Quick comparison
| Criterion | Sanitas | Adeslas | DKV | AXA | Mapfre |
|---|---|---|---|---|---|
| Consulate / non-lucrative visa | Yes — explicit "sin copago"/visa-friendly policies | Often accepted; check policy wording | Generally accepted; some visa-specific products | Yes — has expat/visitor options | Usually accepted; varies by office |
| Price for a healthy 65–70 | Mid–high | Mid | Mid–high | Mid | Mid |
| English customer service | Good (strong expat presence) | Variable (local offices vary) | Good in big cities | Good (international insurer) | Variable |
| Network of private hospitals/clinics | Excellent (large private networks) | Very good | Good (strong in Catalonia/Valencia) | Good (global insurer tie-ins) | Wide network |
| Dental/optical included | Optional add-on | Optional add-on | Optional/limited | Optional add-on | Optional add-on |
| Excess (voluntary) to cut premium | Yes | Yes | Yes | Yes | Yes |
| Pre-existing condition acceptance | Often excluded or with loading | Often excluded or with loading | Often excluded or with loading | Depends; may accept with loading | Depends; may accept with loading |
Start from a situation you know
Picture this: you sold your house back home, your moving date is in three months, and the Spanish consulate emailed back asking for a private health-policy certificate for your non-lucrative visa. The consulate wants a policy that covers you in Spain with no copayments and guarantees repatriation. You’re 68, reasonably healthy, but you take one blood-pressure tablet and worry about pre-existing condition exclusions.
That is the moment many people panic and pick the cheapest online quote. Don’t. The price is important, but the one thing that ruins a move isn't a €40 monthly saving — it's the insurer refusing a claim, the consulate rejecting the paperwork, or discovering a 6‑month waiting period for hip surgery after you’ve needed it.
How we should be comparing these companies
There are four dimensions that decide which insurer is best for you:
1) Visa paperwork and “sin copago” wording
For anyone on a non-lucrative visa, the consulate doesn’t want your promise, they want a policy. The exact demand varies by consulate and by the clerk. Some consulates insist the policy has no copayments (“sin copago”) and covers repatriation explicitly. Others will accept a policy that has copayments but keeps them small; don’t bank on it. See the detail on what consulates typically require at the official foreign ministry site (exteriores.gob.es) and our breakdown at /en/visas-legal/non-lucrative-visa-health-insurance-requirements.
Sanitas and AXA are the easiest here: they publish visa-friendly products and will give the certificate most consulates expect. Adeslas, DKV and Mapfre will also supply suitable policies, but wording can differ between local branches and online products. Ask for a written confirmation that the policy is valid for the non-lucrative visa before you pay.
2) Price, excess and what actually drives premiums
How much will you pay? As of 2026, expect wide ranges because age and health matter more than the brand.
- Typical monthly range for a single retiree: roughly €70–€250 a month. Younger retirees (55–65) sit nearer the bottom; 70+ pushes you toward the top.
- Voluntary excess: adding a €150–€300 yearly excess can cut premiums by 10–30%. That helps if you don’t expect to use private care except for GP visits.
- Pre-existing conditions: insurers usually either exclude them for a period, load the premium (20–100% more), or deny coverage for those conditions. There’s no standard. Be honest on medical questionnaires — nondisclosure voids the policy.
What moves the price most: age, declared health, whether you want hospital-only cover or a full GP + specialist + tests package, and whether you include dental/repatriation. If cost is the single constraint, pick Adeslas or Mapfre with an excess; if you want smoother service and quicker private referrals, pay more and pick Sanitas or DKV.
3) Network, location and English service
Where you settle in Spain matters. If you’ll live on the Costa del Sol or in Mallorca, you want an insurer tied to the private clinics that actually have English-speaking staff. Sanitas has a strong presence in expat areas and an easy-to-use app for bookings. DKV is strong in Catalonia and Valencia. Adeslas has broad national reach and competitive prices. Mapfre is everywhere but some local offices are hit-and-miss on English.
If you live outside a big city or in a smaller town in Andalucía or Murcia, check the insurers’ local lists of hospitals and GPs — the network on paper may not match reality. Start by searching private clinics near your planned address and then ask insurers whether those clinics are in-network.
If you’re considering the Costa del Sol, our guide to retiring there explains which towns have more English-speaking medical services: /en/destinations/andalusia/costa-del-sol.
4) What the policy actually covers — waiting periods, dental and repatriation
A shiny PDF can hide waiting periods and exclusions. Typical traps:
- Waiting periods for many elective procedures: 3–12 months for orthopaedic or dental treatments.
- Dental and optical are often optional extras and expensive as add-ons.
- Repatriation is rarely standard — check the sum insured and whether it covers the cost of returning you to your home country.
- Chronic medication and follow-up for long-term conditions can be limited or excluded for pre-existing problems.
Trap to watch: A policy marked "no copay" for consulate paperwork can still exclude repatriation or have six-month waiting periods for key treatments. Ask for the exact certificate wording — not a brochure sentence — and get an English translation if necessary. If you are applying for a non-lucrative visa, confirm in writing the insurer accepts issuing the consulate-required certificate before you pay.
What this actually costs (concrete examples)
Numbers vary by age, region and declared health. The examples below are indicative ranges you’ll see in 2026 when you get quotes in Spain. Don’t treat them as a quote — use them to set expectations.
- Healthy 60-year-old, full GP + specialist + hospital cover, no excess: €85–€140/month.
- Healthy 70-year-old, same cover, no excess: €120–€230/month.
- 70-year-old adding dental and repatriation: add €15–€40/month for modest dental cover; repatriation can be €5–€15/month depending on sum insured.
- Choose a voluntary annual excess (€150–€300): expect a 10–30% premium cut.
Two real drivers to watch: (1) Declare every medication and diagnosis — omission can void the policy later. (2) If you want the policy for visa paperwork, buy the correct product up front — switching insurers after you arrive is possible, but consulates often want an initial certificate from a Spanish-accepted insurer.