In addition to an exceptionally high quality of life and safe neighborhoods with breathtaking mountain vistas, moving to Andorra also has its challenges. One of these challenges is learning about the healthcare options that are available in the Pyrenees. The healthcare provided by Andorra is regularly rated as one of the most excellent in the world; however, for those who have just moved there, it may be surprising how they obtain this care.
When choosing which health insurance plan will work best for you in Andorra, two major factors come into play: status (legal residence) and need (your family). Whether you’re moving to Andorra alone or with your entire family, the type of medical insurance you’ll require will depend upon whether you are an individual or if you’ve got a family. Here we outline how the system operates, and provide some suggestions for finding the correct medical coverage.
1. The Core Architecture of Andorran Healthcare
Carefully reviewed before providing comparisons of policies; you must understand how Andorra fundamentally funds and delivers medical care. All of the health care systems in Andorra uses a co-pay funding model. Therefore it is not a free-at-the point of use system like the u.k.’s national health service (NHS). Patients are required to make payment for their own healthcare services before receiving reimbursement from the government for all or part of that amount.
+———————————–+
| Patient Pays Up Front |
+—————–+—————–+
|
(Submits Receipt)
|
v
+—————–+—————–+
| CASS Reimburses standard rate |
| (e.g., 75% Outpatient / 90% Hosp)|
+—————–+—————–+
|
v
+—————–+—————–+
| Private Top-Up Policy (Complement) |
| Pays Remaining Copay (10% to 25%) |
+———————————–+
The Standard Copay Tiers
When you use a healthcare provider associated with CASS, you do not get full coverage automatically. CASS pays a set percentage of the official tariff:
- Outpatient Care: 75% reimbursement for doctor visits, specialist consultations, and diagnostic tests.
- Hospitalization: 90% reimbursement for surgical procedures and overnight hospital stays.
- Childbirth and Work Accidents: 100% coverage.
- Prescriptions: 40% to 70% reimbursement depending on the classification of the drug.
For expats, this means a standard doctor visit leaves you with a 25% out-of-pocket expense. A major hospital stay leaves you with a 10% bill. To close this gap, most residents buy a private top-up policy. This is locally called a complement.
The Preferential Pathway (Via Preferent)
In order to receive the standard 75% outpatient reimbursement, you have to follow the rules. Andorra has a referral system named “via preferent.”
You need to select a registered general practitioner as your referring physician (mere referent) when selecting a medical provider. If you go to a specialist without getting a referral from your primary care physician (GP), your CASS reimbursement rate drops. Your reimbursement will be 33% instead of 75%
If you use private physicians that aren’t affiliated with CASS in any way, you can expect reimbursement of only 20% to 33%. Always ask if a clinic is convention-affiliated prior to scheduling an appointment.
The EHIC is Not Valid Here
Many European citizens assume their European Health Insurance Card (EHIC) works in Andorra. It does not. Andorra is not a member of the European Union or the European Economic Area. If you show up at the hospital with only an EHIC, you will be billed as a private patient.
2. What to Verify First: Compliance & Eligibility
Your initial step is to determine your legal status in Andorra. Different residency permits carry completely different health insurance obligations.
RESIDENCY PERMIT TYPE HEALTH INSURANCE REQUIREMENT
┌─────────────────────────────────┐ ┌─────────────────────────────────────┐
│ Active Resident │ —-> │ Mandatorily enrolled in CASS via │
│ (Employed / Active Self-Employed)│ │ payroll or monthly self-employed fee│
└─────────────────────────────────┘ └─────────────────────────────────────┘
┌─────────────────────────────────┐ ┌─────────────────────────────────────┐
│ Passive Resident / Investor │ —-> │ Excluded from CASS. Must buy private│
│ (Category A, B, or C) │ │ insurance with full local coverage. │
└─────────────────────────────────┘ └─────────────────────────────────────┘
┌─────────────────────────────────┐ ┌─────────────────────────────────────┐
│ International Student │ —-> │ Must show proof of valid compliance │
│ (University or Language) │ │ insurance for entire stay duration. │
└─────────────────────────────────┘ └─────────────────────────────────────┘
Active Residents vs. Passive Residents
Active residents are either employed by an Andorran company or registered as active self-employed individuals (autònom). Under this status, you are mandatorily enrolled in CASS.
- Employees contribute 6.5% of their gross salary to CASS, while their employer contributes 15.5%, bringing the total monthly contribution to 22%.
- Self-employed workers pay a flat monthly rate. As of recent updates, the minimum standard contribution sits at approximately €563 per month, representing 22% of the average national wage.
Passive residents do not work locally. Because they do not pay into the social security system, they are legally excluded from CASS. If you hold a passive residency permit, you must secure a private health insurance policy. This policy must cover 100% of medical expenses in Andorra without relying on state infrastructure.
Bilateral Social Security Agreements
Andorra has entered into bilateral agreements on social insurance (social security) with three countries: Spain, France, and Portugal.
These agreements provide significant benefits. If you are a national of one of these countries, or if you have paid into social security programs in those countries, you may be able to transfer your health insurance rights. Such an arrangement would allow you to avoid waiting periods for service as well as receive reciprocal emergency health services from the other country.
For example, the French agreement provides for workers to receive health care in both countries; the Spanish agreement is designed to coordinate health insurance and pension plans and to make it easier for individuals to move back and forth between them.
3. Deep-Dive: Comparing Key Areas of Coverage
When shopping for an insurance policy, cheap options can look appealing. However, look closely at the fine print. Saving a few euros monthly can cost you thousands if you need specialized care.
Inpatient and Outpatient Caps
Ensure that you have a clear understanding regarding both in-patient (in-hospital treatment) and out-patient (day clinic/diagnostic services with physician) limitations on your coverage. Additionally, many major medical emergencies may necessitate referral to larger centers; Andorra’s state-of-the-art National Hospital, Hospital Nostra Senyora de Meritxell, is no exception. For example, high-risk surgical procedures including but not limited to those requiring cardio-surgical expertise and/or complex cancer therapies, are usually performed at the large hospitals in Barcelona and Toulouse. Therefore, your insurance should provide international medical transport (cross border evacuation). Any locally-based coverage will be useless if you need urgent medical attention in Spain.
Prescription Medications
CASS organizes medications into various categories of insurance reimbursement. Reimbursement for chronic and life-saving drugs is typically 70% to 100%. The reimbursement rate for common and non-essential prescription drugs is limited to 40%.
Most supplemental private coverage does not pay for leftover copays from your pharmacy unless you purchase an upper-tier policy. Verify with your insurer how they treat the remaining cost of any prescribed drug if you or another in your household rely upon a routine maintenance regimen.
Maternity and Newborn Care
Under CASS, pregnancy and childbirth are fully insured at 100%. But private health insurance has long waiting periods before they will insure maternity. When arriving in Andorra while pregnant, no private insurance company can provide coverage for delivery expenses.
If you want to add children to your family, consider the carencia (waiting) time. It normally ranges from six to ten months. The insurance company will not pay for maternity services during that period of time.
Dental and Vision Coverage
Although CASS does provide some generous dental care in comparison to many countries within Europe; it only covers the cost of approximately 75% of basic services such as cleaning every six months, with no additional coverage for most advanced treatment options (e.g. crowns, fillings, root canal work, etc.) or vision related services. Therefore, families will want to review their available private insurance plans and add on dental riders to assist in paying for large expenses.
4. Single International Student Needs
As a single international student, your primary focus is keeping costs low while staying fully compliant with immigration authorities.
STUDENT HEALTH COVERAGE CHECKLIST
┌─────────────────────────────────────────────────────────────────────────┐
│ Policy is accepted by Andorran immigration and the university. │
│ Plan covers repatriation and medical evacuation back to home country.│
│ Outpatient care covers local primary care clinics in Andorra. │
│ Plan validity spans the entire academic year without gaps. │
│ Cross-border coverage is active for weekend travel in Spain/France. │
└─────────────────────────────────────────────────────────────────────────┘
Navigating University and Immigration Compliance
To be able to get your student visa, you have to provide immigration authorities with evidence of a health insurance policy that will protect you during the whole length of your stay in Andorra.
The policy should include emergency medical services, hospital stays and repatriation.
if your country has a reciprocal healthcare arrangement with Andorra (France, Spain, or Portugal) then go to your local social security department and ask them to give you the correct application form. This application form will prove that you are entitled to receive reciprocal care. it may also help you avoid purchasing an expensive private policy.
if there is no reciprocal healthcare agreement between your country and Andorra then you will need to buy a private international student policy. make sure the issuer provides a conformity certificate.
Travel Portability
Students travel often during academic breaks. If you choose a strictly local Andorran private plan, you are only covered inside the principality.
An international student policy is far more practical. It provides emergency coverage across the Schengen Area, allowing you to travel safely through Spain, France, and beyond.
5. Family Health Insurance Needs
For families, cheap student policies are not an option. Your priority shifts to comprehensive preventive care, pediatric access, and administrative ease.
Managing the Co-payment Bureaucracy
If you are a family of four with an active child, the standard CASS reimbursement system will likely turn into a part time job. Once you see your physician, you pay them, obtain a receipt (volant) and then upload this document to the CASS Portal in order to receive the reimbursement.
In order to keep from living on borrowed money every month because of the constant reimbursement cycle, find insurance companies that provide a direct billing program, or third party payer. In Colombia we refer to this as tercer pagador. When using a third party payer, the medical facility bills both your private supplemental insurer and CASS directly. The only expense you would incur is the amount not covered by either insurance plan when you check out of your visit.
Pediatric and Preventive Care
Children need to go for many doctor’s appointments, get lots of shots and be checked for how they are developing. Pediatricians are covered under CASS for children, however other forms of supplemental insurance that families can purchase from their local insurer will have a lot more variety in what they cover (i.e. private “top-up” policies).
6. Local vs. Private International Plans: A Direct Comparison
To make the best choice, you must weigh the pros and cons of local Andorran policies against global expat plans.
| Option | Best For | Main Advantage | Main Caution |
| Local/Private Andorran Plan | Residents who stay mostly in Andorra and have CASS. | Cheaper; perfectly aligned with CASS billing and local clinics. | Limited coverage if you travel outside of France and Spain. |
| CASS-Linked Top-Up Plan | Employed residents who want 100% medical coverage. | Fills the 10% to 25% co-pay gaps; very affordable (€40–€80/month). | Does not work if you do not qualify for or lose your CASS status. |
| International Expat Plan | Passive residents, digital nomads, and frequent travelers. | Global coverage, high limits, and cross-border flexibility. | Significantly more expensive than local supplementary plans. |
Why Choose Local?
If you work in Andorra, your participation in CASS is obligatory. In this case, there is no doubt that purchasing a local CASS linked top-up plan would be the most natural course of action. The insurance companies, such as Assegur and DKV, create policies for the remaining 10% or 25% of the copay. They are generally affordable and will cost from €40 to €80 per month for each person.
Why Choose International?
If you are a passive citizen, then you do not have the right to use CASS. In addition, a local supplementary policy will be of little benefit as there is no base level of public health insurance that can be supplemented by this additional coverage.
In order to purchase supplemental, comprehensive, private insurance you need to obtain it directly from one of several providers (Allianz, Cigna, Bupa) who provide multi-million euro limits for medical treatment, pay bills directly to elite hospitals in Barcelona and also cover emergency evacuations world-wide.
7. Actionable Checklist to Secure Your Policy
Use this step-by-step checklist to finalize your health coverage in Andorra:
- Identify your residency path: Are you an active employee, self-employed, a passive resident, or a student?
- Verify bilateral status: If you are from Spain, France, or Portugal, check if your social security transfers directly.
- Find a referring doctor: As soon as you get your CASS card, select your metge referent to avoid the 33% non-referral penalty.
- Confirm the cross-border clause: Verify that your policy covers hospital care in Spain and France.
- Look for direct billing: Choose an insurer that offers tercer pagador to minimize out-of-pocket stress.
- Match coverage to travel habits: If you leave Andorra often, bypass local-only plans and choose a policy with Schengen-wide coverage.
By matching your policy to your official residency status, you will avoid visa delays and protect your personal finances. Taking these steps early ensures you can enjoy your time in the Pyrenees with total peace of mind.
References:
- American Psychological Association. (2023, June 10). Reference examples. APA Style. https://apastyle.apa.org/style-grammar-guidelines/references/examples
- ExpatExchange. (n.d.). Understanding the health system in Andorra. https://www.expatexchange.com/ctryguide/6267/364/Andorra/Understanding-the-Health-System-in-Andorra
- Indigo Expat. (2025, January 15). International health insurance Andorra for expatriate.https://indigo-expat.com/en/informations/country-guide/international-health-insurance-expatriates-andorra/
- MCA Andorra. (2024, October 27). How to choose the best health insurance in Andorra.https://mcaandorra.com/health-insurance-in-andorra-how-to-choose-it/
- P4H Network. (2025, February 4). Andorra.https://p4h.world/en/countries/andorra/
- The Global Wealth. (2026, February 15). Andorra healthcare system: A guide for residents. https://theglobalwealth.com/guides/andorra-healthcare
- Universitat d’Andorra. (2023, December 10). Access to the country and immigration.https://www.uda.ad/en/international-mobility/study-at-the-uda/access-to-the-country-and-immigration/
