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Costs and rules depend on your status, and the official pages we reviewed do not give every figure. Ask the insurer or health authority before you rely on a number.
At a glance
- Germany
- Mandatory; employees usually statutory, costs shared
- Netherlands
- Policy within 4 months; avg €159/month, €385 excess (2026)
- Spain
- Recognition + tarjeta sanitaria; convenio especial €60/€157 per month
- Italy
- SSN enrolment through the local ASL
Your checklist
First steps
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Four countries, three models
In Germany and the Netherlands you must be insured and you buy or join a policy. In Spain public healthcare is a recognised right with a tarjeta sanitaria, and a paid convenio especial exists for people with no other cover. In Italy you enrol in the national health service (SSN) through the local ASL.
In none of the four does registering your address or getting a tax number automatically give you health cover.
Germany: mandatory, mostly statutory
Health insurance is mandatory, and under the insurance contract law in force since 1 January 2009 everyone residing in Germany must be insured with an authorised German provider. Most employees must be in statutory insurance, with employer and employee generally sharing the contributions equally.
Employees with regular income above a threshold can usually choose private insurance, but the official pages we read give no figure. Students need insurance too, and home-country cover from the EU/EEA, Switzerland, the UK or agreement countries is often recognised. Tell your insurer in good time when you leave.
Netherlands: four months to take out a policy
If you live or work in the Netherlands, compulsory standard insurance often applies. You must take out a policy within four months of coming to live or work there, or you can be fined and pay your care costs yourself.
In 2026 the Work in NL site gives an average basic premium of €159 a month and a standard excess of €385 a year. All basic policies cover the same care, you can switch insurer from 12 November to 31 December, and people on a low income can apply for healthcare benefit.
Spain: recognition first, then the card
Workers, pensioners and people who have exhausted unemployment benefit are recognised automatically. Other residents can apply, and you must have no cover through another route. In Madrid the tarjeta sanitaria is free, applied for in person at your health centre, and arrives in about three to four weeks. It needs padrón registration and, for foreigners, a valid residence permit or one in renewal.
If you are economically inactive and need cover to reside, the convenio especial costs €60 a month under 65 and €157 a month from 65. It needs one year of continuous residence, padrón registration and no other access to public cover. Card procedures in other regions were not confirmed.
Italy: enrol through the ASL
The Ministry of Health lists different routes for non-EU citizens, and EU movers should check which country is responsible for their social-security cover. The local ASL handles enrolment, the Tessera Sanitaria and choosing a general practitioner.
Whether enrolment is mandatory, voluntary or coordinated under EU rules depends on your status, and procedures differ by region. The pages we reviewed give no Italian cost figures.
Common questions
Which of the four has a stated deadline to get cover?
The Netherlands: within four months of coming to live or work there. The German pages we read say insurance is mandatory but give no deadline, and the Spanish and Italian pages give none either.
Does an EHIC cover me after I move?
No. It supports necessary care during temporary stays. Check which country is responsible for your cover and arrange local insurance or enrolment.
Which country has the clearest published cost figure?
The Netherlands: an average of €159 a month and a €385 excess in 2026, according to Work in NL. Spain publishes €60 or €157 a month for the convenio especial. Germany’s contribution rates and Italy’s costs were not on the pages we read.
Does my address registration give me cover?
No. In Spain the padrón is needed for the card, and in Italy the Comune registration and the SSN enrolment are separate. In Germany and the Netherlands you still take out or join a policy.
Official sources
Read this first
- European Consumer Centre Germany: insurance in GermanyInsurance is mandatory
- EURAXESS Germany: health insuranceStatutory scheme, contract law and EHIC limits
- Government.nl: health insurance after movingFour-month deadline and fine
- Work in NL: cost of health insurance2026 premium, excess and switching window
- Seguridad Social: healthcare benefit application (form 6-071)Automatic recognition and eligibility
- Comunidad de Madrid: tarjeta sanitariaCard process and conditions in Madrid
- Ministry of Health (Spain): convenio especialCost and conditions of the convenio especial
- Ministry of Health (Italy): healthcare for non-EU citizensRoutes and local ASL role
- Your Europe: health cover when living abroadWhich country covers you and EHIC limits
Rules can vary by nationality, work or study status, and city. Confirm your route with the official authority before you act.