Many Britons are taking early retirement and moving to Spain. But for those expatriates aged around 50 plus, Spain can turn into a disaster if illness strikes and you are unprepared.

There have been unsettling reports from British expatriates in Spain, mainly from early retirees, who have been hit with illness and have been shocked to learn that they are not financially covered for health care in Spain. To make matters worse, they also discover that they are no longer entitled to free health care in the UK. It is too late for health insurance as certain pre-existing conditions usually render the person uninsurable. They are stuck in a health hell-hole.

Those British expatriates who have suffered this misery could have saved themselves from a massive medical bill, financial hardship and a shattered dream if they had done their homework before moving to Spain.

UK state pensioners can get free health care in Spain once they have registered their E121 with the health authority. This normally requires them to have already registered on the Central Register of Foreigners. UK state pensioners in receipt of UK state retirement pension, or those in receipt of long-term incapacity benefit, severe disablement allowance, bereavement benefits or widow’s benefits, should find that they and their dependants are permanently entitled to basic cover free under the Spanish health care system. For those waiting for their E121 to be registered, they should take out private health insurance to cover this interim period.

The Spanish state health scheme covers around 75% of the cost of treatment and the other 25% must be paid by the patient or through a supplementary ‘top-up’ insurance scheme.

If an E121 has been applied for but health care is needed before the E121 is received, it may be possible to get a refund, provided the local Spanish sickness office is informed before you receive treatment that you wish to be treated under EEA rules and that the Form E121 has been requested. A claim for a refund must then be made from the Instituto Nacional de Seguridad Social (INSS) when you have received your E121.

It is also possible to obtain temporary cover for health care in Spain under the Form E106 system, so long as your recent UK NationaI Insurance (NI) record is up to date. The period for which free cover can be obtained depends on the period for which you left the UK, but is for a maximum of two and a half years and is effectively related to your entitlement to short term benefits such as short-term incapacity benefit.

In order to be able to obtain an E106, you must have made full Class 1 or Class 2 NI payments for each year in respect of the two complete tax years prior to the year of application. NI credits count towards complete payment years.

An E106 should be applied for at least two months before leaving the UK as the processing time is between six and eight weeks. You must have a date of departure, as this will be the date from which the form provides valid cover. For readers who have not yet moved to Spain permanently there is still time to do this if applicable, but for those who are already living here it may be too late.

Even though some expatriates obtain an E106, some of them fall ill and find that their E106 has run out which leaves them financially uncovered for Spanish state health care.

Both the E121 and the E106 can be obtained from the Department for Work & Pensions, Pensions & Overseas Benefits Directorate, Newcastle Upon Tyne, NE98 1BA, UK. (www.dwp.gov.uk). For E106 telephone: 0191 218 1999. For E121 call 0191 218 6503. Or H M Revenue & Customs Residency Helpline, at HMRC Residency (Newcastle), Longbenton, Newcastle Upon Tyne NE98 1ZZ, UK. (www.hmrc.gov.uk/cnr). Telephone: 0845 9154811 (or from abroad +44 191 203 7010).

Some people who move to Spain keep a UK address, possibly that of a son or daughter or some other relative. They do not register in Spain and do not tell the UK authorities that they have left the country to live in Spain. In this way they return to the UK for their health treatment on the NHS. This is illegal. Officially, if you have lived in Spain for more than three months you are no longer entitled to treatment on the NHS.

Expatriates who have been unaware of this law have returned to the UK to seek medical or surgical treatment and been told to their horror that to receive this on the NHS they will have to repatriate. Repatriation to the UK involves living there for six months, registering and providing evidence such as utility bills.

Others who have moved to Spain rely on the E111, now called the EHIC, which is a temporary health cover meant for EU nationals who are tourists in another EU country. It is not for long-term health care. Spanish authorities have realised that some people are claiming free health care on an EHIC to which they are not entitled and are cracking down on this type of activity.

What many Britons who move to Spain do not realise either is that the health care can be basic and not what they are used to in the UK. Spanish health treatment is good but the medical services are limited. If you are hospitalised, for instance, your family is expected to assist with the nursing care and with your personal needs. There is also virtually no after care in Spain or social services. If you have a stroke, for instance, you are expected to return home and fend for yourself. Any rehabilitation treatment such as physiotherapy will have to be sought for and bought privately. Without health cover, if your illness required medication or regular monitoring, such as scans, these too will have to be paid for privately.

The future, however, may look brighter. Some communities are recognising the amount of Euros that British expatriates put into the economy and are attempting to ease the health care cost problem. Alicante, for example, and other provinces in the Costa Blanca now have free health care for early retirees. Murcia is also working towards a similar arrangement.

If you have retired early to Spain and have no health cover it is vital that you rectify the situation immediately. A serious health problem is bad enough but when you could find yourself with a €7,000 to €22,000 bill for medical expenses or possibly much more, you could not only lose your health but your home as well.

Article by Blevins Franks