Andorra (AD)

Andorra is a tiny parliamentary co-principality nestled in the Pyrenees mountains between France and Spain, governed jointly by the French President and the Bishop of Urgell.

Capital: Andorra la Vella

Region: Europe

Language: Catalan

Currency: EUR (€)

Cost of living: Moderate (index 70)

Emergency: 112

Healthcare in Andorra

Andorra's healthcare system is centred on the SAAS (Servei Andorrà d'Atenció Sanitària — Andorran Health Care Service) and funded through CASS (Caixa Andorrana de Seguretat Social). The system is small but high-quality — modelled on French and Spanish healthcare standards. The main hospital is the Hospital Nostra Senyora de Meritxell (HNSM) in Escaldes-Engordany, a modern facility with around 160 beds. For complex specialist care, residents are referred to hospitals in Barcelona (Hospital Vall d'Hebron, Clínic Barcelona) or Toulouse (CHU Toulouse). The system delivers excellent outcomes despite Andorra's small size, with short waiting times and accessible primary care.

Andorra's healthcare quality is high by European standards — WHO rankings have placed it among the top 10 countries globally. The Hospital Nostra Senyora de Meritxell (HNSM) is modern and well-equipped for a country of 79,000. Waiting times for GP appointments are very short (same-day usually available). Specialist waiting times are longer — many residents use cross-border care in Barcelona or Toulouse for non-urgent specialist consultations.

Public healthcare: CASS — Caixa Andorrana de Seguretat Social

Andorran Social Security Fund

Eligibility:All Andorran-registered employees and their employers must register with CASS. Self-employed workers register as autònoms. Passive residents enrol voluntarily. Dependants (spouse, children under 21, or up to 25 if in full-time education) are covered under the primary member's registration. Frontaliers (cross-border workers entering from Spain/France daily) have limited CASS coverage.

Monthly cost:For employees: 6.5% of gross salary (employee share); employer pays 15.5%. Self-employed autònom: 22% of net income. Passive residents (voluntary): flat monthly contribution assessed by CASS based on elected contribution base — approximately €350–700/month for standard health coverage.

What's included:

GP consultations at SAAS-affiliated doctors (75% reimbursed)
Specialist consultations with CASS-approved specialists (75% reimbursed)
Hospital stays at HNSM (80–100% for acute care; standard co-pay for elective)
Emergency care — fully covered within Andorra
Maternity care: prenatal consultations, childbirth at HNSM (80% covered)
Prescription medications from Andorran pharmacies (70–80% reimbursed)
Physiotherapy with doctor referral (CASS-reimbursed up to annual limits)
Medical imaging (X-ray, MRI, CT) when prescribed — CASS-reimbursed at 75–80%
Dental care: basic treatments partially reimbursed (40–60% depending on treatment)
Mental health consultations with CASS-registered psychiatrists/psychologists
Cross-border referrals to Spain/France (Barcelona or Toulouse) — CASS covers agreed percentage

Not included (or co-pay required):

Cosmetic procedures and aesthetic treatments
Dental implants and major prosthetics (minimal CASS coverage)
Vision care: glasses, contact lenses, laser eye surgery
Homeopathy and alternative medicine
Non-urgent treatments without CASS authorisation
Experimental treatments not on the CASS approved list

Co-payments:CASS reimburses 75–80% of the official tariff. The remaining 20–25% (ticket modérateur) is paid by the patient. Most Andorran residents take out complementary private insurance (mutualitat) to cover co-payments. For serious chronic illness or long-term conditions, CASS can increase coverage to 100%. Children have reduced co-payments.

How to enrol:Employed workers: your employer registers you with CASS immediately on starting work. You receive a CASS membership card within 2–4 weeks. Self-employed: register at CASS offices (Carrer Prat de la Creu, Andorra la Vella) with proof of autònom status. Passive residents: register at CASS directly — CASS will assess your voluntary contribution level based on your declared assets/income.

Waiting period:No waiting period for employees — coverage begins from the first day of employment or CASS registration. Passive resident voluntary contributors: coverage begins immediately upon first payment confirmation.

Private healthcare: Assegurança Complementària de Salut (Complementary Health Insurance)

Who can use it:Open to all CASS members. Covers the 20–25% co-payment not reimbursed by CASS, plus dental implants, optical care, private room upgrades, and cross-border specialist care beyond CASS limits. Many Andorran employers provide group complementary insurance as part of the employment package.

When it makes sense:Strongly recommended: CASS only covers 75–80% of costs. Andorra's medical fees for non-CASS services can be significant. A complementary policy (€60–180/month) eliminates most out-of-pocket expenses. Particularly important for families with children (dental, orthodontics), older residents, and anyone with existing conditions requiring regular specialist care.

Monthly cost:€60–180/month for individual. Family: €150–350/month.

Major providers:

CASS Complementari (CASS's own complementary product)Allianz AndorraAXA AndorraApril International (specialist expat health)Cigna Global (internationally mobile residents)BUPA International

Accessing care

GP system

Choose a médic de capçalera (GP) from the CASS-approved list published on the CASS website. No catchment area assignment — you can choose any CASS-approved GP. Present your CASS card at consultations for direct reimbursement (tiers payant). SAAS primary care centres (CAP — Centres d'Atenció Primària) in each parish offer GP services with shorter waiting times. English-speaking GPs: available in Andorra la Vella and Les Escaldes — ask specifically when booking.

Specialist referral

GP referral letter is strongly recommended for CASS reimbursement of specialist consultations. Specialists available at HNSM and private clinics in Andorra la Vella. For complex or rare cases: CASS authorises cross-border referrals to Barcelona (Hospital Clínic, Vall d'Hebron) or Toulouse (CHU Toulouse) with CASS covering the agreed tariff. Processing a cross-border referral: 1–2 weeks for non-urgent cases.

Emergency care

Call 116 (SAAS medical emergency) or 112 (general emergency). Hospital d'Urgències HNSM (Hospital Nostra Senyora de Meritxell): main 24/7 A&E — Avenue Fiter i Rossell, Escaldes-Engordany. Ambulance response time: typically 5–10 minutes. CASS covers emergency care at 100% for CASS members. Ski resort medical services: each major resort has its own ski patrol and medical station for on-piste emergencies — connected to HNSM for serious injuries.

Out of hours

Outside standard hours: HNSM A&E is open 24/7. For urgent but non-emergency needs: SAAS operates an out-of-hours consultation service at HNSM on evenings and weekends. Pharmacie de garde (duty pharmacy): a rotating emergency pharmacy is always available — list posted on all pharmacy doors and announced on Andorra Telecom's information service.

Prescriptions

Prescriptions from CASS-approved doctors are directly reimbursable at Andorran pharmacies via the CASS tiers payant system — present your CASS card. Pharmacists can confirm reimbursement status. French and Spanish prescriptions are accepted for cross-border medications but reimbursement is more complex — have your Andorran GP re-issue if possible. Retain all prescription receipts for complementary insurance claims.

Dental

Dental clinics are plentiful in Andorra la Vella. Basic treatments (consultations, fillings, extractions) are partially reimbursed by CASS at 40–60%. Implants, orthodontics, and cosmetic work require complementary insurance or direct payment. Cross-border dental in Spain (La Seu d'Urgell, 15 minutes away) is often cheaper for major work — confirm CASS reimbursement status before treatment. English-speaking dentists available in Andorra la Vella.

Mental health

SAAS operates mental health outpatient services at the HNSM psychiatric department — accessible with GP referral. CASS reimburses sessions with CASS-registered psychiatrists and clinical psychologists at standard rates (75%). Private psychologists and therapists are available in Andorra la Vella — many speak English, Spanish, and French. Crisis line: +376 736 363 (business hours). After hours: HNSM A&E for psychiatric emergencies. International expat support: April International and Cigna Global offer 24/7 mental health telephone support for policyholders. Online therapy platforms (BetterHelp, Talkspace) accessible from Andorra via video call.

Maternity

HNSM Maternitat provides full maternity services. Prenatal consultations: CASS-reimbursed from confirmation of pregnancy. Childbirth at HNSM: covered by CASS (80% of standard tariff). Postnatal care and breastfeeding support available at HNSM. Some residents choose to deliver in Barcelona or Toulouse for specialist neonatal care — CASS covers cross-border maternity under authorisation. Non-CASS mothers (tourists, unregistered residents): maternity care billed at private rates.

Expat-specific advice

First steps on arrival:

Register with CASS as soon as your employment or residency is confirmed — healthcare access depends on CASS membership.
Choose a CASS-approved médic de capçalera (GP) immediately — your first point of contact for all health needs.
Obtain complementary health insurance to cover the 20–25% CASS co-payment — check whether your employer provides a group plan.
Locate your nearest pharmacy and the current farmàcia de guàrdia (duty pharmacy) schedule.
Keep your CASS card with you at all times for direct billing at doctors and pharmacies.
Save HNSM emergency number (+376 871 000) and general emergency 116/112 in your phone.

Finding English-speaking doctors:English is widely spoken in Andorra la Vella medical facilities. HNSM has English-speaking staff in A&E and specialist departments. Most private GPs in the Les Escaldes and Andorra la Vella area speak English and Spanish. Ask specifically when booking: "Parla anglès?" — nearly all medical professionals accommodate English-speaking patients. April International and BUPA can refer policyholders to their network of English-speaking Andorran practitioners.

International insurance:International health insurance (Cigna Global, BUPA, Allianz Care) is accepted at HNSM and private clinics. Always carry your policy card and insurer's emergency phone number. Confirm direct billing capability before treatment. Dual coverage (CASS + international) is allowed and useful for cross-border specialist care in Barcelona or Toulouse.

Emergency card info:Carry an ICE (In Case of Emergency) card with: blood group, allergies, current medications, CASS number, GP name and number, next of kin contact. HNSM's compact A&E responds quickly — clear information speeds care. Consider a medical alert bracelet for serious conditions. Andorra's mountain environment means altitude-related conditions (AMS, hypothermia, ski injuries) are common — be aware of symptoms and seek care promptly.

EHIC notes:Andorra is NOT an EU member — the European Health Insurance Card (EHIC) is NOT valid in Andorra. EU nationals in Andorra must be covered by CASS through employment or voluntary registration. Tourists from EU countries: standard travel insurance is required — EHIC does not cover Andorra. French and Spanish citizens working in Andorra: covered by CASS, not their home country's social security.

Pharmacies (Farmàcia)

Hours:Standard hours: Monday–Friday 09:00–13:00 and 15:30–20:00. Saturday: 09:00–13:00. Many tourist-area pharmacies in Andorra la Vella: extended weekday hours until 20:30. Farmàcia de guàrdia: rotating emergency pharmacy always available for urgent medication outside standard hours — list posted on all pharmacy doors.

After-hours / emergency:Farmàcia de guàrdia (duty pharmacy): one pharmacy in each parish is always available for urgent needs outside business hours. The duty schedule is published by SAAS and posted on all pharmacy doors. HNSM hospital pharmacy also dispenses urgently prescribed medications 24/7.

Prescription rules:Prescriptions from CASS-approved Andorran doctors are directly reimbursed via tiers payant at participating pharmacies — present your CASS card. French and Spanish prescriptions accepted for recognised medications. Prescriptions from non-EU countries require re-issuance by an Andorran GP. Pharmacy staff speak Catalan, Spanish, and usually French; English common in tourist-area pharmacies.

Available over-the-counter:

Paracetamol (Doliprane, Paracetamol Ratiopharm) — widely available without prescription
Ibuprofen (Nurofen, Advil, Buscapina) — OTC at standard doses
Antihistamines (Clarityne, Zyrtec, Cetirizina) — available without prescription
Sunscreen (SPF 30–50+) — essential for mountain UV levels; well-stocked year-round
Altitude/mountain sickness remedies — ibuprofen, hydration tablets common
Ski injury first aid: heat/cold packs, NSAIDs, bandages widely available
Vitamin D and zinc supplements — common given mountain winter with reduced sunlight
French and Spanish pharmaceutical brands widely stocked (Bioderma, La Roche-Posay, Avène)

Typical costs

GP visit (with insurance)	€0–10 co-payment (with CASS + complementary)
GP visit (private pay)	€40–80 (full private rate)
Specialist visit	€10–30 co-payment with CASS; €80–200 without
Emergency visit	€0 with CASS (fully covered); €200–600 without CASS
MRI scan	€30–60 with CASS; €250–500 without
Prescription average	€3–10 co-payment per prescription with CASS
Dental check-up	€20–40 with partial CASS reimbursement; €60–100 fully private
Baby delivery	€300–800 with CASS; €2,000–5,000 fully private

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