Nestled between France and Spain in the heart of the Pyrenees, Andorra is a microstate known for its scenic beauty, high standard of living, and favorable tax laws. Despite its small size, Andorra has developed a comprehensive and efficient health insurance system, offering a unique blend of public and private healthcare services.
This article explores the intricacies of health insurance in Andorra—how it works, who is covered, how it is financed, and what makes it different from systems in neighboring countries.
1. Introduction to Andorra’s Healthcare System
Andorra’s healthcare system is widely regarded as one of the best in Europe. The country offers universal health coverage through a semi-public model that blends state support with private delivery.
The system is governed by the Caixa Andorrana de Seguretat Social (CASS), or the Andorran Social Security Fund, which is responsible for health insurance, pensions, and other social benefits.
Key characteristics of Andorra’s healthcare system include:
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Mandatory public health insurance for workers and residents.
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A reimbursement-based model where patients pay upfront and are later reimbursed.
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A well-integrated public-private healthcare network.
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High-quality medical services available both domestically and in nearby France and Spain.
2. The Role of CASS (Caixa Andorrana de Seguretat Social)
CASS is the central pillar of health insurance in Andorra. It manages contributions, reimburses medical expenses, and ensures access to essential healthcare services.
All employed individuals, self-employed workers, and residents are required to register with CASS. Employers are also mandated to enroll their employees and contribute to the system.
Coverage provided through CASS includes:
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Medical and hospital care.
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Specialist consultations.
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Surgery.
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Maternity and pediatric care.
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Pharmaceuticals.
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Rehabilitation and physiotherapy.
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Emergency and urgent care.
3. Contribution and Financing Model
Andorra’s health insurance system is funded through social contributions from employers, employees, and self-employed individuals.
Contribution Rates:
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Employers: 15.5% of the employee’s gross salary (of which 7% goes to health insurance).
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Employees: 6.5% of gross salary (3% allocated to health).
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Self-employed: 22% of declared income.
These contributions cover not only health insurance but also pensions and social benefits.
Non-working residents can also contribute voluntarily to access coverage through CASS.
4. Reimbursement Model: How It Works
Unlike many European countries with direct state-funded systems, Andorra uses a co-payment and reimbursement system. Here’s how it works:
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The patient pays upfront for medical services.
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The patient submits receipts and documentation to CASS.
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CASS reimburses a percentage of the cost—usually between 75% to 100%, depending on the service.
Reimbursement Rates:
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Primary care and general consultations: 75% reimbursed.
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Hospitalization and surgeries: Up to 90% reimbursed.
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Prescribed medications: 75% to 90% reimbursed.
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Workplace accidents or chronic conditions: 100% reimbursed.
This model encourages cost awareness and reduces unnecessary use of services, while still offering strong financial protection.
5. Healthcare Providers in Andorra
Andorra has a mixed healthcare provider model. Most physicians and specialists operate in private practice, but are affiliated with the public system and provide services reimbursed by CASS.
Key institutions include:
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Hospital Nostra Senyora de Meritxell – the country’s only public hospital, offering emergency, surgical, maternity, and intensive care services.
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CAPs (Centres d'Atenció Primària) – primary care centers throughout the country.
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Private clinics and specialists, especially in diagnostics, dental care, and physical therapy.
Andorrans also benefit from cross-border healthcare agreements with France and Spain, allowing them to access care in those countries when needed.
6. Private Health Insurance in Andorra
While the public system is comprehensive, private health insurance plays a supplementary role. Many residents and expats opt for private insurance to:
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Cover the remaining 10-25% not reimbursed by CASS.
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Gain faster access to specialists and elective procedures.
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Access additional services such as dental, vision, or alternative medicine.
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Obtain international coverage when traveling.
Leading private insurers in Andorra include Andbank Seguros, Crèdit Andorrà Assegurances, and international providers offering expat health plans.
Premiums vary based on age, medical history, and coverage levels, but are generally affordable due to the already high baseline of public coverage.
7. Coverage for Foreign Residents and Workers
Foreigners living or working in Andorra must register with CASS to access the health system. Legal residency or employment is required to enroll.
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Employed expats: Automatically covered through employer contributions.
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Self-employed expats: Must contribute directly.
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Non-working residents: Can enroll voluntarily by contributing a set amount monthly.
Tourists and short-term visitors are not covered by CASS. They must purchase travel insurance or private health insurance for the duration of their stay.
8. Maternity and Family Care
Andorra offers robust maternity and child healthcare, including:
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Prenatal checkups and delivery.
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Postnatal care and pediatric visits.
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Parental leave benefits through CASS.
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Child vaccination programs.
Mothers receive partial wage compensation during maternity leave, while healthcare services for children are heavily subsidized or free under the public system.
9. Health System Performance and Rankings
Andorra consistently ranks among the top countries for life expectancy, health outcomes, and access to care.
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Life expectancy: One of the highest globally (around 83–85 years).
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Infant mortality: Among the lowest in Europe.
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Healthcare satisfaction: High among both residents and expatriates.
The system’s mix of personal responsibility (via co-payments) and generous public support has contributed to a well-balanced, sustainable health model.
10. Challenges and Reforms
Despite its strengths, Andorra’s health insurance system faces some challenges:
a. Aging Population
Like much of Europe, Andorra has a growing elderly population, increasing pressure on long-term care and chronic disease management.
b. Healthcare Costs
While reimbursement helps contain costs, advanced treatments and external care in France/Spain can strain the system financially.
c. Dependency on Neighboring Countries
For some highly specialized treatments or emergencies, patients are transferred to hospitals in Barcelona or Toulouse.
d. Digitalization
Ongoing efforts are being made to modernize patient records, streamline reimbursement, and introduce e-health platforms.
The government is actively pursuing healthcare reforms, including telemedicine, integrated care networks, and better health data systems.
11. Conclusion
Andorra has successfully crafted a hybrid health insurance model that blends public coverage with private sector efficiency. By using a reimbursement-based system, the country balances access, cost control, and personal responsibility. Residents enjoy high-quality medical care with low financial barriers, while private insurance offers extra comfort and convenience.
As Andorra continues to evolve and adapt to new health challenges, its system remains a model of sustainable healthcare for small states and micro-nations. Whether you're a local, a foreign resident, or considering moving to this mountain paradise, understanding how health insurance works in Andorra is key to securing your well-being.