Healthcare in Andorra: how it works and what is actually covered

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🏥 Understanding the Andorran healthcare model: efficiency, co-payment and predictability

One of the first questions any expatriate asks when considering a move to Andorra is simple: “How does the healthcare system work, and how much will I really have to pay?”

The answer is far more favourable than most people expect.
Andorra combines a highly efficient public co-payment system, short waiting times and seamless integration with complementary private insurance — which, in practice, often means paying nothing or almost nothing for most medical services.

➤ To understand how the CASS works in detail, we recommend reading the article The CASS in Andorra: contributions, coverage and key points for 2025

🩺 The structure of healthcare: CASS and SAAS as the pillars of the system

Andorra’s healthcare system is built on two main institutions:

🔹 CASS: the social security authority

The Caixa Andorrana de Seguretat Social manages:

• public health coverage
• sick leave
• reimbursements
• contributions from employees and self-employed workers

🔹 SAAS: the public healthcare operator

The Servei Andorrà d’Atenció Sanitària manages:

• the Nostra Senyora de Meritxell Hospital
• primary care centres
• contracted specialists
• emergency services

It is a hybrid, agile system, comparable to the French model but adapted to the scale and efficiency of a small, well-organised country.

💳 How healthcare costs are actually paid in Andorra

Although the system historically operated under a “pay and claim back” model, this no longer reflects current practice.

Today, for most public and contracted medical services:

• patients pay around 25% of the cost
• the CASS pays the remaining 75% directly to the medical provider

This applies to:

• GP and family doctor consultations
• specialists
• diagnostic tests
• contracted physiotherapy
• prescribed medication
• services at Meritxell Hospital

In other words: you do not pay 100% and wait for reimbursement.
The co-payment is applied instantly.

Only private visits or non-contracted medical acts require full upfront payment, followed by partial or full reimbursement depending on the case.

🛡️ A key element: most residents hold complementary insurance

This is essential to understanding how the system actually works.

The vast majority of residents — locals and expatriates alike — take out a complementary private insurance policy covering:

• the remaining 25% co-payment
• private rooms
• dental and optical care
• second medical opinions
• access to private networks in Spain or France

The combination CASS (75%) + complementary insurance (25%) means that, in practice, most residents pay nothing for routine medical visits.

This is one of the reasons Andorra is considered among the most efficient and predictable healthcare systems in Europe.

📘 What the CASS actually covers

Public coverage includes:

• primary healthcare
• contracted specialists
• 24/7 emergency services
• hospitalisation
• maternity and childbirth
• rehabilitation within the approved network
• a large proportion of prescribed medication

Standard reimbursement rates:

• 75% of outpatient consultations
• 90% of hospitalisation
• 100% of workplace accidents
• 75% of regular medication

Following the Via Preferent — the referral pathway through the designated family doctor — ensures maximum reimbursement.

🚫 What is not covered or only partially covered

Some areas offer limited or no public coverage:

• advanced dental treatments
• glasses and contact lenses
• non-reconstructive cosmetic surgery
• alternative therapies
• procedures outside the contracted catalogue

In these areas, complementary insurance becomes particularly important.

Aside from these specific exceptions, the rest of the healthcare system is fully covered, making it one of the most comprehensive in Europe.

🏨 Meritxell Hospital and the public healthcare network

The Nostra Senyora de Meritxell Hospital, located in Escaldes-Engordany, is the country’s only general hospital and concentrates:

• emergency care
• intensive care
• surgery
• maternity services
• hospitalisation
• diagnostic imaging

The public network also includes parish-level health centres and specialists across the country, resulting in very short waiting times and rapid access to healthcare professionals.

➤ To understand how the country is structured territorially, we recommend the article The parishes of Andorra

Certain highly specialised treatments are referred to hospitals in Catalonia or France through institutional agreements.

🌍 Healthcare outside Andorra: agreements with Spain, France and Portugal

Andorra maintains bilateral social security agreements with:

• Spain
• France
• Portugal

These allow residents, in certain situations, to:

• receive healthcare in these countries
• obtain reimbursement or authorisation through the CASS
• access high-complexity treatments that Andorra cannot provide internally

⚠️ For uninsured tourists, emergency care can be extremely expensive.
It is strongly recommended to have proper coverage.
Visitors practising sports such as skiing often face significant costs if they do not take out the insurance offered by the resorts.

➤ To learn more about skiing in the country, we recommend the article Skiing in Andorra: Grandvalira Resorts, Pal Arinsal and Ordino Arcalís

👤 What this means for an expatriate

Andorra’s healthcare system is:

• reliable
• fast
• efficient
• transparent
• and supported by very short waiting times

The CASS covers the majority of costs (residents only pay 25%), and in most cases this 25% is also covered by complementary insurance — usually for less than €80 per month.

The result is virtually free access to healthcare, with a quality level well above the European average.

➤ If you are considering relocating to Andorra, we recommend reading the article Living and working in Andorra

📬 If you would like a personalised assessment

If you are planning a full or partial move to Andorra and want to understand how the healthcare system would affect your specific situation, you can book a meeting or contact us through the form.

Last updated: November 2025