Andorra’s social security system is recognized as one of the most competent in the world. In particular, the Andorran health system is currently considered one of the best, and has even been ranked first in several specialized rankings.

The body that manages social security is the CASS or Andorran Social Security Fund, while the SAAS or Servei Andorrà de Atenció Sanitaria (Andorran Health Care Service) is in charge of healthcare.

Both entities coordinate to offer a health system of the highest quality in which no one is excluded. Today we will tell you everything you need to know about it.

How the healthcare system works

Something that is interesting within this system is the so-called “principle of free choice”, which allows any citizen to freely treat themselves with the health professional(s) of their choice. There are private clinics that operate in association with CASS, and many times patients can be treated in one or the other center indistinctly, according to their preference.

On the other hand, healthcare operates on a co-payment system: the state largely finances medical care and procedures, but a percentage must be covered by the users themselves.

However, if a person demonstrates that he or she does not have sufficient resources to cover his or her share, the state will also cover that percentage. Initially, the patient will have to disburse it, but after a few days it will be fully reimbursed through the due process (which nowadays has started to be automated and much faster).

Costs and coverage of the health system

Depending on the type of service, CASS covers the following percentages:

• Consultations with general practitioners. 100% is covered.
• Consultations with specialists. A minimum of 75% is covered.
• Examinations and diagnostics. Generally, between 75% and 90% is covered.
• Physiotherapy treatments. Covered at up to 65%.
• Hospitalization. Covered up to 90% (no need to pay initially and then ask for reimbursement).
• Occupational accidents, occupational diseases and childbirth. Coverage of 100%.
• For health expenses through private establishments not associated with the Andorran health system, there may be a reimbursement of up to 33%.

Advantages and disadvantages of the system

One of the strengths of the Andorran system is that it offers a considerable subsidy on dental treatment, unlike other countries such as Spain, where dentistry is practically excluded from public healthcare.

Other advantages are:

• The aforementioned free choice
• High general coverage for different services
• The solidarity system that protects those who cannot afford medical care
• High efficiency and organization of the system
• Health coverage in neighboring countries

But there are also disadvantages, such as being a place with a small population there are specialties that are not available.

However, there are agreements with the governments of Spain and France to carry out consultations related to these specialties in these countries. You can read more about this in the following section.

Agreements with other countries

Spain and France are the two countries with which Andorra has an agreement regarding medical treatments and consultations, both in the Principality for people traveling from other places, as well as for Andorran residents who require treatment in neighboring territories. Below, we talk a little about each case.

Medical care outside Andorra

In general, there are agreements with hospitals and medical centers located in Spain and France for those treatments or specialties that are not available in Andorra. In such cases, the Andorran resident will be referred by his/her general practitioner and the visit and appointment must be arranged through CASS. Subsequently, the corresponding percentage of the expenses will be reimbursed.

Agreement with France

The agreement with France establishes that any worker, regardless of nationality, who performs work in Andorra or in France, may receive medical care in the country where he/she is. It also applies to retired persons, public workers and insured persons who do not work.

This agreement includes maternity, occupational accidents and occupational diseases, care for disabled or elderly people, family benefits and general medical care.

Can I use the European Health Insurance Card in Andorra?

Something important to note is that, as Andorra is not a member of the European Union, the European Health Insurance Card is not valid in the Principality. Therefore, people wishing to travel from other countries should inquire about the mechanisms for medical care depending on each case, if so required.

Is it necessary to take out private insurance?

Although it is not completely necessary, in some cases it is not a bad idea, since for a reasonable contribution you get full coverage for any consultation or treatment. Private insurances also offer supplementary benefits for salaried people who are on sick leave.

A significant difference with other countries is that private insurance allows care in the same medical centers as people covered by the public health system. They are simply responsible for paying the patient’s share of the bill.

What is the “referring physician”?

One of the particularities of the health system in Andorra is the “referring doctor”. This is a professional that every resident must choose as a general practitioner.

This doctor makes the corresponding referrals to specialists and monitors the patient’s health. For each consultation with this doctor, only 25% of the cost is paid, which is usually around 5-7 €.

This system of care is beneficial because, as the patient is attended by a specific professional, he/she is able to provide a closer, more personal and detailed attention. Sometimes, diagnoses can be more accurate than when dealing with a larger number of doctors, since the primary care physician can become more familiar with each case.

Subscribing to the Andorran Social Security Fund

Almost all the inhabitants of Andorra are covered by the CASS. For salaried persons, affiliation is compulsory, whether you are self-employed, employed or self-employed. Unemployed persons can become affiliated by means of a monthly contribution.

Distribution of medical centers and pharmacies

In Andorra there are ten main medical centers, distributed throughout the territory, among which the large Meritxell hospital stands out.

The quality of care is very good, but many of them do not provide care during weekends. There is continuous care for emergencies and home care.

As for pharmacies, there are about fifty establishments, a very high number considering the size of the Principality. There are pharmacies on duty at all times and, in general, pharmacies are open on weekends.

These establishments sell over-the-counter medicines, medicines not covered by CASS, and prescription products 75% of which are covered by CASS via reimbursement.

Are you interested in residing in Andorra?

If you are considering moving to Andorra, we recommend reading the report “The definitive guide to living in Andorra”, with the most complete information on Andorran taxation, residence and society.

You can also contact us, our team of specialists in obtaining Andorran residency can help you.