Andorra's healthcare system is renowned globally for its high quality and efficiency, consistently ranking among the top worldwide. It operates on a hybrid model, combining a robust public social security system with a complementary private sector. The system is primarily managed by two key institutions: the Caixa Andorrana de Seguretat Social (CASS), which handles social security contributions and reimbursements, and the Servei Andorrà d'Atenció Sanitària (SAAS), responsible for the direct delivery of public healthcare through its hospital and health centers. Healthcare in Andorra is founded on principles of co-responsibility, solidarity, and freedom of choice, allowing residents to select their own doctors and specialists. Expats who are legal residents and contribute to CASS benefit from this comprehensive system, while passive residents and tourists are required to have private health insurance. The co-payment model means patients pay a portion of costs upfront, which is then largely reimbursed by CASS, often supplemented by private insurance for near-full coverage.

The public healthcare system in Andorra is primarily funded through mandatory social security contributions to the Caixa Andorrana de Seguretat Social (CASS). This system covers approximately 92-98% of the population. CASS operates on a co-payment basis, where the state covers the majority of medical expenses, and the patient pays a smaller percentage out-of-pocket.

Coverage Details:

• Outpatient care (GP visits, specialist consultations, diagnostic tests, medication, dental care): CASS reimburses 75% of the cost.
• Hospitalization: CASS covers 90% of expenses, including surgeries and treatments.
• Occupational accidents, occupational diseases, and childbirth: 100% covered.
• Prescription medication: Generally 75% covered, with some variations.
• Dental care: CASS generously subsidizes 75% of dental care, including two annual cleanings.

Reimbursements are typically processed quickly, often within 2 to 5 business days, after submitting receipts through the CASS online portal or mobile app. The public system is known for minimal waiting times for specialist appointments and diagnostic tests. The quality of care is high, with medical professionals often receiving training in neighboring Spain or France. The main public hospital is Hospital Nostra Senyora de Meritxell, supplemented by several primary care centers across the parishes.

While Andorra's public system is highly comprehensive, a private healthcare sector exists primarily through private clinics offering specialized outpatient care. Andorra does not have private hospitals, but Hospital Nostra Senyora de Meritxell houses both public and private physicians. Many residents, including expats, opt for supplementary private insurance to cover the remaining co-payment portion (typically 10-25%) not covered by CASS, effectively achieving 100% coverage for most services.

Private insurance also offers additional benefits such as access to private rooms, broader dental and optical care, second medical opinions, and access to private networks in Spain or France. The quality of care in private clinics is generally excellent, often comparable to or exceeding public services, with the added benefit of potentially faster access to specific specialists. Typical consultation costs in private clinics for non-CASS affiliated individuals or for services outside CASS agreements are higher, with an emergency room visit potentially costing around €350 (approximately $375 USD) for non-residents. For CASS-affiliated residents with supplementary insurance, out-of-pocket costs are minimal or non-existent for covered services. Some notable private clinics include Clinica Sant Vicenç, known for dermatology, physiotherapy, and diagnostic imaging.

Access to healthcare in Andorra for foreigners and expats depends significantly on their residency status.

• Employed Residents (Active Residency): If you are employed by an Andorran company or are self-employed, affiliation with CASS (Caixa Andorrana de Seguretat Social) is mandatory from your first day of employment. This grants you and your family access to the public healthcare system. Registration involves obtaining your social security number and ensuring your employer registers you with CASS.
• Passive Residents (Non-Working Residency): Individuals holding passive residency permits are not eligible for CASS coverage as they do not contribute to the social security system. It is a legal requirement for passive residents to hold comprehensive private health, disability, and retirement insurance that provides coverage within Andorra.
• Tourists and Visitors: The European Health Insurance Card (EHIC) is not valid in Andorra as it is not an EU member state. All tourists and visitors are responsible for the full cost of any medical treatment received. It is strongly advised to obtain comprehensive travel insurance that covers medical emergencies and potential repatriation before visiting Andorra.

Andorra has bilateral health agreements with Spain, France, and Portugal. CASS-affiliated residents can receive specialized treatment in these countries if it's not available in Andorra, provided they have a referral from their Andorran doctor and CASS authorization (a 'volant mèdic') before the appointment. Without prior authorization, reimbursement for treatment abroad may be significantly reduced.

Expats in Andorra have several health insurance options, depending on their residency and employment status:

1. Mandatory Public Contributions (CASS): For employed and self-employed residents, contributions to CASS are compulsory. As of 2025-2026:

   • Employees: Contribute 6.5% of their gross salary, with employers contributing an additional 15.5%.
   • Self-employed (Autonòm): Pay a fixed monthly contribution, which was €563.42 in 2025 and €588.21 in 2026. Discounts may apply for the first two years of business activity.
   • Unemployed (affiliated previously): Can maintain CASS coverage by paying a voluntary contribution, approximately €153-€336 per month in 2026, depending on whether pension contributions are included.

2. Voluntary Private Plans (Supplementary Insurance): The vast majority of CASS-affiliated residents opt for supplementary private insurance. These plans cover the 10-25% co-payment portion not reimbursed by CASS, effectively providing near 100% coverage for most medical services. They also offer benefits like private rooms, enhanced dental/optical care, and access to private networks in Spain or France. Typical monthly premiums for supplementary insurance range from €30 to €110 per person (approximately $32-$118 USD).

3. Mandatory Private Insurance (for Passive Residents): Passive residents, who do not work in Andorra, are legally required to hold comprehensive private health, disability, and retirement insurance that covers them within the Principality. This insurance must meet specific standards set by Andorran immigration authorities. The cost for full private insurance for passive residents will be higher than supplementary plans, though a specific typical monthly range is not consistently provided in available data. International health insurance providers like Allianz Care and Cigna Global offer plans suitable for expats in Andorra, often including worldwide coverage and emergency evacuation.

4. Employer-Provided Plans: Some employers may offer supplementary private health insurance as part of their benefits package, enhancing the coverage provided by CASS.

Andorra's co-payment healthcare model means that while the public system (CASS) covers a significant portion of medical expenses, patients are responsible for the remainder.

For CASS-affiliated Residents:

• GP Visits & Specialist Consultations: CASS reimburses 75% of the cost, leaving a 25% co-payment.
• Hospital Stays: CASS covers 90% of expenses, meaning a 10% co-payment.
• Prescriptions: Generally 75% covered by CASS.
• Dental Care: 75% covered by CASS, including two annual cleanings.
• Occupational Accidents, Diseases, and Childbirth: 100% covered by CASS.

Many residents opt for supplementary private insurance, which typically covers this 10-25% co-payment, resulting in virtually no out-of-pocket costs for routine medical services.

For Tourists, Passive Residents, and Uninsured Foreigners:

• Without CASS affiliation or private insurance, individuals are liable for 100% of medical costs, which can be substantial.
• Emergency Room (ER) Visit: Can cost approximately €350 (around $375 USD) or more.
• Hospitalization: Can exceed €1,000 (around $1,075 USD) per night.
• Non-affiliated Private Providers: If a CASS-affiliated resident chooses a non-affiliated private provider without CASS authorization, reimbursement drops significantly, sometimes to as low as 20-33% of the CASS tariff.

It is crucial for visitors and non-CASS affiliated expats to have comprehensive private health or travel insurance to cover these potentially high costs.

Andorra has a well-organized emergency medical service system, accessible to everyone, though costs vary significantly based on insurance status.

How to Call for Help:

• For immediate medical emergencies and an ambulance, dial 116 (Servei Urgent Mèdic - SUM).
• For general emergencies, including mountain rescue, police, and fire, dial 112.
• Other direct numbers include 110 for Police and 118 for Fire Brigade.

What to Expect:

• Emergency services are centralized at the country's only main hospital, Hospital Nostra Senyora de Meritxell in Escaldes-Engordany. This hospital is well-equipped and offers a variety of specializations.
• Medical professionals in Andorra are often trained in Spain or France, ensuring high standards of care.
• For non-life-threatening issues outside regular clinic hours, a Medical Out-of-Hours Service (Clinica Verge de Meritxell) with general practitioners is available on weekends and public holidays.

Costs for Foreigners:

• Emergency treatment is available to everyone. However, for tourists, passive residents, and uninsured foreigners, treatment is not free. You will be liable for 100% of the costs, which can be substantial.
• Hospitals in Andorra typically require upfront payment, even if you have travel health insurance, so ensure you have accessible funds.
• An emergency room visit can cost approximately €350 (around $375 USD), and hospitalization can exceed €1,000 (around $1,075 USD) per night.
• Comprehensive travel insurance is strongly recommended for all visitors to cover these potential costs.

Ambulance Availability: Ambulances are readily available through the 116 medical emergency number.

Andorra's healthcare system consistently receives high praise and is ranked among the best in the world.

• International Rankings: In 2017, The Lancet's Healthcare Access and Quality (HAQ) Index ranked Andorra first globally with a score of 95 out of 100, surpassing countries like Iceland and Switzerland. The WHO World Health Report 2000 also placed Andorra fourth worldwide for overall health system performance. This high quality contributes to Andorra's high life expectancy, estimated at 83-84 years.

• Strengths:

  • World-class Quality: High standards of medical care, often delivered by professionals trained in Spain or France.
  • Minimal Waiting Times: Fast access to specialists and diagnostic tests, with virtually no waiting lists.
  • Freedom of Choice: Patients can choose their own doctors and specialists within the CASS-affiliated network.
  • Comprehensive Coverage: CASS offers extensive coverage for a wide range of services, including generous dental benefits.
  • Modern Facilities: The Hospital Nostra Senyora de Meritxell is well-equipped, and health centers provide high standards of primary care.

• Weaknesses:

  • Limited Specialties: As a small country, certain highly specialized treatments may not be available locally, requiring referrals to hospitals in Spain or France.
  • Weekend Availability: Most primary healthcare centers do not operate on weekends, though emergency services are always available.
  • Single Main Hospital: Reliance on one central hospital for all major services.

• Comparison to Neighboring Countries: Andorra's healthcare system is often compared favorably to its neighbors, Spain and France, particularly in terms of efficiency and waiting times. Its social insurance model is similar to the French system. While Spain and France also have excellent healthcare, Andorra's smaller scale allows for a highly integrated and efficient system, contributing to its top international rankings.