Living Abroad, Medical Insurance and Getting NHS Treatment

A recent case involving an expatriate British woman living in Turkey who sought treatment under the NHS has highlighted the fact that, once you move abroad and make your permanent residence somewhere outside the UK, you lose your automatic right to free care and treatment under the NHS.

However, other expats have experienced a different scenario and some expatriate forums suggest ways in which Brits can get around government rulings that ban the free treatment for non-resident Britons…

So in this article we’ll be looking at living abroad, medical insurance and getting NHS treatment so that if you’re already living abroad or you’re thinking of retiring overseas or working away from home, you’ll know what your entitlement is, what your own financial liabilities and obligations are, and where you can turn if you do find you need treatment and care.

A recent judicial review of one’s entitlement to NHS treatment took place after a failed asylum seeker in the UK was given free care under the NHS system.  The findings of this review are relevant to expatriate Britons because they state the following: -

“All patients, regardless of their status or nationality are subject to the same basic screening process and should be asked the following question about their residential status as part of the hospital registration procedure:
• Where have you lived for the last 12 months?
• Can you show that you have the right to live here?

A person who has not been living in the UK for the last 12 months is subject to the NHS (Charges to Overseas Visitors) Regulations and can therefore expect to be asked further questions such as,
• On what date did you arrive in the UK?
• What is the basis for your stay in the UK?

Patients who are unable to provide answers to these questions, or whose answers indicate that they may not be eligible for free hospital treatment should be referred to the NHS trust’s Overseas Visitors Manager, who will conduct a full interview with the patient to establish whether he/she is chargeable.  However, immediately necessary treatment should never be delayed or withheld because of doubts about the patient’s chargeable status or his/her ability to pay.”

From this one can ascertain that anyone who has been non-resident in the UK for a year or more loses their right to automatic free treatment on the NHS.  They will however still be treated, but they are liable for charges for their treatment.  This is in line with the case of the expatriate Briton referred to in the first paragraph of this article.  She had been living in Turkey for 5 years and had returned to the UK for essential treatment for liver and heart problems – she received the treatment but was charged for it.  Many feel that this is an unfair situation as the woman in question, and her husband, had worked all their lives in the UK and had made National Insurance contributions during that period of time.  However, fair or unfair, the ruling stands – once you become permanently non-resident in the UK you are no longer entitled to free treatment under the NHS.  This loss of entitlement is understood to come into effect 12 months after you leave.

On some expat forums where people have posed the question about getting around this, suggestions have been made ranging from maintaining an address in the UK to declaring yourself a resident again in order to receive treatment.  However, particularly with the latter suggestion, this can have negative knock on effects such as affecting a person’s tax status.  Our advice therefore is as follows – understand the government’s rules and guidelines and accept that there are no easy or legitimate ways around them, and prepare yourself accordingly.

Depending on your status, age and where you move to live abroad it could be that there is a reciprocal agreement in place that will allow you to be treated for free under your new country’s state healthcare system.  This is usually only the case for Britons over the retirement age who retire within the EU.  For all others it comes down to a question of health insurance.  So, before you think about moving abroad, retiring to the sun or going and working away from home, you need to look into the level of health insurance you will need.  You will have to factor in the cost for this insurance on an ongoing basis – unless you want to risk it and face paying for any treatment you receive either abroad or if you return ‘home’ to Great Britain.

If you’re moving to a nation with basic medical facilities, it could be that your health insurance will need to include provision for repatriation to Great Britain and for paying for NHS care.  Look carefully into what level of cover you need, and get that in place – because this is your health we’re talking about, without it you’re no good to anyone!