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NHS charges for people from abroad

NHS charges and people from abroad

Your entitlement to free NHS treatment depends on the length and purpose of your residence in the UK, not your nationality. There may be charges for some NHS services, for example, your dental treatment, and you may be entitled to help with these charges. Any free NHS treatment you receive, or any help with NHS costs, does not affect your immigration status.

If you are entitled to it, you can obtain free treatment immediately. There is no qualifying period.

If you have to pay for treatment because you do not meet the residence conditions, this does not count as discrimination. However, you must be given clear information about charges in a way you understand. This could include providing information in a foreign language or an interpreter, if necessary. If you aren't given clear information, this might be discrimination and you can complain about it.

For more information about making a complaint about the NHS in England, see Dealing with NHS problems - where to start. In Scotland, see NHS complaints. In Wales, see NHS complaints in Wales. In Northern Ireland, see HPSS complaints in Northern Ireland.

Treatment which is always free of charge

Some hospital treatment is free of charge for everyone who needs it, regardless of how long they have been or intend to stay in the UK. This is:-

  • treatment for accidents and emergencies as an outpatient in a hospital’s accident and emergency department. In England and Wales, emergency treatment in a walk-in centre is also free of charge. However, if you are referred to an outpatient clinic or admitted to hospital from an accident and emergency department, you will be charged
  • compulsory psychiatric treatment
  • In England and Scotland, compulsory treatment under a court order
  • treatment for certain communicable diseases, such as tuberculosis, cholera, food poisoning, malaria, meningitis and pandemic influenza. In England, HIV treatment is free. In Scotland, Wales and Northern Ireland, testing for the HIV virus and counselling following a test are both free of charge, but any necessary subsequent treatment and medicines may have to be paid for. If you have any problems with accessing HIV treatment, you can get advice from the Terrence Higgins Trust at THT Direct on 0808 802 1221
  • family planning services.

Who can receive all NHS hospital treatment free of charge

You can get free NHS hospital treatment if you are lawfully entitled to be in the UK and usually live here. This is called being ordinarily resident.

Some people from abroad who are not ordinarily resident in the UK can receive all NHS hospital treatment free of charge. If you are entitled to free NHS hospital treatment, family members including your spouse, civil partner and dependent children will also be able to get free treatment, but only if they are lawfully allowed to live in the UK. In many cases, they must also be living with you throughout your stay to qualify.

You can receive free NHS hospital treatment if you:-

  • have been living legally in the UK for at least 12 months when you start treatment, and did not come to the UK for private medical treatment. Temporary absences from the UK of up to three months (in England, up to 182 days) are ignored
  • have come to the UK to take up permanent residence, for example, if you are a former UK resident who has returned from abroad, or if you have been granted leave to enter or remain as a spouse
  • have come to the UK to work, either as an employee or self-employed person. In England and Wales, if you are employed, your employer's main place of business must be in the UK or be registered in the UK. This could be, for example, a branch of an overseas company. If you are self-employed your main place of business must be in the UK
  • normally work in the UK, but are temporarily working abroad for less than five years. You also need to have lived in the UK continuously for at least ten years before going overseas.
  • In Scotland, you normally work in the UK but are temporarily working abroad. You must have lived in the UK continuously for at least ten years and taken home leave in the UK at least once every two years. However, if you are studying abroad you may not be entitled to free NHS treatment
  • are receiving a UK war pension
  • have been granted, or made an application for temporary protection, asylum or humanitarian protection
  • in Wales, have applied for asylum
  • in England, are an failed asylum seeker in certain circumstances, or in Scotland and Wales, are a failed asylum seeker
  • in England, are a child the local authority has taken into care
  • have been identified as having been trafficked from abroad or are believed to have been trafficked from abroad
  • are imprisoned in the UK or detained by UK immigration authorities
  • get a UK state retirement pension and live in the UK for at least 182 days a year (in Scotland and Wales, six months a year) and live in another European Economic Area (EEA) member state or Switzerland for the other part of the year. If you have registered as a resident of another EEA state or Switzerland, you may be entitled to free NHS hospital treatment if you fall ill during a trip back to the UK
  • are from a European Economic Area (EEA) country or Switzerland and have a European Health Insurance Card (EHIC). The EHIC does not cover coming to the UK just to get medical treatment but it allows you to get free care if you're referred to the UK for pre-planned treatment with an E112 or S2 certificate
  • are a student following a course of study which lasts at least six months, or a course that is substantially funded by the UK, Welsh, Scottish or Northern Ireland Governments.

EEA countries are the European Union countries and Liechtenstein, Iceland and Norway.

To find out which countries are in the European Union, go to The European Union.

Visitors who can sometimes receive NHS hospital treatment free of charge

You are entitled to free NHS hospital treatment if you are one of the following people and fall ill during your visit. You are not entitled to routine treatment for a pre-existing condition.

You are entitled to receive free NHS care if you:

  • come from a country outside of European Economic Area and your country has signed a health care agreement with the UK. What you are entitled to depends on the agreement
  • get a UK state retirement pension or another state benefit and normally live in a non-EEA country. You must have lived lawfully in the UK for at least ten years continuously in the past, or worked for the UK government for at least ten years continuously. Your spouse, civil partner and dependent children are also entitled to free NHS hospital treatment if they fall ill. They must be living with you throughout your stay in the UK
  • have lived lawfully in the UK for at least ten years continuously in the past and are now living in an EEA member state, or Switzerland, or in a country with which the UK has a healthcare agreement. Your spouse, civil partner and dependent children are also entitled to free NHS hospital treatment if they fall ill. They must be living with you throughout your stay in the UK
  • in England, you have been granted leave to enter the UK for medical treatment. If you want free care, you must apply to the Secretary of State before you try to get treatment. Permission will only be given if there are exceptional humanitarian reasons to justify this. If you have been granted leave to enter the UK to accompany someone who is entitled to treatment for exceptional humanitarian reasons, you are also entitled to free NHS hospital treatment if you fall ill during your visit
  • in England, you are taking part in or involved with the London 2012 Olympic or Paralympic Games.

To find out which countries are in the European Union, go to The European Union.

To find out which non EEA countries have a healthcare agreement with the UK, go to www.nhs.org.uk

In addition, people from some countries can get free hospital treatment if they have been referred to the UK for that treatment, under the terms of the reciprocal agreement. There are also special arrangements with certain countries which enable people from outside the UK to get free treatment. The Department of Health can give details of countries with which the UK has a reciprocal agreement and for which there are special arrangements.

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GPs and dentists

It is up to the GP or dentist whether to accept you onto their list of NHS patients. They may accept you on their list if you are living in the UK, but they don't have to.

Visitors are not usually entitled to get non-hospital treatment. For example, if you used to live in the UK and then went to live abroad, you wouldn't normally get free treatment if you came back for a visit. There are some exceptions to these rules, for example, if you need emergency treatment.

A GP may, in practice, be flexible in deciding whether you are resident in the UK, in order to qualify for free treatment. You will usually have to show that your stay in the UK has some degree of permanence and stability.

If you are a visitor in the UK for less than three months, a GP may accept you as a temporary resident. Otherwise, a GP may offer to accept you as a private patient and you will have to pay for treatment.

You may have difficulty finding a GP or a dentist who is prepared to register you. In this situation you should contact, in England, NHS England. In England and Wales, you can also get help to find a doctor from NHS 111 service. In Scotland, you can contact NHS 24 on 0845 424 2424. In Northern Ireland, you should contact the Central Services Agency on 028 9032 4431 or go to www.hscni.net.

Even if you are accepted onto a GP or dentist's list of NHS patients, you have to pay charges for some things like prescription charges and dental treatment.

For more information about charges and the help you might get to pay for them, see Help with health costs.

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How hospitals decide who should pay

Hospital staff will ask you questions to work out whether you or your family member will have to pay for treatment.

In England, hospital registration staff will ask if:

  • you are a UK or EEA or Swiss national, or if you have a valid visa or leave to enter or remain in the UK and
  • which country or countries you have lived in during the past twelve months.

If you answer 'no' to the first question, the hospital's overseas visitors team will interview you to decide whether you have to pay for treatment.

You will also be interviewed if you say you have not lived in the UK in the past twelve months or you say you have lived in the UK and another country in the past twelve months. Registration staff may ask you to prove where you live.

In Scotland and Wales, hospital registration staff will ask if:

  • you or your family member have been living in the UK for the past twelve months or
  • you, or your family member intend to live in the UK permanently and
  • when you or your family member arrived in the UK.

In Wales, if you have been living in the UK for longer than 12 months, you will be asked to provide evidence that you have been living lawfully in the UK.

If you haven't been living in the UK for more than 12 months, you will be interviewed by the hospital to work out if you have to pay for treatment. You may be asked to give proof of your residence in the UK. Medical opinion may also be needed, for example, to prove that your illnesses began or got worse during your visit to the UK.

In Northern Ireland, there is a more simple procedure to identify who should pay for treatment, and the above process may not apply. You may be asked questions to confirm your residency.

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Paying for hospital treatment

Once the hospital has established that you must pay for treatment, you will usually be asked to pay the full cost in advance, unless emergency treatment is required immediately.

If you cannot pay in advance, the hospital will ask for a written undertaking to pay.

If you cannot provide proof that you can afford to pay, treatment will be refused and you may be offered the chance to be treated privately.

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Refusal of treatment

If you are not entitled to receive free NHS hospital treatment you will not be refused medical treatment that stabilises a life-threatening condition, for example, for renal failure. Treatment will be given to deal with the emergency, but you will be expected to return home for it to be completed, once the emergency is over.

If there is not an emergency, but treatment has to start immediately, you may be asked to give an undertaking to pay. In these circumstances, it is very important that you find out the likely cost.

If it is not urgent, you will be given the opportunity to refuse the treatment if you cannot afford it. Treatment can be delayed until you can raise the money. If you cannot do so, treatment will be refused.

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Complaints about charges

If you are entitled to free hospital treatment, but have been told that you will be charged, you should contact the Health Authority (England and Wales) or Health Board (Scotland and Northern Ireland) for a refund.

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