Do American citizens need a visa to live in Spain?
Yes. As a US citizen, you can visit Spain visa-free for up to 90 days in any 180-day period under the Schengen zone rules. But to live in Spain — to establish residency and stay beyond that 90-day window — you need a Spanish residency visa. The Non-Lucrative Visa (NLV) is by far the most popular route for Americans who want to retire to Spain, live there on passive income, or work remotely for US employers or clients.
The NLV requires you to demonstrate sufficient passive income and to hold compliant private Spanish health insurance. The visa is applied for in person at the Spanish consulate serving the state where you currently live in the United States — you cannot apply at a consulate in Spain.
Spanish consulates in the United States — particularly New York, Miami, Los Angeles, Chicago, and Houston — apply the most detailed scrutiny to NLV insurance documents of any consulates globally. They frequently require repatriation (repatriación) to be explicitly stated on the certificate, expect the certificate to be in Spanish, and sometimes request the minimum coverage amount (€30,000) to appear on the document. Some applicants whose certificates have been accepted at other consulates have been rejected at US consulates for the same policy. Use an insurer with a proven US consulate track record and do not submit your application with a generic policy schedule.
What health insurance do Americans need for the Spanish NLV?
Every NLV applicant — regardless of nationality — must meet the same six core insurance requirements. For American applicants, the certificate wording and document presentation are especially important given US consulate scrutiny.
Zero copayments, zero deductible, zero co-insurance. The policy must cover 100% of costs. Any cost-sharing is grounds for rejection.
At least one year from the policy start date. Short-term, travel, or temporary policies are rejected without exception.
Must cover all of Spain — mainland, Canary Islands, Balearic Islands, Ceuta, and Melilla. Mainland-only or regional policies are rejected.
Must be from a Spanish-registered insurer. US insurers — including Medicare, Medicaid, Blue Cross, Aetna — are not accepted. Period.
US consulates frequently require repatriation (repatriación) to be explicitly stated on the certificate. All recommended plans include it — verify it appears on the visa letter before submitting.
US consulates require a certificate in Spanish. All recommended insurers issue visa certificates in Spanish — always request the carta para visado, not the standard policy schedule.
Does US health insurance work for the Spanish NLV?
No — American health insurance coverage of any kind is not accepted for Spanish NLV purposes. This applies without exception to all of the following:
US government health programs. They only cover healthcare within the United States and have zero relevance to Spanish visa applications. Absolutely not accepted.
US private health insurers are not registered with Spain's DGS (Directorate General of Insurance) and cannot issue the required Spanish-language visa certificate. Their policies do not meet NLV compliance requirements.
International expat health insurance plans are generally not accepted because they are not Spanish-registered and cannot issue certificates compliant with Spanish consulate requirements. Even if they technically cover Spain, they do not satisfy the formal requirements.
Travel insurance is for temporary trips and does not constitute residential health insurance. Spanish consulates will reject any travel policy presented as NLV health insurance.
Which insurers are accepted at US Spanish consulates?
Given the heightened scrutiny at US consulates, insurer choice matters more for American NLV applicants than for almost any other nationality. The following two insurers have the strongest and most consistent track records at US Spanish consulates:
Sanitas is the most consistently accepted insurer at all US Spanish consulates — New York, Miami, LA, Chicago, and Houston. Its visa certificate is issued instantly by email at policy activation, is in Spanish, explicitly states repatriation, and includes the coverage amount. The Residents and Residents Platinum plans are the top choice for American NLV applicants. Many US-based immigration lawyers specifically recommend Sanitas for their American clients.
ASSSA is an expat-specialist insurer built specifically for people moving to Spain from English-speaking countries. It has an excellent track record at US Spanish consulates and is one of the few insurers that accepts new applicants above age 70 — making it the top choice for older American retirees. English-speaking customer service team.
Caser Adapta Salud is also a solid option for American applicants under 70, and offers dental cover included as standard. However, for applicants applying at particularly strict consulates (Miami, NY), Sanitas or ASSSA are the safer choice.
Best health insurance plans for American NLV applicants
All prices shown are indicative monthly premiums for a solo applicant aged 45. Exact quotes depend on age and selected coverage tier. All zero-copayment policies only.
Which Spanish consulate do I apply to?
Americans must apply in person at the Spanish consulate that serves the state in which they currently live. You cannot apply in Spain or at a consulate in another country. The main Spanish consulates in the United States and their general jurisdictions are:
Spanish consulate appointment slots in New York, Miami, and Los Angeles book out quickly. In 2026, wait times of 2–4 months for an appointment are common. Combined with document preparation time, Americans should begin the NLV process at least 4–6 months before their intended move to Spain. Do not leave insurance and document preparation until you have an appointment date.
How to apply for the Spanish NLV as an American citizen
Choose Sanitas or ASSSA for the most reliable US consulate acceptance. Activate the policy and immediately request the carta para visado — verify the certificate explicitly states: no copayments, full territory, repatriation, and coverage amount. Sanitas issues this instantly by email.
Gather: valid US passport (12+ months remaining), National Visa application form and Form EX-01, passport photos, bank certificate showing ~$31,000+ equivalent in passive income/funds, FBI criminal background check (apostilled), physician's medical certificate, and proof of accommodation in Spain.
Book at the Spanish consulate serving your state as soon as possible. US consulate appointments book out 2–4 months in advance at many locations. Monitor the consulate website for released slots.
Bring all originals and photocopies. The consulate reviews documents on the day and takes your passport. The consulate has one month to issue a decision — if no decision comes, the application is deemed rejected under "administrative silence."
Once approved, collect your passport with the NLV visa sticker. Valid for one year. Within 30 days of arriving in Spain, register at the ayuntamiento and apply for your TIE at the local police station (extranjería office).
Frequently asked questions — Americans & the Spanish NLV
You must apply at the Spanish consulate that covers your state of residence. Main US consulates: New York (NY, NJ, CT, PA), Miami (FL, GA, SC, NC, TN and others), Los Angeles (CA, AZ, NM, HI, NV, UT), Chicago (IL, OH, MI, IN, WI, MN and others), Houston (TX, OK, CO, WY, MT, ID), plus Washington DC, San Francisco, and Boston. Always verify the current jurisdiction on the consulate website before booking.
No. US private health insurers do not satisfy Spanish NLV requirements. They are not registered with Spain's insurance directorate (DGS), cannot issue a Spanish-language visa certificate, and their policies do not comply with the specific wording and terms required by Spanish consulates. You must use a Spanish-registered insurer — Sanitas, ASSSA, or Caser are the recommended options for American applicants.
Absolutely not. Medicare and Medicaid are US government health programs that only operate within the United States. They have no standing whatsoever for Spanish visa applications. Every American applying for the NLV must purchase a Spanish private health insurance policy from a Spanish-registered insurer.
The benchmark is 400% of Spain's IPREM index — approximately €28,800/year, which is roughly $31,000–$32,000 USD at current exchange rates. Acceptable sources include passive income, dividends, pension/retirement income, and savings. Social Security income counts. You cannot supplement with active employment income from US clients or employers while on the NLV (you'd need a Digital Nomad Visa for that). Each additional family member requires an extra ~€7,200/year.
US Spanish consulates — particularly New York, Miami, LA, and Houston — apply the most detailed document review of any consulates processing NLV applications. They regularly require repatriation to be explicitly named on the certificate, request the coverage amount (minimum €30,000) to be stated, and expect a in Spanish document. Applicants whose certificates were accepted at European consulates have been rejected at US consulates for the same policy. Always use an insurer with a proven US consulate track record.
Allow 4–6 months minimum. Consulate appointment wait times at major US cities are 2–4 months. Add time for document preparation (FBI background check can take 2–4 weeks, medical certificate, bank certificate), insurance activation, and certificate receipt. Do not leave document preparation until you have secured a consulate appointment — prepare everything in parallel.
Yes. Every person named in the NLV application needs their own individual health insurance certificate. Some insurers offer family pricing covering everyone under one contract, but each person still receives a separate certificate document for the consulate. Sanitas and Adeslas both offer multi-person pricing — confirm with the insurer that individual certificates will be issued for each applicant.
Yes. When you renew your TIE (typically after 1 year, then every 2 years), you must show that your health insurance remains active. Simply renewing your existing policy and providing the updated certificate is sufficient. Plan ahead — some insurers take 2–5 working days to issue renewal documentation, so do not leave it until the last minute before your appointment.