The Health Card (Tarjeta Sanitaria) in the Comunidad de Madrid

Covers: the Comunidad de Madrid (a regional service). Other regions have their own rules.

This guide is for internationals who have recently moved to the Comunidad de Madrid and want to understand its public health care. After reading it, you will know who qualifies, which documents are needed, how to apply for the tarjeta sanitaria (individual health card) at a health centre or online, and how the DASE works for foreigners without registered or authorised residence.

• Who has access to public health care
• What the card is and how long it lasts
• Requirements and documents
• How to apply and what happens next
• The DASE for foreigners not registered as residents
• FAQ

Who has access to public health care

In Spain, each region (comunidad autónoma) runs its own health service. In Madrid this is the Servicio Madrileño de Salud, under the regional Consejería de Sanidad (health department). Whether someone is entitled to publicly funded care is decided at national level by the Instituto Nacional de la Seguridad Social (INSS, the National Social Security Institute), information line 901166565, according to the Comunidad de Madrid health card page.

The region issues a card to residents whom the INSS recognises as an asegurado (insured person) or beneficiario (dependant). Insured people include:

• workers registered with Social Security and in active or equivalent status;
• Social Security pensioners;
• people receiving any periodic Social Security payment, including unemployment benefit and allowance;
• people whose unemployment benefit has run out and who are registered as job seekers.

If none of these applies, EU, EEA and Swiss nationals living in Spain and entered in the EU Citizens Register, and foreigners holding a residence authorisation, may also qualify as insured under INSS criteria. Dependants living in Spain include a spouse or officially registered partner, a dependent former spouse, and descendants under 26 or with a disability of 65% or more.

Some people receive care without a Madrid card: holders of the European Health Insurance Card or equivalent documents from the EU, EEA, Switzerland, Andorra or Chile; asylum seekers, through a procedure set by the Consejería; holders of another region’s card during a temporary stay; and foreigners not registered or authorised as residents, through the DASE.

What the card is and how long it lasts

The card gives access to public health services in the Comunidad de Madrid and across the national health system. As a rule it has no expiry date. For foreign holders, it is valid for as long as the Tarjeta de Identidad de Extranjero (TIE, foreigner’s identity card) for non-EU nationals, or the EU registration certificate for EU nationals. After each permit renewal, the new expiry date has to be updated at the centro de salud (local health centre). A mobile version, the Tarjeta Sanitaria Virtual, can be used in health centres and pharmacies in the region.

Requirements and documents

The regional e-government page for the procedure sets three requirements for a first card: empadronamiento (registering your address on the municipal register, the padrón) in the Comunidad de Madrid, an entitlement recognised by the INSS, and, for foreigners, a residence permit that is valid or being renewed. There is no fee.

The health card page lists these documents:

• the DNI (Spanish ID card) or, for foreigners, a valid TIE; children under 14 without either can present the Libro de Familia (family book) or a full birth certificate;
• the volante de empadronamiento (proof of address registration), issued by your ayuntamiento (city council) within the previous 90 days;
• the Documento Acreditativo de Derecho a Asistencia Sanitaria (DAD), the INSS document showing your entitlement, also available online from Social Security.

The padrón is run by each city council, not by the region. Residents of the city of Madrid can authorise the health service to check the city register instead of bringing the volante; the page offers this for that municipality only. You can also authorise a check of your INSS data instead of bringing the DAD. Registering as a dependant is done at a Social Security office. A name differing from the Civil Register requires the Anexo I form, and only parents or legal guardians can apply for a minor.

How to apply and what happens next

In person. Apply at your assigned health centre between 8.30 and 20.30. No form is needed there; staff tell you which documents apply in your case.

Online. This requires an electronic DNI or a digital certificate recognised by the Comunidad de Madrid. You can authorise checks of certain data so you do not have to submit those documents.

After applying. Once the documents are validated, the card is sent in about 3 or 4 weeks to the health centre where your family doctor or paediatrician is assigned, whichever route you used. Collection hours are Monday to Friday, 08:30 to 20:30. An address change does not produce a new card; the centre gives you a new label for the back.

The DASE for foreigners not registered as residents

The DASE procedure is for foreign nationals who live in Spain but are not registered or authorised as residents. It is free. The requirements are:

• more than 90 days since entering Spain;
• at least 3 months of empadronamiento in Spain;
• no valid stay visa;
• no obligation to prove health cover by another route, and no ability to export cover from the country of origin (relevant to EU citizens, Chile and Andorra);
• no third party liable for payment.

Unless you object, the region checks your NIE if you have one, any residence permit, your padrón records and your INSS status. The health centre provides information and the form, and if you meet the requirements, books an appointment at the Unidad de Tramitación (processing unit) for your registered address. Online applications need a recognised electronic signature.

If the documents are correct when handed in at the unit, you receive a provisional document valid for up to 3 months. If no unfavourable notice arrives within 3 months, the application is approved and the final document follows. A refusal cancels the provisional document and leads to billing for care received meanwhile. The DASE is valid for two years and can be renewed by the same procedure. A new residence permit, changes affecting entitlement or data errors must be reported within ten days to the same unit.

FAQ

Is there a fee for the tarjeta sanitaria or the DASE?

No. The Comunidad de Madrid states that neither procedure requires a fee.

Can I see a doctor before my card arrives?

Yes. The regional page says anyone needing care before receiving the card can go to their health centre, which will provide access to care.

Does a health card from another region work in Madrid?

During a temporary stay, holders of another region’s card receive the care they need. The pages do not describe moving a card permanently; the health centre decides what is needed.

What happens when a residence permit is renewed?

The card’s validity follows the TIE or EU registration certificate, so the new expiry date has to be updated at the health centre after each renewal.

Sources: comunidad.madrid · sede.comunidad.madrid · sede.comunidad.madrid

Last verified: 3 November 2026 against the pages linked above. Rules and fees change; the responsible authority always has the final word.

This is general information, not legal, tax or immigration advice. For your own situation, ask the office that handles your case (the Oficina de Extranjería, your ayuntamiento, the Seguridad Social or the Agencia Tributaria), a lawyer (abogado) or a gestor administrativo.