Andorra Healthcare System

Like most European countries, Andorra has compulsory public healthcare (Servei Andorrà d’Atenció Sanitària – SAAS) with a private option. Andorra’s social security system finances the healthcare system. In 2017, the medical journal “The Lancet” published the Healthcare Access and Quality Index (HAC). Andorra ranked #1 in the world with a HAC score of 95/100. The commonwealth-funded report found that Andorra’s public healthcare system ranked 4th globally in terms of equity, efficiency, and entry-level care. Healthcare is financed by its citizens and residents: working individuals, the unemployed, those receiving pension payments, and employers.

World Health Organization (WHO) reported that Andorra’s life expectancy is really high: 86 years for women and 80 years for men. The Andorran Social Security system is centralized in a single public institution, responsible for the administrative, financial, and technical management of the entire health system, also known as CASS (Caja Andorrana de Seguridad Social).

Health Coverage in Andorra

As a resident, you access the health system by joining the Andorran Social Security System – CASS. More than 90% of Andorra inhabitants are protected by social security. Individuals who are not covered are believed to be passive residents but are required to use private insurance.

To be covered by CASS as an employee you need to be working for an Andorran or foreign company. Unemployed can opt for CASS by contributing €200 to €400 per month. Having Andorran social security is not separate health coverage. CASS covers accidents in neighboring countries in France, Portugal, and Spain. Note that you are only covered if CASS is notified before travel and medical bills are sent to CASS for reimbursement. This is one of the reasons, why so many expats choose Andorra for residency.

Referring Doctors

One of the novelties of the Andorran healthcare system is the referring family doctor, to improve access, efficiency, and coordination of medical care.

CASS users must choose a general practitioner or pediatrician as referring doctor, who provides more personalized but general health care and monitors individual health status over time. The doctor is the first node for initial diagnosis, the one who requests visits to specialists and acts as a guide through the health system, and coordinates with the different health professionals who treat the patient.

Healthcare Cost and Reimbursement in Andorra

Healthcare is one of the strongest points of the Principality of Andorra and is based on the principles of co-responsibility, solidarity, and freedom of the doctor’s choice. Therefore, a co-payment system with a full subsidy for the most disadvantaged operates through agreements between the health professional associations and CASS itself.

In most cases CASS reimburses the unsubsidized amount with percentages applied:

• Outpatient clinics or health centers, for consultations or specialist visits, CASS covers at least 75% of the cost
• In case of hospitalization, the CASS coverage is 90% of the expenses, also allowing direct payment of the percentage not covered by social security
• Expenses caused by accidents at work or occupational diseases and childbirth are covered at 100%
• Finally, if your health expenses in Andorra are incurred by services not affiliated with the Andorran social security, reimbursements can be up to 33% of the total

For new employees of an Andorran company is mandatory to register with CASS. An employee pays 6-9% of salary and the employer pays 15.5% of social security contributions. When seen by a doctor, individuals are given a stamped form and receipts. Recovery of expenses is done through a local CASS office with all documentation. Reimbursement comes by a bank transfer.

Hospitals and Elderly Care Centers in Andorra

Andorra’s healthcare network is quite large considering the size of the Principality. There is one main state hospital with 220 beds (Hospital Nostra Senyora de Meritxell).

Throughout the Principality, 10 health centers provide very high levels of care. They are open during the week, but rarely during the weekend. The centers provide preventive care, immunizations, first aid, prenatal and child care, family planning, and general counseling. One can receive urgent care by visiting a health center or having a home visit without an appointment. Elderly patients can be cared for in a 50-bed private geriatric center (Centre Geriàtric Sant Vicenç d’Enclar).

Andorra has one of the world’s largest per capita ratios of pharmacies to population. There are more than 50 pharmacies in the principality providing prescription and non-prescription drugs and health supplements.

Private Health Insurance in Andorra

Private health insurance is recommended but not necessary. Extra insurance gives access to private clinics and medical care and allows to extend the already complete Andorran social insurance. About 25% of the Andorran population obtained private health insurance. Private doctors are legally authorized to perform surgical and diagnostic operations in a hospital.

Besides, there are complementary insurances that cover the remaining percentage (25%) by applying the corresponding CASS subsidy, to avoid punctual payments altogether.

Spain – Andorra Agreement

In addition to double taxation agreements, Andorra has signed social security agreements with other countries. The most important are those with France and Spain. Although it would be necessary to see each agreement point by point, in general, these agreements are based on reciprocity, in such a way that a person can obtain social security care in the other country and the other country charges the cost to the state of the country of which individual is a resident. Resident in Andorra who visits Spain is insured and can receive care in Spain, and the costs are paid by Andorran CASS.

France – Andorra Agreement

On 12/12/2000, France and Andorra prepared a social security/health agreement. Treaty aims to cover as many people as possible in the health and social protection sector. The agreement specifies that individuals are subject to the social security system of the country in which they are working:

• Salaried or non-salaried workers, regardless of their nationality, exercising now or previously an occupational activity in one of the two countries
• The insured persons without activity, whatever their nationality
• Public employees in exercise or retired.

Branches subject to the Franco-Andorran agreement in the field of health and social protection are the following:

• Sickness and maternity
• Accidents at work and occupational diseases
• Disability and death
• Old age
• Miscellaneous family benefits

Healthcare System in Andorra: FAQ