UK health insurance for foreign expats

The UK’s public healthcare system, the National Health Service (NHS), was launched in 1948, making it the first public healthcare system that was free at the point of delivery and available to everyone.⁵ The NHS was founded on the ideal that good healthcare should be available to all, regardless of wealth or the ability to pay. 

Today, the NHS is guided by seven key principles, as outlined by its constitution. These principles include the fact that NHS services are available to all, and that access will be based on clinical need, not an individual’s ability to pay. It’s a public healthcare system, funded by taxes, so the constitution also states that the NHS is accountable to the people it serves and that it’s committed to providing the best possible value for money to all taxpayers.  

Even though it’s funded through taxes and free at the point of use, the UK’s healthcare system is complex. Each of its four countries – England, Scotland, Wales, and Northern Ireland – operate slightly different systems. They’re each funded separately, with Scotland, Wales and Northern Ireland receiving block grants from the UK central government to fund their own systems as they see fit. Visit the NHS website for more information on the different UK health systems and how they work.  

Each of the four systems provides healthcare through different local authorities and regional teams that, in turn, oversee various NHS trusts, foundations and care organisations. So, while the key principles of the NHS should remain consistent wherever you are in the UK, the reality is that the speed and quality of your experience could differ depending on your location as well as what type of service you need. 

One of the seven key principles of the NHS is that it ‘aspires to the highest standards of excellence and professionalism’.  

Overall, the healthcare system in the UK offers high-quality healthcare services and facilities. It was ranked 15th in the World Index of Health Innovation, published by the Foundation for Research on Equal Opportunity (FREOPP) in 2022.⁶ Your experience will depend on your location, but UK hospitals and clinics tend to be equipped with modern medical equipment and staffed by well-trained personnel.  

The UK has extensive experience in healthcare research, innovation, and training, with some of the best research facilities and universities in the world. In fact, in the Times Higher Education 2024 list of the world’s best universities for medicine, three of the top five places were filled by UK universities – Oxford University and Cambridge University placed first and second respectively, while Imperial College London was fourth.⁷  

Each country within the UK oversees its own NHS body. The differences between them are largely structural, but there can be differences in the services that are covered and the way they’re delivered. But, as a rule, the NHS is committed to covering all aspects of medical care, including: 

• GP (General Practitioner) appointments 
• Emergency healthcare, including treatment at the A&E (Accident and Emergency) department in NHS hospitals 
• Hospital follow-ups, operations and inpatient stays 
• Maternity care, including pre-natal appointments 
• Health screenings, imaging scans (like MRI scans and X-rays) immunisations and vaccinations 
• Physiotherapy and rehabilitation services 
• Inpatient medication 
• Clinically necessary dental care 
• Mental health care 
• Palliative care and some long-term care 
• Home visits by community-based nurses 
• Subsidised dental care 

Prescription medication (this is either subsidised or free depending on where you are in the UK). 

Most NHS services are free at the point of care. This means you won’t have to pay any deductibles or co-payments, nor do you have to pay up front and then claim the money back later through an insurance scheme.  

There are, however, a few exceptions and services that don’t fall under the NHS umbrella.  

For example, in England you may have to make a small co-payment for prescription medication. The current prescription charge is £9.65 per item,⁸ which you’ll pay over the counter when you pick up your medication at a pharmacy. Prescriptions are currently free of charge in Scotland, Wales, and Northern Ireland, as well as during inpatient hospital stays, so you don’t pay for any drugs you receive during hospital treatment.  

Most adults need to make payments for NHS dental care. The amount you’ll pay will depend on the type of treatment you have, where you are and your individual circumstances. The costs are determined by the different NHS bodies, so the amount you’ll pay will depend on which country you live in. 

And, while the NHS does provide free eye tests for some people, including under 16s and over 60s, you can expect to pay for most other optical care. This includes any prescription glasses or contact lenses. 

All UK residents, including expats, can access NHS services for free. However, whether you’re moving to the UK to settle down, work or study, you’ll need the right visa or permit before you can become a lawful resident. 

Depending on your immigration status and the type of visa you’re applying for, you might also need to pay an immigration health surcharge (IHS) as part of your visa application. This is something you should thoroughly investigate and research while planning your move – you’ll find a comprehensive overview on the UK’s government website.  

Once you've been granted a resident status through your visa application and have received your Biometric Resident Permit (BRP) in the UK you’ll be able to register with the NHS. The first step is to find a local GP practice and register with them by filling in a GMS1 form – this can be done online via the GP’s website, or you can fill it out at the surgery. You can also download the form here and bring it with you to your first appointment. You may also need to show a proof of address and valid ID as part of the registration process. 

You’ll then be assigned an NHS number, which will be displayed on the registration letter you receive in the post. 

Following the UK’s exit from the EU, there’s no longer freedom of movement, so you’ll need to go through the process of becoming a resident as outlined above.  

However, if you’re from an EU country or Switzerland, you’ll still be able to use your European Health Insurance Card (EHIC), or a new UK Global Health Insurance Card (GHIC), on a temporary visit to the UK. This means your EHIC will enable you to access public healthcare in the UK if you have a medical emergency or fall ill during your stay. This includes the treatment of pre-existing conditions and routine maternity care, as long as the reason for your visit isn’t specifically for the purpose of receiving medical attention or to give birth. 

It's important to note that the EHIC and GHIC don’t cover planned treatment, medical evacuation, or any private healthcare for EU citizens. They are only valid for necessary treatment during temporary stays and shouldn’t be seen as an alternative to registration with the NHS or international health insurance. 

Once registered with the NHS, the process of using the different services should be relatively straightforward. However, as mentioned before, while public healthcare is delivered through the NHS, each nation has its own structure. This means the process for accessing certain healthcare services may vary depending on where you are, so the following is more of a general overview, based mainly on NHS England. 

Doctors and GPs  

As a rule, your local doctor or GP will be the first point of contact for any medical or health concern. You’ll need to have a referral from them to get an appointment with a specialist, a physiotherapist, or a mental health professional through the NHS. 

You’ll need to be registered with a local GP practice. There are separate directories online for GPs in England, Scotland, Wales and Northern Ireland. Once you’ve found a GP surgery, you can complete your registration by filling in a GMS1 form online (via the GP’s website) or in-person at your first appointment. You can also download the form here and bring it with you. Be aware that some GP surgeries may not be able to accept new patients depending on their capacity. 

Once registered with a GP, you can make an appointment over the phone, in-person or online if your GP practice has an app or web booking form. Waiting times to see a GP will depend on where you are and on your individual circumstances. Most GPs have emergency appointments each day, but for routine appointments you could find yourself waiting for over a week. Some surgeries now open outside of normal business hours, while out of hours help is available by calling 111 or visiting the A&E department of your nearest hospital. 

Specialists

To see an NHS specialist, you’ll need a referral from your GP, so you’ll first need to make an appointment with them as outlined above. They will assess your case and refer you if they feel it’s clinically necessary. 

An exception to this is in the event of an emergency, where you can be referred to a specialist or admitted to hospital directly from the A&E department if necessary. Otherwise, a specialist will only see you if you have a referral letter from your GP.  

It’s worth noting that some NHS services and specialisms are very stretched, so GPs may suggest further tests or other forms of treatment as a first step. If you do get referred, you could be waiting for up to 18 weeks to see a specialist.  

Hospitals

If your GP or a specialist deems it necessary for you to have a hospital appointment, you'll be sent a letter, email and / or text message that tells you everything you need to know about your appointment. This will include details of where to go, when to arrive, what to bring, how to prepare and whether you need to refrain from eating before a procedure. 

You’ll need to arrive ahead of your appointment time and sign in at the relevant reception desk. Most hospitals have an information desk to help point you in the right direction.  

Emergency care 

In an emergency, there are a number of options open to you. 

For life-threatening situations, the emergency telephone number in the UK is 999.  

Alternatively, if you need urgent medical attention, you can call 111 or visit 111.nhs.uk to be directed to appropriate support. You can also go to your nearest hospital’s Accident & Emergency department (A&E) department or to an urgent treatment centre without an appointment, though if you call or visit 111 first, they’ll be able to advise on where best to go. 

In the UK, emergency healthcare services are free to all, regardless of whether you’re fully registered with the NHS or as a resident. 

Pharmacies and medication 

Pharmacies are located throughout the UK, either as stand-alone facilities or connected to larger shops, including some larger supermarkets and Boots stores.  

In England, you may have to make a small co-payment for prescription medication of £9.65 per item. You’ll pay for this over the counter when you pick up your prescription and it only applies to outpatient medication from the pharmacy, so you don’t pay for any drugs you receive during a hospital treatment.  

Prescriptions are currently free of charge in Scotland, Wales, and Northern Ireland. 

Pharmacists in the UK are qualified healthcare professionals who train in the use of medicines for five years. They’re also qualified to provide health and wellbeing advice, and to treat or help manage minor conditions that don’t need a prescription. 

Dental care in the UK  

To access dental care in the UK, you’ll need to be registered with a dentist. There are directories online, and it may take some time to find a dentist that’s accepting new NHS patients depending on what area you’re in. 

Dental care is subsidised through the NHS, but it’s usually not free. There are some exceptions to this, but most adults need to make payments for NHS dental care. The amount you’ll pay will depend on the type of treatment you have, where you are and your individual circumstances.  

In England, there are three price bands. The first is £25.80, which covers things like routine examinations, diagnosis, advice and any clinically needed X-rays or scale and polish. The second band is £70.70. This covers everything in Band 1 as well as further treatment including fillings, tooth extraction or a root canal. The third band is £306.80 and includes everything in Band 1 and Band 2, plus more complex procedures, like a crown or a bridge.⁹

In Wales, services are banded in the same way, but the costs are lower – Band 1 is £14.70, Band 2 is £47 and Band 3 is £203. In Scotland, NHS dental examinations are free. You’ll then have to pay 80% of the costs of any additional treatment, up to a maximum of £384. Northern Ireland operates the same system as Scotland, except the initial examination isn’t free and can cost between £7.62 and £23.94.⁹

As the NHS covers most healthcare services, and emergency care is available to all, private health insurance isn’t mandatory. However, if you’re not able to register with the NHS for any reason, or if you’re waiting for your registration to go through, it could save you from incurring large medical bills as healthcare costs can build up quickly. UK Private health insurance cover also gives you more choice than the NHS and can reduce the amount of time you wait to receive treatment. And, depending on the plan you take out, private health insurance in the UK can also cover dental care, optician fees and medication costs in England. 

The UK public healthcare system differs to many other European countries. It has a government sponsored universal healthcare system called the called the National Health Service (NHS). This means expats can access the NHS free of charge, but their eligibility and the extent of their cover can vary.

Expats under temporary residency staying in the UK for more than six months might need to pay the Immigration Health Surcharge (IHS) as part of your Visa application. This grants access to NHS services. The prices are as follows:

- £624 per year for most adults

- £470 per year for students, Youth Mobility Scheme applicants, and children under 18.¹⁰

Expats labelled as permanent residents and have ‘settled status’ or ‘indefinite leave to remain’ will have full access to the NHS on the same basis as a resident. 

999 and 112 are the UK emergency numbers. The European emergency number is also 112. Both numbers can be used to call for all types of emergencies.

You can use your European Health Insurance Card (EHIC) if you're visiting from an EU country. If your care is deemed medically necessary, you'll have access to state medical care and receive treatment. Please note EHICs only cover you for state healthcare, so you’ll still be responsible for the costs of private healthcare.