Health care in Andorra: no CAK, the CASS for whoever works, your own policy for whoever does not, and one hospital
Andorra is not a treaty country for health care: after you emigrate there is no CAK scheme. If you work in Andorra, you are compulsorily insured with the CASS, for 6.5 percent of your wage; as a self-employed person you pay 22 percent on a base you choose. Through your regular GP the CASS reimburses 75 percent of a consultation and 90 percent of a hospital stay. Whoever comes on passive residence or as a nomad does not pay the CASS and needs a private policy.
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Andorra is not a treaty country for health care. The CAK, which arranges health care for pensioners in treaty countries, does not list Andorra. After you emigrate your Dutch basic insurance stops, and there is no CAK scheme. In Andorra health care runs through the CASS, the Caixa Andorrana de Seguretat Social: the Andorran social security for health care and pensions. If you work, you are compulsorily insured there. If you do not work, you need your own policy.
Who is insured how?
| Situation | Who arranges it | What you pay |
|---|---|---|
| You are an employee | the CASS, through your employer | 6.5% of your wage; your employer pays 15.5% |
| You have your own business | the CASS, yourself | 22% on a base you choose: €146.99 a month in the first year, €587.95 at the full base |
| Your partner without work, your children up to 24 | co-insured with the CASS | |
| You live on passive residence or as a nomad | yourself, with a private policy that covers all medical costs in Andorra | the whole premium |
| You are 60 or older, without work | yourself; the policy only needs to cover medical costs | the whole premium |
How does the CASS work?
As an employee, your employer withholds 6.5 percent of your wage: 3 percent for health care and 3.5 percent for your pension. As a self-employed person you pay 22 percent on a percentage of the average wage the CASS uses (€2,672.52 in 2026); in the first year you may start at 25 percent.
The CASS works with a regular GP, the metge referent, and the via preferent: the preferred route. If you stay within that route, the CASS reimburses 75 percent of a consultation, an examination and medicines, 65 percent of rehabilitation, 90 percent of a hospital stay and 100 percent for pregnancy and childbirth. If you go outside it, that is 33 percent for a consultation or hospital stay and 60 percent for the rest. With a doctor without an agreement with the CASS you get 20 percent. For an accident at work, an occupational disease and on a low income the CASS reimburses 100 percent; for a chronic illness 90 or 100 percent. You pay the difference yourself, or you take out a supplementary policy.
Who is co-insured?
Your spouse or registered partner, your children up to and including 24 and whoever is fully dependent on you are assegurat indirecte: co-insured. Conditions: no work of their own, living legally in Andorra, and no pension that itself gives a right to health care. Your parents do not count.
What if you do not work?
Whoever comes on passive residence or as a nomad pays no contributions to the CASS and is not insured there either. Immigració then requires a private policy that covers 100 percent of the medical costs in Andorra, for the whole term of your permit, plus cover for disability and old age. If you are 60 or older, only the medical cover is needed. At every renewal you submit the policy again.
Voluntary membership of the CASS is only open to a few groups, such as whoever lived in Andorra for ten years and received a pension capital there. A Dutch pensioner who has just arrived does not fall under that. So count on a private policy, and ask for a quote before you leave: an insurer may assess a 67-year-old differently from a 40-year-old.
Where do you go when you are ill?
Andorra has one hospital: the Hospital Nostra Senyora de Meritxell in Escaldes-Engordany, telephone 871 000. For an ambulance you call 116, for a general emergency 112, for the police 110 and for the fire brigade 118.
What the hospital cannot do is done in Spain or France. Your regular GP refers you, and the CASS gives permission if the waiting time is too long (more than a week through the preferred route, more than a month outside it), if the specialism is missing or if your treatment is already running there. The CASS has agreements with hospitals in Catalonia, such as Vall d'Hebron, Clínic and Sant Pau in Barcelona and Arnau de Vilanova in Lleida, and with the CHU de Toulouse in France. For that you request a volant, the referral slip, at least three working days in advance; the French daily hospital charge is not reimbursed by the CASS. In an emergency the referral is not needed.
Why do you arrange it before you leave?
The CAK writes: if your new country of residence is not in the list, take out health insurance yourself. For Andorra that means: your policy starts on the day your Dutch insurance stops. As an employee you are only insured once your employer has registered you with the CASS; cover the weeks before that with travel insurance or a temporary policy. How you cancel your Dutch insurance without a single uninsured day is in cancelling your health insurance without a gap.
Your application also includes a medical examination by the Servei Mèdic d'Immigració, on the next working day after you submit. You do not need to come fasting; the cost is included in the fees. The examination is about public health, such as infectious diseases, and the day after it you get your permit. If you take medicines with you, read medicines across the border.
In Vertrekklaar this is phase 5 of 5 of the journey, step 5.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Andorra or go straight to step 5.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- CAK — the treaty countries for health care; Andorra is not listed — hetcak.nl
- CASS — the contributions for employees and employers — cass.ad
- CASS — the contribution for the self-employed, with the amounts per base — cass.ad
- CASS — the via preferent, with the reimbursements of 75 and 90 percent and the referral abroad — cass.ad
- CASS — who is co-insured as assegurat indirecte — cass.ad
- CASS — reimbursement up to 100 percent, the exceptions — cass.ad
- CASS — the hospitals and doctors in Catalonia with an agreement — cass.ad
- CASS — the hospitals in France with an agreement — cass.ad
- Decret 407/2025 — the regulation for residence without work, with the insurance requirement (article 3) and the examination (article 7) — documents.bopa.ad
- SAAS — the medical emergency number 116 — saas.ad
- NederlandWereldwijd — travel advice Andorra, with the emergency numbers — nederlandwereldwijd.nl
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