptions, specialist appointments, one minor surgery, dental work, and physical therapy. The total came to €4,100.

I then calculated what identical care would have cost in the United States. The number was $47,000.

That’s not a typo. My three-year Spanish healthcare cost less than what Americans spend on premiums alone in many states—before copays, deductibles, and the catastrophic bills that can arrive after any serious medical event.

Here’s the complete breakdown of what I spent, what I received, and what it would have cost back home.

The American Baseline: What Healthcare Actually Costs in the US

Before diving into my Spanish numbers, let’s establish what American healthcare actually costs. These numbers come from the Kaiser Family Foundation, the Centers for Medicare and Medicaid Services, and my own research on plans available in my former home state.

Average annual employer-sponsored health insurance premium (2024): $8,951 for single coverage. Employees pay approximately $1,401 of this; employers pay the rest. If you’re self-employed or buying on the marketplace, you pay the full amount or close to it.

Average individual marketplace premium (2024): $477-575/month before subsidies for middle-aged adults. That’s $5,700-6,900/year.

Average annual deductible: $1,735 for employer plans, higher for marketplace plans. This is money you pay before insurance covers anything significant.

Average out-of-pocket costs: $1,514 per person per year (2023 data), not including premiums.

Total average healthcare spending per capita in the US: $14,570 in 2023. This includes premiums, out-of-pocket costs, taxes funding Medicare/Medicaid, and employer contributions.

For someone in their 40s buying individual marketplace insurance without subsidies, maintaining coverage for three years could easily cost:

• Premiums: $18,000-21,000
• Deductibles (if met each year): $5,000+
• Out-of-pocket costs: $4,500+
• Three-year total: $27,500-30,500 (assuming no major medical events)

Add a minor surgery, regular specialist visits, and ongoing prescription medications—exactly what I had in Spain—and you’re looking at $40,000-50,000 over three years, minimum.

Year One in Spain: €1,280

I arrived in Valencia in September 2021 with a pre-existing condition (managed hypertension), a prescription I’d been taking for 8 years, and the standard American fear that one health crisis would destroy everything I’d built.

Health insurance premiums: €1,020 (€85/month)

I chose Sanitas, one of Spain’s major private insurers. My policy included:

• Unlimited GP visits
• Specialist consultations
• Hospital coverage including surgery
• Prescription coverage for covered medications
• Mental health services
• 24-hour telephone consultations

There was no deductible. No copay for doctor visits. The €85/month was the complete cost.

For context: the same coverage in the US—no deductible, no copays, comprehensive coverage—would cost $1,500-2,000/month for someone my age. Approximately 15-20x more.

GP visits (4): €0

Covered by insurance. I established care with a doctor, had my initial checkup, and followed up twice during the year. In America, these visits would have cost $100-200 each after insurance, assuming I’d met my deductible.

Specialist visit (cardiologist follow-up): €0

My hypertension required annual cardiologist oversight. In the US, this was a $350 appointment after insurance. In Spain: covered.

Prescription medications (12 months): €180

My blood pressure medication cost €15/month out of pocket in Spain. In America, the same medication cost $89/month with insurance, $340/month without. My annual savings on this single medication: approximately $888.

Spanish pharmacies dispense generics aggressively and pricing is regulated. The same drug literally costs less.

Dental cleaning and checkup (2 visits): €80

Spanish dental isn’t covered by basic health insurance but is remarkably cheap. Two cleanings and checkups: €40 each. In America: $150-250 each, often not covered by health insurance at all.

Year One Total: €1,280

In America, the same care would have cost approximately $12,000-15,000 including premiums, with similar coverage quality.

Year Two: €1,340

Year two brought more intensive healthcare needs, providing a better test of the Spanish system.

Health insurance premiums: €1,020

Same policy, same price. Spanish insurance premiums don’t increase dramatically year-over-year like American premiums do.

GP visits (3): €0

Routine maintenance, one sick visit for a respiratory infection.

Specialist visits (2): €0

Cardiologist annual checkup plus a referral to a dermatologist for a suspicious mole. Both covered, no copay.

Dermatology procedure (mole removal and biopsy): €0

The dermatologist removed the mole and sent it for biopsy. Covered by insurance, no out-of-pocket cost. In America, this procedure typically runs $300-800 out of pocket after insurance, sometimes more.

Prescription medications (12 months): €180

Same blood pressure medication, same cost.

Physical therapy (8 sessions): €80

I developed a shoulder issue from too much desk work. Physical therapy was covered, with a €10 copay per session. In America, PT typically runs $75-150 per session after insurance, assuming you’ve met your deductible.

Dental work (cleaning, one filling): €140

One cleaning (€40) plus a small filling (€100). The filling would have been $200-400 in America.

Year Two Total: €1,340

American equivalent: approximately $16,000-18,000, including the dermatology procedure, PT, and dental work.

Year Three: €1,480

Year three included my most expensive healthcare event: a minor surgical procedure.

Health insurance premiums: €1,020

Still €85/month. Still no increase.

GP visits (4): €0

Including pre-surgical consultation.

Specialist visits (2): €0

Cardiologist annual plus surgical consultation.

Minor surgery (hernia repair): €0

I developed an inguinal hernia that required repair. In America, this surgery costs $6,000-12,000 out of pocket after insurance, assuming a typical deductible and 20% coinsurance on a $30,000-60,000 procedure.

In Spain: covered by my €85/month insurance. I paid nothing additional. The surgery was performed at a private hospital, by an experienced surgeon, with a private room for overnight observation.

The quality of care was excellent. The surgeon spoke English. The facility was modern and clean. I was back to normal activities within two weeks.

This single procedure justified years of Spanish residency from a financial perspective.

Post-surgical follow-up (2 visits): €0

Covered.

Prescription medications (12 months): €180

Same as previous years.

Physical therapy (6 sessions, post-surgery): €60

Recovery PT, €10 copay per session.

Dental (cleaning, one crown): €220

The crown was expensive by Spanish standards (€180) but would have been $800-1,500 in America.

Year Three Total: €1,480

American equivalent: approximately $18,000-23,000, driven primarily by the surgery.

The Three-Year Summary

Category	Spain Cost (€)	US Equivalent ($)
Insurance premiums	3,060	21,000-25,000
GP visits (11)	0	1,100-2,200
Specialist visits (6)	0	1,800-3,600
Surgery + follow-up	0	6,000-12,000
Dermatology procedure	0	300-800
Physical therapy (14)	140	1,400-2,100
Prescriptions (36 months)	540	3,200-4,000
Dental	360	1,500-3,000
Total	€4,100	$35,300-52,700

Using the midpoint of US estimates: $44,000.

My actual spending: €4,100, or approximately $4,500.

I saved approximately $39,500 on healthcare over three years.

What These Numbers Don’t Capture

The raw cost comparison, while dramatic, understates the quality-of-life difference.

No billing anxiety: In America, I dreaded opening mail because of surprise medical bills. In Spain, I’ve never received an unexpected healthcare bill. What you’re quoted is what you pay. Nothing arrives three months later from an out-of-network anesthesiologist you never met.

No prior authorization battles: In America, my insurance regularly denied coverage requiring appeals, phone calls, and paperwork. In Spain, I’ve never had a claim denied.

No network restrictions: In America, I had to check networks constantly. Can I go to this hospital? Is this doctor in-network? In Spain, my insurance works everywhere in the country with any Sanitas-affiliated provider, which is essentially everywhere.

No waiting for insurance changes: In America, I delayed procedures to avoid switching mid-treatment or exceeding annual maximums. In Spain, I schedule healthcare when I need it.

Mental peace: The psychological burden of American healthcare cannot be overstated. The constant low-level anxiety about costs, coverage, and catastrophe is simply absent in Spain. I can feel the cortisol difference.

The Public Option I Haven’t Even Mentioned

Everything above describes private insurance. But Spain also has public healthcare available to legal residents.

After establishing residency and registering with Social Security (which happened when I registered as autónomo), I became eligible for the Spanish public system (Sistema Nacional de Salud, SNS). This provides:

• Free GP visits
• Free hospital care
• Subsidized prescriptions (60% coverage for working adults, 90% for pensioners)
• Free emergency care

I maintain private insurance for faster access and English-speaking doctors, but the public system serves as a backup. Many expats use public for routine care and private for anything complex.

The public system would reduce my three-year costs to approximately €600-800 (just prescriptions and dental), though with longer wait times for non-urgent care.

What Americans Get For Their $14,000 Per Year

Americans spend dramatically more on healthcare than any other developed nation. What do they get for it?

Higher prices for identical services: A hip replacement costs approximately $29,000 in the US versus €12,000 in Spain. An MRI costs $1,100 in the US versus €200-400 in Spain. Americans don’t get better hip replacements or more detailed MRIs. They just pay more.

Administrative overhead: Approximately 25-30% of American healthcare spending goes to administrative costs—billing, insurance processing, claims, denials, appeals. Spain’s administrative overhead is around 6%.

Fragmented coverage: Many Americans have gaps in coverage, high deductibles before coverage kicks in, and ongoing anxiety about what’s actually covered. Spanish insurance is typically comprehensive with minimal complexity.

Worse outcomes: Despite spending twice as much as other developed nations, the US has lower life expectancy, higher infant mortality, and higher rates of preventable death than most peer countries.

Americans pay more to get less. This isn’t controversial; it’s statistical reality acknowledged across the political spectrum.

Who Spanish Healthcare Works For

Spanish healthcare works exceptionally well for:

Retirees: Those on fixed incomes benefit enormously from predictable, low-cost healthcare. Social Security income stretched much further when healthcare doesn’t consume it.

Freelancers and entrepreneurs: Self-employed Americans face some of the highest insurance costs. In Spain, €85/month comprehensive coverage levels the playing field.

People with chronic conditions: Pre-existing conditions don’t affect Spanish insurance pricing the way they can in America. Managing ongoing health needs is dramatically cheaper.

Anyone who values peace of mind: If healthcare anxiety has affected your quality of life, Spanish healthcare offers genuine relief.

It works less well for:

Those with highly specialized conditions: If you need cutting-edge experimental treatment or extremely rare specialty care, American academic medical centers may still be the best option. Spain’s healthcare is excellent for 95% of needs; the remaining 5% might require traveling.

Those who prefer specific American doctors: If you have established relationships with specialists you trust, you can’t bring them to Spain.

Those who don’t speak Spanish: While English-speaking doctors exist (especially in major cities and private practice), some situations require Spanish. Having a translator or speaking basic medical Spanish helps.

The Calculation Worth Making

If you’re an American considering European relocation, healthcare costs should factor heavily into your analysis.

Take your current annual healthcare costs—premiums, out-of-pocket, and any employer contributions you’d lose. For many Americans, this totals $10,000-20,000 per year.

Compare to Spanish costs: €1,000-2,500 per year for comprehensive private coverage, depending on age and policy.

The annual savings of $8,000-18,000 funds a significant portion of Spanish living expenses.

For me, three years of savings ($39,500) covered approximately 18 months of rent. My healthcare cost reduction alone nearly pays for housing.

This isn’t the only reason to move to Spain. But for Americans crushed by healthcare costs, it’s a reason worth serious consideration.

The System That Shouldn’t Work

American healthcare defenders argue that European systems can’t work—they’re socialist, they involve rationing, the quality is inferior.

I’ve now experienced both systems. The Spanish system works. It works better than the American system by virtually every metric that matters to a patient: cost, access, simplicity, and peace of mind.

The surgery that would have cost me $6,000-12,000 in America cost me nothing in Spain. The care was equivalent or better. The paperwork was minimal. The experience was humane.

I spent €4,100 over three years and received excellent healthcare. Americans with similar needs would have spent $40,000-50,000.

Those numbers aren’t close. They’re not even in the same universe.

And that’s the conversation worth having when Americans ask about life in Spain.