Medicare is not Spanish public cover
Do not assume US health cover will satisfy a visa requirement or pay for routine care in Spain. Confirm overseas benefits directly with the programme or plan.
The totalisation agreement
A US certificate of coverage can determine which country’s Social Security legislation applies. The US Social Security Administration explains that an exemption from Spanish coverage generally means no contributions or benefits under Spanish programmes covered by the agreement, including health insurance. The certificate does not create Spanish public healthcare entitlement.
Use the route-specific guide
Check the NLV, Digital Nomad or other relevant visa instructions and obtain written evidence that matches the application.
NLV applicants
Most US applicants using the NLV need suitable private cover because the route does not create Spanish Social Security entitlement.
Digital nomads
The answer depends on Social Security arrangements and whether they provide healthcare in Spain.
Buying from the United States
Check the insurer in the DGSFP register, confirm the network where you will live and obtain the final certificate before submission.