Published on and written by Cyril Jarnias
Sooner or later, moving to the United Kingdom raises a crucial question: how do you get medical care, at what cost, and with what rights as an expatriate? Behind the image of a universal public system, the National Health Service (NHS), lies a rather technical set of rules, which vary depending on immigration status, length of stay, country of origin, and even the nation where you live (England, Scotland, Wales, Northern Ireland).
This article deciphers in French the rules applicable to expatriates in the UK. It is based solely on the facts from a provided research report, without extrapolation, to constitute a practical, precise, and directly usable guide.
Understanding the NHS logic: residence rather than nationality
The NHS is a public system, funded by taxes, intended to provide “free at the point of use” care to people living in the UK. But free access depends neither on your passport nor on contributions paid. Everything revolves around a key concept: “habitual residence”, or ordinarily resident.
Being considered “ordinarily resident” means living in the UK legally, stably, and in the normal course of your daily life, for a certain period – without the law imposing a minimum duration. This status has nothing to do, legally, with nationality, possession of an NHS number, payment of UK taxes, or owning property.
To be recognized as a habitual resident in the UK, an expatriate subject to immigration control must generally have a durable residence status, such as *indefinite leave to remain* or a status under the *EU Settlement Scheme*.
Anyone who does not meet this definition is classified as an “overseas visitor” and becomes, in principle, chargeable for hospital care, unless exempt.
The rules for billing overseas visitors are set by the National Health Service (Charges to Overseas Visitors) Regulations 2015 and their amendments, which apply specifically to England. Scotland, Wales, and Northern Ireland have their own arrangements, sometimes more favorable, especially for certain vulnerable groups.
First point of access: the General Practitioner (GP)
For an expatriate, the good news is that access to primary care is widely open. Any person present in England can register with a General Practitioner (GP) practice and consult for free, regardless of their immigration status or country of origin. The GP remains the main gateway to the healthcare system: they provide family medicine, prevention, prescription renewals, and refer to hospital services.
Registering with a general practitioner is done by filling out the standard GMS1 form. Although some practices may ask for ID or proof of address, this request is not a legal requirement. Doctors are not allowed to screen patients based on their immigration status or lack of documents. A refusal to register is only legal for reasonable and non-discriminatory reasons, such as an already full patient list or the patient living outside the practice’s defined catchment area.
Even in case of refusal, the practice must explain its decision in writing within fourteen days and ensure, if necessary, “immediately necessary” treatment for free for a period of up to fourteen days. This applies to anyone presenting in the practice area, including a passing visitor.
For a stay of more than 24 hours and less than three months in the same area, it is possible to register temporarily with a general practitioner (GP). Under this arrangement, consultations with this doctor and with nurses remain free.
It is important to understand, however, that being registered with a GP does not by itself guarantee free hospital care. Full hospital free care depends on residence status or possible exemptions.
Emergency care, free services for all, and chargeable services
The UK healthcare landscape is divided into several blocks. Some services are free for everyone, others remain chargeable even to residents, and a large part of hospital care may be chargeable for expatriates depending on their status.
It is useful to clearly distinguish these categories.
Services always free, regardless of status
Several types of care are free for any person present in the country, whether they are a settled expatriate, tourist, student, or even without a residence permit, provided they did not travel to the UK with the explicit aim of receiving this treatment.
Among these services free for all, you notably find: services free for all
– Hospital emergency department services (Accident & Emergency, A&E), including at walk-in centers, minor injury units, or urgent treatment centers. The entire initial assessment, including exams, remains free of charge. However, if the patient is admitted to a hospital ward for follow-up or hospitalization, this part becomes chargeable for non-residents.
The cost of general practice and primary care nurse consultations is zero pounds, with no condition linked to immigration status.
– The diagnosis and treatment of many notifiable infectious diseases, including tuberculosis, HIV, or certain respiratory infections, as well as all sexually transmitted infections.
– Family planning services, in their contraceptive dimension (IUD fitting, pill, etc.), excluding abortion and infertility treatments.
– Care related to specific violence or trauma: consequences of torture, female genital mutilation, domestic or sexual violence, provided the person did not travel to seek this specific care.
– Palliative care provided by registered charities or community interest companies.
– The NHS 111 telephone advice service, as well as NHS 111 online, which provide guidance in case of doubt about the severity of a symptom.
– All screening, testing, treatment, and vaccination services related to COVID‑19, for which no immigration status verification is carried out.
Care deemed immediately necessary or urgent should never be delayed or refused for financial reasons. Even an expatriate liable for hospital charges must be given priority care in an emergency, with the bill settled later.
Chargeable services, even for residents
Even when fully eligible for free NHS care, some items remain the patient’s responsibility. Expatriates integrated into the system are no exception.
This is particularly the case for:
– Dental consultations and treatments under the NHS
– Prescriptions in England (but not in Scotland, Wales, and Northern Ireland)
– Part of optical care (eye tests, glasses, contact lenses)
– Some assisted reproduction procedures
– Purely cosmetic treatments.
For expatriates, it is essential to clearly distinguish between what falls under the partially chargeable NHS basket of care and what falls under the private sector (private dental practice, private clinic, etc.), where pricing is free and can be significantly higher.
Hospitalization, overseas visitor status, and surcharged billing
Where things get complicated for expatriates is at the hospital. NHS facilities have a legal obligation to determine whether a patient is “ordinarily resident” or should be considered an overseas visitor. In the latter case, the facility is required to charge for the care, unless the person falls into one of the many exemption categories.
For planned care, like cataract surgery, the hospital generally requires full payment in advance or the signing of a payment agreement before the procedure. In contrast, for an emergency such as acute appendicitis, care is provided immediately and billing occurs after treatment, even if the patient cannot pay upfront.
Billing for overseas visitors is based on the NHS national tariff, increased by 50%. In practice, a non-habitual resident expatriate will therefore be billed 150% of the usual NHS tariff. The government publishes a reference schedule, the Overseas Patient Tariff, which serves as the basis for these calculations.
Summary table of key points to know regarding healthcare billing for overseas visitors in England.
Overseas visitors may be subject to charges for using the National Health Service (NHS), except under reciprocity agreements or for certain emergency services.
It is strongly recommended, and often required for visa issuance, to take out private health insurance covering the stay in England.
Immediately necessary treatments at emergency departments (A&E) are generally provided without upfront fees, but subsequent care may be billed.
A passport or ID may be requested to verify eligibility for free care and avoid incorrect billing.
Some countries have agreements with the UK (like those of the EEA or bilateral agreements) allowing access to medically necessary urgent care.
It is possible to receive a bill after treatment, even if no fees were mentioned at the time. It is crucial to keep all documents.
| Patient Situation in Hospital (England) | Billing Rule |
|---|---|
| Habitual resident (ordinarily resident) | Hospital care covered by the NHS (excluding usual charges) |
| Holder of a visa with Immigration Health Surcharge paid | Rights equivalent to a habitual resident for the visa duration (excl. dental, prescriptions..) |
| Overseas visitor without specific right or exemption | Billing at 150% of the NHS national tariff |
| Non-urgent or planned care for overseas visitor | Full payment required before care is provided |
| Urgent or immediately necessary care for overseas visitor | Treatment carried out, bill issued afterwards |
| A&E services without admission | Free for all |
In practice, a hospital may choose not to recover a debt when the patient is clearly unable to pay, for example in a situation of great hardship. But this discretion remains limited and the existence of a significant unpaid debt (generally over £500 for more than two months) can impact future visa applications or entry to the UK, as information can be shared with the Home Office.
Immigration Health Surcharge: the visa-linked health “subscription”
For the vast majority of expatriates moving to the UK with a visa lasting more than six months, a key component is the Immigration Health Surcharge (IHS). This is a health contribution paid at the same time as the visa application, in one lump sum for the entire permit duration.
The amount depends on the visa category. According to report data, several levels have been in force in recent years, but the logic is constant: a reduced rate for students, Youth Mobility visa holders, and minors, and a higher rate for other expatriate categories.
We can summarize the orders of magnitude indicated in the sources as follows:
| Visa Applicant Category (stay > 6 months) | Immigration Health Surcharge Level (per year) |
|---|---|
| Students, Youth Mobility visas, children under 18 | Approx. £470–£776 depending on the regulatory period |
| Other categories (work, family, etc.) | Approx. £624–£1,035 depending on the regulatory period |
The principle, however, is clear: once the IHS is paid and the visa is granted, the expatriate has, for the validity period of their visa, access to NHS hospital care in England under conditions similar to those of a habitual resident. They remain, however, subject to the same charges as everyone for prescriptions, dental care, or specific procedures like assisted reproduction.
Certain groups, such as asylum seekers, some victims of trafficking, people applying for ‘indefinite leave to remain’, or others benefiting from specific protections, are exempt from paying the IHS surcharge. In contrast, holders of a standard visitor visa (stay ≤ 6 months) do not have to pay it, but are not entitled to free hospital care in the UK; they are therefore strongly advised to take out private health or travel insurance.
Europeans, reciprocal agreements, and the effects of Brexit
For nationals of the European Union, the European Economic Area, and Switzerland, the landscape has been profoundly reshaped by Brexit. However, several tools still guarantee at least partial access to NHS care.
EHIC, PRC, and S2: the toolbox for temporary stays
A European expatriate on a temporary stay in the UK can, under certain conditions, use the European Health Insurance Card (EHIC) issued by their country of residence. This card entitles them to coverage of “medically necessary” care during their stay, including for pre-existing conditions and routine maternity care, as long as the primary purpose of the trip is not to receive treatment or give birth.
In the absence of an EHIC card, it is possible to request a *Provisional Replacement Certificate* (PRC) from the health insurance institution of the country of origin, which will serve the same purpose. Failing to present one of these documents, hospital care may be billed at the overseas visitor tariff, i.e., 150% of the NHS tariff.
Advice for healthcare abroad
For planned care, such as a scheduled procedure, the European expatriate must use the S2 scheme, which allows the public insurer in their country of residence to cover in advance a treatment carried out in the UK. Only care provided by the public sector is covered and co-payments (e.g., prescription charges) remain the patient’s responsibility.
Norwegian visitors can obtain medically necessary care simply by presenting a valid passport. For nationals of Iceland, Liechtenstein, and Switzerland, the situation is more restrictive: billing at the overseas visitor tariff may apply, unless a specific agreement covers the stay.
European residents in the UK and the EU Settlement Scheme
EU citizens, and those of Norway, Iceland, Liechtenstein, or Switzerland who were legally living in the UK before the end of the Brexit transition period and obtained, or applied on time for, a status under the EU Settlement Scheme (pre‑settled or settled status) can continue to access the NHS for free, provided they are considered ordinarily resident.
Those who arrived after this date are treated as any other third-country national: for a stay of more than six months, they must obtain a visa and pay the Immigration Health Surcharge. For a shorter stay, they cannot rely on overall free hospital care and must insure themselves against the risk of billing.
Returning British expatriates and those living abroad
An element often misunderstood by expatriates themselves is that eligibility for the NHS does not follow the passport. A British citizen who has left the UK to settle permanently abroad is no longer automatically covered by the NHS when they return for a visit. They are then treated as an “overseas visitor” and may be billed at 150% of the NHS tariff, unless they benefit from a coverage agreement from their country of residence (through an EHIC, PRC, or S2) or another scheme (S1, for example, for certain retirees).
A British citizen who returns to settle stably in the UK immediately becomes ‘ordinarily resident’ again and regains the right to free NHS care. They often need to prove this permanent return with evidence such as a rental or purchase agreement, an employment contract, or the cancellation of foreign health insurance.
For British nationals settled in the EU or in certain countries with a reciprocity agreement with the UK, there are specific mechanisms like the S1 form, which allows the UK to fund their care in their country of residence while preserving access to the NHS during temporary visits.
Prescriptions, financial contributions, and rules between UK nations
In the field of medication, expatriates must navigate a landscape that is both simple and fragmented. In England, most prescriptions are chargeable: a fixed fee is applied per prescribed medication. The report indicates a standard amount of £9.90 per medication in 2025. This is not the case in Scotland, Wales, and Northern Ireland, where prescriptions are free for patients residing and registered locally.
For people on long-term medication with multiple drugs, the Prescription Prepayment Certificate (PPC) scheme is a beneficial option. It works like a subscription: in exchange for a single lump-sum payment, valid for a period of three or twelve months, it significantly reduces the overall cost of all medical prescriptions during that period. This system is specifically designed to lighten the bill for patients with many prescriptions to renew regularly.
Certain categories are exempt from these prescription charges in England: children and young people in full-time education, people aged 60 and over, pregnant women or those who have given birth in the last twelve months, people with certain chronic conditions benefiting from a medical exemption certificate, or those eligible for the NHS Low Income Scheme.
The HC1 form allows you to obtain an HC2 certificate (full help) or HC3 (partial help). This help covers part of dental costs and other health costs beyond prescriptions, for people on low incomes and certain expatriates in great hardship without recourse to public funds.
Specific rules also govern “cross-border” prescriptions within the UK. For example, a Welsh or Scottish patient who has a prescription filled in England must pay the English tariff, unless they have special exemption cards, while an English patient presenting their prescription in Wales or Scotland may be subject to the tariff of their country of origin, even if the act is carried out in another nation.
Dental care: often difficult terrain for expatriates
Dental care is a chapter in itself in the life of an expatriate in the UK. In theory, any resident, including an established expatriate, can access NHS dental care. In practice, finding a dentist who accepts new NHS patients can sometimes be very difficult, with “dental deserts” in some regions, waiting lists that can stretch for years, and a high proportion of dentists practicing partially or exclusively in the private sector.
The costs of procedures carried out under the NHS are regulated in England according to three main bands of care, with a fixed price per “course of treatment” rather than per individual procedure. The research sources provide several schedules, reflecting changes over time, but the structure remains similar:
| NHS Dental Care Band (England) | Main Content (examples) | Example Indicative Price* |
|---|---|---|
| Band 1 | Examination, diagnosis, x-rays, advice, scale & polish if clinically needed | ≈ £23–£27 |
| Band 2 | All Band 1 care + fillings, root canals, extractions | ≈ £65–£75 |
| Band 3 | All Band 1 & 2 care + dentures, crowns, bridges | ≈ £280–£330 |
– The precise amounts change regularly; the figures above illustrate the orders of magnitude from the data cited in the report.
Dental emergencies are generally charged at the Band 1 rate. In case of severe facial trauma or extreme pain with other symptoms, you should go to the emergency department (A&E) of a hospital, where the emergency consultation is free.
Certain patient categories benefit from total free NHS dental care: children under 18, young people under 19 in full-time education, pregnant women or those who have given birth (or had a late miscarriage or stillbirth) in the last twelve months, as well as people receiving specific social benefits (Income Support, guaranteed pensions, certain jobseeker’s or disability allowances, etc.) and their dependents under 20. People on low income who are not already covered by these benefits can apply for help via the NHS Low Income Scheme.
For expatriates, NHS dental practices cannot require proof of identity, address, or immigration status, nor refuse a patient due to their dental condition or a protected characteristic (gender, origin, religion, sexual orientation, disability, etc.). However, they can limit the number of NHS patients they accept, which contributes to shortages in some areas.
In reality, many expatriates turn to private care, an activity practiced by about one-fifth of dentists exclusively, and by the majority in a mixed NHS/private mode. Prices there are much more variable, with no regulatory cap, but appointments are often quicker, with more time devoted to the patient and increased availability in the evening or on weekends. Some private health insurance policies, including international plans for expatriates, offer more or less extensive dental coverage.
Vulnerable groups, refugees, and asylum seekers
For humanitarian reasons, the British system provides broad exemptions for certain profiles of forced migrants: refugees, asylum seekers, victims of human trafficking, children in the care of local authorities, detainees, people under compulsory psychiatric treatment, etc.
All asylum seekers in the process and recognized refugees, as well as their dependents, benefit from full free NHS care, including hospital care. People whose asylum claim has been refused also retain this free access if they receive certain public support (accommodation, allowances) provided for by specific laws. In all cases, access remains free for general practice, emergency (A&E) care, treatment of infectious diseases, and care for victims of violence.
However, recent research shows that this population suffers from poor oral health, frequent pain, low use of dental services, and many barriers to access: cost, unfamiliarity with the system, language problems, inflexible hours, fear of billing or stigma.
To facilitate access to dental care, public health agencies in the UK have developed a seven-step pathway to guide asylum seekers and refugees to an NHS dentist. This model includes the use of mediators and professional translators, and recommends a dental visit within the first month of arrival.
For practitioners, methodological guides emphasize the importance of taking a detailed oral history (hygiene habits, diet, tobacco and alcohol consumption), systematically offering professional interpreting services when language is a barrier, avoiding asking for immigration status documents, and informing patients about their care rights and possibilities for financial exemption.
Mental health, waiting times, and recourse to private care
While the article focuses mainly on general access to care, it would be incomplete without a word on mental health, very often at the heart of expatriates’ concerns when facing isolation, work stress, or cultural adaptation.
The NHS offers free mental health services, ranging from first-line psychotherapy (programs like NHS Talking Therapies in England) to psychiatrist consultations and hospitalizations. Access is most often via the GP, who refers to the appropriate services, but self-referral systems exist for certain conditions (anxiety, depression, OCD, PTSD).
Waiting times to see a specialist in the public sector can be very long, often exceeding twelve weeks. For quicker access to care, many residents and expatriates turn to the private sector or charities. International insurers (Cigna Global, Bupa Global, Allianz, AXA, etc.) offer optional mental health coverage, covering psychotherapy, psychiatric consultations, and sometimes hospitalization in a specialized clinic.
It should be kept in mind, however, that mental health, like the rest of care, remains an area where the NHS remains the primary safety net, especially for serious cases requiring legal oversight (psychotic episodes, suicide risk, etc.), covered by the Mental Health Act.
The interplay between the NHS and private insurance for expatriates
The UK does not impose mandatory private health coverage on expatriates. However, authorities strongly recommend that all visitors and residents not covered by the NHS, or uncertain of their status, take out comprehensive health or travel insurance. This recommendation is particularly insistent for those coming from countries outside the EU/EEA without a reciprocity agreement.
The private sector does not replace the NHS for life-threatening emergencies, but it is a valuable complement for:
The main benefits offered by private health insurance for residents in the UK, beyond the public NHS service.
Accessing specialists more quickly, bypassing NHS waiting lists.
Choosing your hospital, surgeon, or dentist more freely.
Benefiting from private rooms and more comfortable accommodation conditions during hospitalization.
Covering care little or not covered by the NHS: extended dental, optical, some elective surgeries, in-depth preventive medicine, etc.
Organizing potential medical repatriations or care abroad.
Policies come in two main families: local British policies, which complement the NHS for residents, and international insurance for expatriates, designed to cover care both in the UK and in other countries (including the home country), with high limits, multilingual services, and high portability.
An expatriate holding a visa who has paid the health surcharge (IHS) and is ordinarily resident can use their private insurance for quick consultations, dental, optical care, or non-urgent operations, while relying on the NHS for emergencies and major care. Conversely, a short-term visitor without IHS must consider their private insurance as their primary coverage, as they would be billed 150% of the NHS tariff in case of hospitalization without insurance.
Documentation, status checks, and data protection
A point that sometimes worries expatriates concerns immigration-related checks when accessing care. In practice, GP practices are not responsible for checking immigration status nor for playing a role as an auxiliary to the Home Office. They may ask for proof of address for administrative reasons, but should not refuse registration in the absence of papers, as illustrated by the “Safe Surgeries” doctrine promoted by some NGOs.
Hospitals must identify patients who may be liable for charges as overseas visitors. To do this, they may require documents (passport, residence permit, proof of address, proof of employment or studies) and, within a regulated framework, consult the Home Office to verify immigration status.
Conversely, facilities must, in certain cases, inform the Department of Health and Social Care of unpaid debts exceeding a certain threshold and duration, information which may itself be shared with the Home Office. Nevertheless, the confidentiality of medical data remains protected by British and European law: clinical information is not supposed to be transmitted to immigration authorities as part of these exchanges.
Living and receiving healthcare in the UK as an expatriate: key takeaways
The UK healthcare system, viewed from abroad, can seem both generous and intimidating. Generous, because it widely opens the doors to general practice and emergency services to all, regardless of nationality or immigration status. Complex, because the line between free care and billing depends on a mosaic of criteria: type of visa, length of stay, country of origin, ordinary resident status, belonging to a vulnerable group, existence of bilateral agreements, possible payment of the Immigration Health Surcharge, etc.
For an expatriate considering moving to the UK, a few key lines emerge from the data gathered in the report:
To secure your access to healthcare in the UK, it is crucial to anticipate several steps. First, quickly determine whether you will be considered “ordinarily resident” and for which types of care. Next, check if your visa application involves paying the “Immigration Health Surcharge” (mandatory for a stay of more than six months) and understand precisely the rights it grants. It is also recommended to register promptly with a general practitioner (GP), even with incomplete documents, to guarantee access to primary care and preventive services (vaccinations, screenings, pregnancy follow-up). Depending on your situation (student, posted worker, spouse of a British citizen, retiree, asylum seeker…), identify the exemptions you may be entitled to. It is also important to inquire about the specific rules of the UK nation (England, Scotland, Wales, Northern Ireland) where you are settling, as charges (e.g., on prescriptions) and hospital tariffs can vary. Finally, beyond the public NHS system, consider the usefulness of private or international health insurance, especially to reduce waiting times and cover dental, optical care, or certain treatments not covered by the NHS.
The NHS remains, despite its fragilities and administrative constraints, a pillar of security for millions of people, expatriates included. But to fully benefit from it, it’s better to prepare with a clear understanding of the rules of the game, rather than discovering them through a hospital bill at 150% of the national tariff.
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Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.
On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.
Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.
