Who has to pay for NHS care?

Rules on charges for hospital care are complex so we've put together a Q&A to make things clear and bust some misconceptions.
Hospital bed

Do you have to pay for NHS care if you’re from overseas?

It depends. We explain below.

Doctor’s surgery/GP care

This is free to anyone, regardless of your immigration status.

If you’re in England for a short visit you can be seen as a temporary patient at a doctor’s surgery. You could also visit an NHS walk-in or urgent treatment centre, call 111, or visit a pharmacy for advice.

If you’re staying in the UK longer, you can register with a GP if you live in their area and they’re accepting new patients.

Accidents and Emergencies

Care in A&E departments is free for anyone, but if you need to be admitted to the hospital for further care, you could be charged.

Treatment for most infectious diseases

This is free to anyone, and includes treatment for sexually transmitted infections.

Treatment for torture, female genital mutilation, domestic violence or sexual violence

This is free to anyone, unless you came to England to seek this treatment.

Operations or other specialist hospital care:

This is where the rules are more complicated. Hospital care such as outpatients, scans, operations and other specialist treatment, is free to people who are ‘ordinarily resident’ in the UK. Free care isn’t based on your nationality or whether you have paid tax and national insurance now or in the past.  Certain vulnerable groups of patients are also entitled to free care.

Who is entitled to NHS hospital care for free?

  • people who are ‘ordinarily resident’ in the UK
  • to visiting/returning government employees such as members of the armed forces
  • refugees
  • asylum seekers
  • children looked after by a local authority
  • victims of modern slavery or human trafficking
  • EU citizens who are settled in the UK
  • people on study, work or spouse visas who have paid the government’s Immigration Health Surcharge of up to £400 per year (however the surcharge does not cover NHS fertility treatment)
  • people receiving court-ordered psychiatric treatment
  • people detained in prison or immigration centres

If you are from overseas, how would you prove you are ‘ordinarily resident’? 

There is no one single way to prove this, with national guidance saying people must be in England legally and should be ‘settled’ here.

NHS guidance to hospitals suggests staff ask people whether they have lived in here in the last six months, whether they work here, have a place to live or if their children go to school here, and possibly get documentation to prove this. If hospitals are unsure of how to prove entitlement, they are told to refer to Home Office guidance.

What about pregnant women from overseas?

If they are not eligible for free hospital care, they may be asked to pay, but national guidance says the NHS must not refuse women any maternity care if they cannot pay at the time of needing it. The national charity Maternity Action has further useful advice on this topic.

If you’re not eligible for free hospital care, how much will you have to pay?

The government says you will be charged 150% of the usual cost of the NHS treatment. Hospitals are free to decide their own charges. A national suggested list of prices, says general surgery would cost £301 for a first outpatient appointment, £1,621 for an operation in which you go home the same day, £4,559 for a planned operation needing a stay in hospital, or £6,471 for unplanned, urgent surgery.

The list also shows an MRI would cost around £500, a dialysis session would cost £400, and radiotherapy, £1,617 each time.

When would the person have to pay the charges?

Government guidance says charges ‘must’ be paid upfront before treatment, ‘unless doing so would delay the provision of treatment that is clinically assessed as either immediately necessary or urgent’.

Who decides at the hospital if a person has to pay charges?

Guidance says it is not up to doctors. Organisations should have a dedicated administrator, such as an ‘overseas visitor manager’ whose role is to recover costs.

What information should hospitals give people about charges?

Guidance says hospitals ‘should provide robust communications to patients about the charging rules, so they are aware of and understand any impact that these may have on their care’. Information should also cover exemptions, and who people can speak to for more information or to make a complaint.

Where can I get help to check my rights or entitlements?

If you live in Reading, you can contact Healthwatch Reading for general information, or support from our NHS Complaints Advocacy service. This advice and support is free, independent and confidential.

Find out more

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