Andorra, a small principality nestled between France and Spain, boasts a highly efficient healthcare system, largely structured around its public insurer—Caixa Andorrana de Seguretat Social (CASS). While CASS covers the majority of the population, private health insurance plays a vital supplementary or primary role, especially for non-working residents and those seeking enhanced services. Understanding the distinctions and overlaps between these two systems is crucial for residents and expats navigating healthcare in the country.
Similarities Between Public and Private Insurance
Both public and private health insurance in Andorra aim to ensure access to quality medical care and share several commonalities:
- Reimbursement-Based Models: Both systems reimburse policyholders for medical expenses. CASS reimburses between 75% to 100% of costs depending on the service type, while private insurers may reimburse up to 100%, particularly for services not fully covered by CASS.
- Choice of Providers: Public and private systems alike allow patients the freedom to choose their healthcare provider. CASS affiliates can select doctors from both public and private clinics that have agreements with CASS. Similarly, private insurance policies often include broad provider networks, both domestically and internationally.
- International Reach: Both systems offer international healthcare access. CASS has reciprocal healthcare agreements with France, Spain, and Portugal, whereas private insurers like Allianz and AXA offer worldwide coverage, often appealing to expats and frequent travelers.
Differences Between Public and Private Insurance
Despite their shared goals, public and private health insurance in Andorra differ significantly in structure, eligibility, and coverage specifics.
- Eligibility and Enrollment:
- CASS (Public): Mandatory for employed, self-employed individuals, pensioners, and their families. Even the unemployed can join by paying a monthly contribution.
- Private Insurance: Typically voluntary and often essential for passive residents—those who live in Andorra but are not employed. It is also used by CASS affiliates for enhanced or supplementary coverage.
- CASS (Public): Mandatory for employed, self-employed individuals, pensioners, and their families. Even the unemployed can join by paying a monthly contribution.
- Funding Mechanism:
- Public Insurance: Funded through payroll deductions—employees contribute 6–7% and employers add around 15%. Self-employed individuals and unemployed residents pay a flat monthly fee.
- Private Insurance: Funded through individual premiums based on risk assessment, age, and coverage level. No employer involvement is needed.
- Public Insurance: Funded through payroll deductions—employees contribute 6–7% and employers add around 15%. Self-employed individuals and unemployed residents pay a flat monthly fee.
- Scope and Speed of Service:
- CASS: Covers essential healthcare services including general practitioner visits, hospitalization, childbirth, and workplace injuries, though often with co-payments.
- Private Insurance: Offers broader service options such as advanced dental care, wellness treatments, homeopathy, and often faster access to specialists and private clinics.
- CASS: Covers essential healthcare services including general practitioner visits, hospitalization, childbirth, and workplace injuries, though often with co-payments.
- Limitations:
- CASS: Requires co-payments (up to 25%) unless complemented with private coverage; some services may be excluded or require pre-approval.
- Private Insurance: Can be costly, may involve medical underwriting, and not always available to individuals with pre-existing conditions.
- CASS: Requires co-payments (up to 25%) unless complemented with private coverage; some services may be excluded or require pre-approval.
Top Public Health Insurances in Andorra
Andorra, a small principality nestled between France and Spain, has a highly centralized public healthcare system primarily administered by a single entity. Unlike many larger nations, Andorra does not operate multiple public health insurance schemes. Instead, its healthcare system is anchored by the Caixa Andorrana de Seguretat Social (CASS), the sole public health insurance provider in the country. Below is an in-depth look at CASS and how it functions as the backbone of Andorra’s public health system.
1. Caixa Andorrana de Seguretat Social (CASS)(Official website: https://www.cass.ad)
Cost:
CASS is funded by mandatory contributions from employers, employees, and the self-employed. Employees contribute approximately 6.5% of their gross salary, while employers contribute about 15.5%, making the total contribution rate roughly 22%. For the self-employed, the full burden (22%) falls on them directly. While the rates may seem high, these contributions cover not only health insurance but also pensions and family support.
Available Services/Coverage Features:
CASS offers comprehensive healthcare coverage, including but not limited to:
- General practitioner and specialist consultations
- Diagnostic tests and imaging
- Prescription medications
- Hospitalizations and surgeries
- Maternity care
- Emergency services
- Rehabilitation and physiotherapy
Reimbursement is based on a co-payment system:
- 75% of outpatient medical care costs
- 90% for hospital care
- 100% for occupational injuries and serious illnesses
Patients initially pay the full amount for services and are reimbursed by CASS afterward. However, if care is provided within the public system or in-network private facilities, direct billing can often be arranged, minimizing upfront costs for the insured.
Open for All or Limited:
CASS is mandatory and universal for all residents who are employed or self-employed in Andorra. Dependents, including spouses and children, can also be covered. Tourists and temporary visitors are not eligible unless they secure private insurance or bilateral coverage through international agreements.
Core Financial Features:
- Reimbursement Model: Partial reimbursement (75%–100%) depending on the service category.
- Direct Billing: Available for in-network services, reducing financial burden.
- Income-Linked Contributions: Contributions are proportional to income, which helps maintain system equity.
- Cross-Border Agreements: CASS has partnerships with French and Spanish healthcare systems, allowing Andorran residents to access medical care in neighboring countries under certain conditions.
Consumer Satisfaction Score:
Although specific consumer satisfaction surveys are not regularly published, anecdotal and expat community reviews suggest high satisfaction levels due to:
- Short wait times
- High quality of care
- Ease of accessing specialists
- Multilingual services (Catalan, Spanish, French, and often English)
CASS is regarded as efficient and well-managed, with a strong emphasis on preventive care and patient education.
Top Private Health Insurance Providers in Andorra
Andorra’s healthcare system is primarily supported by the public provider CASS, but residents and long-term expatriates often seek private health insurance to gain broader access to services, private clinics, and international healthcare coverage. Due to Andorra’s small size and close relationships with neighboring countries, many private insurance options are either international or tied to companies operating within the region. Below are the most prominent private health insurance options available in Andorra.
1. Assegurances Generals d’Andorra (AGA)(Official website: https://assegurancesgenerals.com )
Cost:
Premiums typically start from €60–€150/month depending on age, health status, and coverage level.
Available Services/Coverage Features:
AGA offers various private health insurance plans that include:
- Private specialist consultations
- Surgical procedures
- Dental and optical care (optional add-ons)
- Access to private hospitals in Andorra and Spain
- International emergency medical coverage
Open for All or Limited:
Open to Andorran residents, including both locals and expatriates with residency permits.
Core Financial Features:
- Offers direct billing with partnered clinics.
- Deductibles and co-payments vary depending on the plan tier.
- Supplemental to CASS or as stand-alone coverage.
Consumer Satisfaction Score:
Rated high for local customer service, personalized support, and broad access to regional private clinics.
2. MAPFRE Andorra(Official website: https://www.mapfre.es/oficina/es_ES/andorra/L5692/ )
Cost:
Plans range from €50–€200/month, depending on coverage type and whether it’s used to supplement CASS.
Available Services/Coverage Features:
- Comprehensive outpatient and inpatient services
- Private room hospitalization
- Preventive check-ups and diagnostics
- Dental and vision add-ons
- Medical evacuation and repatriation services
Open for All or Limited:
Available to both citizens and legal residents of Andorra.
Core Financial Features:
- Partial reimbursements or full direct coverage within MAPFRE’s network.
- International coverage available, particularly in Spain and across Europe.
- Tiered pricing for different age brackets and health needs.
Consumer Satisfaction Score:
MAPFRE enjoys high reputation for multilingual service, easy claims processing, and expansive provider network in Spain.
3. Allianz Andorra (via international plans)(Official website: https://www.allianz.es/descubre-allianz/allianz-andorra.html )
Cost:
Premiums typically begin at €100/month and may exceed €300/month for comprehensive international packages.
Available Services/Coverage Features:
- Global medical coverage including specialist care, surgery, and cancer treatment
- 24/7 international medical support
- Annual check-ups and diagnostics
- Second medical opinion services
Open for All or Limited:
Primarily for expatriates, professionals, and those needing international mobility.
Core Financial Features:
- High annual benefit limits (up to €1 million+ depending on plan)
- Flexible deductibles and co-payment options
- Often used as a stand-alone policy, not necessarily integrated with CASS
Consumer Satisfaction Score:
Ranked very high by expats for international portability, excellent app/portal usability, and customer support in multiple languages.
4. Sanitas Internacional (Spain-based but used by Andorra residents)(Official website: https://sanitasinternationalexpats.com/en )
Cost:
Plans begin at €60/month and go up depending on coverage and age.
Available Services/Coverage Features:
- Direct access to Sanitas private network in Spain
- Dental and optical care
- Chronic disease and long-term illness coverage
- Maternity and pediatric services
Open for All or Limited:
Available to Andorran residents who frequently travel or seek care in Spain.
Core Financial Features:
- Direct billing with major private hospitals in Spain
- Optional top-up plans for international coverage
- Co-pays apply depending on service and plan type
Consumer Satisfaction Score:
Rated moderate to high for affordability and access to high-end care, especially in Barcelona and Madrid.
5. AXA Global Healthcare(Official website: https://www.axaglobalhealthcare.com/en/)
Cost:
International plans starting from €120/month, with customizable tiers for coverage scope.
Available Services/Coverage Features:
- Worldwide healthcare including specialist treatments and surgery
- Maternity care, mental health, and wellness programs
- Emergency evacuation
- Virtual doctor services
Open for All or Limited:
Geared toward expats and high-net-worth individuals residing in Andorra or traveling frequently.
Core Financial Features:
- High coverage limits (up to €1 million+)
- Variable deductibles and co-insurance options
- Premium pricing for full international mobility
Consumer Satisfaction Score:
Known for excellent customer support, digital tools, and seamless claims reimbursement for global care.
READ MORE: Private and public health insurance of Latvia (Make informed choices)
