Most people who move to the UK assume the NHS will be there for them the moment they arrive. That assumption is expensive. Access to NHS secondary care is not determined by geography or goodwill; it is determined by immigration status, and the rules differ sharply depending on whether someone is settling permanently, on a long-term visa, or visiting for a matter of weeks.
Get this wrong and a single hospital admission can generate a bill charged at 150 per cent of the NHS tariff rate. Get it right and NHS access is comprehensive, broadly resident-equivalent, and already paid for before the flight lands.
How the NHS Determines Who Pays for Treatment
The legal basis for NHS charging
The legal foundation for NHS charging is the National Health Service (Charges to Overseas Visitors) Regulations 2015, as amended. For the purposes of cost recovery, an overseas visitor is defined as someone who is not ordinarily resident in the UK. Being ordinarily resident broadly means living here on a lawful, voluntary, and settled basis for the time being.
What ordinary residence actually means
Ordinary residence is not the same as holding a visa, possessing an NHS number, or being registered with a GP. A person is not ordinarily resident in the UK simply because they have British nationality, hold a British passport, are registered with a GP, have an NHS number, own a property in the UK, or have paid National Insurance contributions and taxes in the UK. These are administrative facts, not statements of entitlement.
Anyone who is subject to immigration control cannot be ordinarily resident in the UK unless they hold Indefinite Leave to Remain, or pre-settled or settled status under the EU Settlement Scheme.
Primary care vs secondary care: why the distinction matters
Two parts of the NHS operate under entirely different rules.
Primary care, which includes GP surgeries, walk-in centres, school nursing, and health visitor services, sits outside the charging regulations entirely. Anyone physically present in the UK can register with a GP without charge, regardless of immigration status or length of stay. No visa, Biometric Residence Permit, or proof of address is required.
Secondary care, which includes hospital treatment, outpatient appointments, maternity services, planned surgery, and specialist referrals, is where the charging framework applies. Those who are not ordinarily resident in the UK, including former UK residents who have returned, are overseas visitors and may be charged for NHS services. Each NHS trust employs an Overseas Visitor Manager whose role is to assess chargeable status and recover costs where applicable.
The GOV.UK guidance on charging overseas visitors, last updated December 2025, sets out the full framework for NHS providers in England.
The Immigration Health Surcharge Explained
What the IHS is and what it grants
The Immigration Health Surcharge (IHS) was introduced in April 2015 under section 38 of the Immigration Act 2014. The Government stated the purpose was to ensure that migrants make a proper financial contribution to the cost of their NHS care, in addition to their contribution as UK taxpayers.
Payment of the IHS entitles the payer to NHS-funded healthcare on the same basis as someone who is ordinarily resident, from the date their visa is granted and for as long as it remains valid.
What the IHS does not cover
The surcharge does not cover all NHS costs. Prescriptions in England remain chargeable at £9.90 per item. NHS dental treatment and optical services carry charges across most of England. Assisted conception and IVF are excluded regardless of surcharge status.
The IHS cannot be substituted with private health insurance
There is no opt-out on the grounds that private cover exists. The surcharge is a legal requirement for applicable visa categories, and the Home Office will not process an application without a valid IHS reference number. Even applicants with comprehensive private medical insurance must pay the surcharge in full.
Refunds are not granted for non-use
A visa holder who pays the surcharge and never requires NHS treatment receives no refund on that basis. Refunds are available only in specific circumstances: visa refusal, curtailment, or overpayment. The full refund conditions are set out in the exemptions section below.
IHS Rates in 2026: How Much Does It Cost?
In February 2024 the standard rate increased to £1,035 per year of the visa, paid in advance. The previous rate was £624 per year. This represented a 66 per cent increase.
- Standard rate: £1,035 per year Applies to the majority of adult applicants, including Skilled Worker, family, Global Talent, and most other long-term route applicants.
- Reduced rate: £776 per year Applies to students and their dependants, Youth Mobility Scheme applicants, and all children under the age of 18.
The surcharge is calculated on the total length of permission applied for, not the duration of a contract or academic course. It is paid in full, upfront, at the point the visa application is submitted. There is no instalment option.
Worked cost examples by visa type
| Visa type | Duration | Rate | Total IHS |
| Skilled Worker | 3 years | £1,035/yr | £3,105 |
| Skilled Worker | 5 years | £1,035/yr | £5,175 |
| Student | 3 years 9 months | £776/yr | £2,910 |
| Spouse / partner | 2 years 9 months | £1,035/yr | £2,846 |
| Youth Mobility Scheme | 2 years | £776/yr | £1,552 |
| Dependent child (under 18) | 3 years | £776/yr | £2,328 |
Each applicant named in an application, including every dependent, pays the surcharge separately at the applicable rate. There are no group discounts and no family cap.
The surcharge applies regardless of nationality. There is no reduced rate or waiver based on an applicant’s country of origin. A student from Nepal, India, or Pakistan pays the same reduced rate as a student from any other country.
Dependants aged 18 or over usually pay the same amount as the main applicant. Where a dependent joins a main applicant mid-visa, the IHS liability for the dependent is calculated on the remaining period of the main applicant’s permission, not the full original duration.
Use the official IHS calculator on GOV.UK to confirm the exact amount due before submitting any application.
Who Is Exempt from the Immigration Health Surcharge?
Exemptions are set in legislation and are not discretionary. The following categories do not pay the IHS.
Health and Care Worker visa holders and their dependants, this exemption was introduced in August 2020. The Certificate of Sponsorship must confirm the exemption applies. A Health and Care Worker on a five-year visa avoids a surcharge liability of over £5,000 compared to the standard Skilled Worker rate.
Applicants for Indefinite Leave to Remain (ILR) and British citizenship, settlement applications do not attract the surcharge because settlement itself grants ordinary residence status.
Asylum seekers, refugees, and those granted humanitarian protection, including individuals supported through the National Referral Mechanism as victims of human trafficking.
Visitor visa holders. Those on a Standard Visitor visa for up to six months do not pay the IHS. They are charged at the point of use for hospital treatment instead.
Children in local authority care. These children are exempt and must still obtain an IHS reference number, but no payment is due.
Frontier workers holding a Frontier Worker Permit who live outside the UK and commute to work.
Fee waiver recipients. Migrants applying in certain circumstances on family and human rights routes and the Hong Kong British National Overseas (BNO) immigration route can apply to have the visa fee and the IHS waived. A fee waiver application must be submitted prior to an application for immigration permission being made.
NATO civilian employees and certain defence personnel working for NATO or the Australian Department of Defence in the UK.
IHS refunds
Refunds are available where a visa is refused, curtailed, or where overpayment has occurred. They are not available because the NHS went unused. IHS refunds following a visa refusal can only be processed once 14 calendar days have elapsed since the refusal date. It can take up to 6 weeks for a refund payment to appear in the applicant’s bank account. Refunds are made to the bank account that made the initial IHS payment, and the bank account cannot be amended prior to a refund being attempted.
What NHS Services Can You Access in the UK?
Free for everyone, regardless of immigration status
The following services are available to any person physically present in the UK with no requirement to have paid the IHS or to be ordinarily resident.
- Accident and Emergency (A&E) treatment at NHS hospitals
- GP registration and primary care consultations
- Family planning services, including contraception
- Diagnosis and treatment for specific infectious diseases, including tuberculosis, sexually transmitted infections, and HIV testing
- Compulsory psychiatric treatment under the Mental Health Act
- Treatment for conditions caused by torture, female genital mutilation, domestic violence, or sexual violence
Free for IHS payers and ordinarily resident individuals
Those who have paid the IHS, or who are ordinarily resident, access the following without additional charge at the point of use.
- NHS hospital treatment, including planned surgery and inpatient care
- Maternity services, including antenatal, intrapartum, and postnatal care
- Mental health services beyond compulsory treatment
- Outpatient appointments and specialist referrals
- Ambulance services
- Community health services
Chargeable for everyone in England, regardless of immigration status
The following carry charges for all patients in England, whether the IHS has been paid or not.
- Prescriptions: The cost of a single prescription is frozen at £9.90 per item for 2025/26. Prescriptions are free in Scotland, Wales, and Northern Ireland.
- NHS dental treatment: Band 1 costs £27.40, Band 2 costs £75.30, and Band 3 costs £326.70, with charges applying from 1 April 2025. One charge covers a full course of treatment regardless of the number of appointments. See NHS dental charges on NHS.uk for full band descriptions.
- Optical services and sight tests: Charges apply to most adults.
- Assisted conception and IVF: Not covered by the IHS under any circumstances.
NHS Access for Short-Term Visitors to the UK
Visitors on a Standard Visitor visa, or nationals from visa-exempt countries staying for under six months, do not pay the IHS. They will be charged at 150% of the NHS national tariff, unless an exemption applies to them or the service they are accessing, or they are covered by a reciprocal healthcare agreement between the UK and their country.
Treatment in A&E departments and at GP surgeries remains free for all. Any follow-up treatment arising from an emergency admission, including inpatient stays, further procedures, and specialist referrals, may be charged at the 150 per cent tariff once the immediate emergency has been resolved.
Visitors from countries with which the UK holds a reciprocal healthcare agreement may be entitled to some free treatment. EU nationals visiting the UK may use a European Health Insurance Card (EHIC) issued by their home country, or a Global Health Insurance Card (GHIC), to access medically necessary treatment during their stay. Irish citizens benefit from the Common Travel Area and generally access NHS treatment on the same basis as UK residents.
Travel insurance with adequate medical cover remains strongly advisable for all visitors, regardless of any reciprocal arrangements. Reciprocal agreements cover only medically necessary treatment, not the full range of NHS services, and the process for recovering charges from uninsured overseas patients is active and systematic.
Further information on reciprocal healthcare arrangements is available via NHS.uk overseas visitors guidance.
Differences in Scotland, Wales and Northern Ireland
The IHS itself is uniform across all four nations
The Immigration Health Surcharge is levied on a UK-wide basis by the Home Office. There is no devolved difference in whether the surcharge applies, what it costs, or who is exempt. A Skilled Worker visa applicant destined for Glasgow, Cardiff, or Belfast pays the same IHS rate as one destined for London.
Where the devolved nations diverge in a way that directly affects visa holders and new arrivals is in what is free at the point of use once NHS access is established.
Prescriptions
Prescriptions are free for all patients in Scotland, Wales, and Northern Ireland. In England, the charge is £9.90 per item for 2025/26 unless the patient qualifies for an exemption such as being under 16, over 60, pregnant, or in receipt of certain qualifying benefits.
NHS dental treatment
Dental charges follow different structures in each nation. In England, the three-band system applies at £27.40, £75.30, and £326.70 from April 2025. In Scotland, patients pay 80 per cent of treatment cost up to a maximum of £384 per course of treatment, with free dental care for all patients under 26. In Wales, a new dental contract taking effect from April 2026 introduces a system where patients pay 50 per cent of treatment package value, capped at £384. Northern Ireland follows the same 80 per cent structure as Scotland, with the same £384 cap.
GP registration and primary care
GP registration and primary care operate on the same open-access basis across all four nations. No patient can be refused registration on grounds of nationality or immigration status, though a practice may decline if it has reached full capacity.
Optical services
Optical services are free for certain groups in all four nations, with Scotland offering the most generous provision: free NHS eye examinations for all residents regardless of age or income. In England, Wales, and Northern Ireland, free sight tests are available to children under 16, those on qualifying benefits, and certain other groups, but not universally to all adults.
Frequently Asked Questions
Q. Can foreigners use the NHS in the UK?
A. Yes, but on different terms depending on immigration status. Anyone can access a GP and A&E treatment free of charge. Long-term visa holders who have paid the Immigration Health Surcharge access hospital and specialist services on the same basis as UK residents. Short-term visitors are charged for hospital treatment at 150 per cent of the NHS tariff if no exemption applies.
Q. Who is eligible for free NHS treatment?
A. Anyone ordinarily resident in the UK is entitled to free secondary NHS care. Visa holders who have paid the IHS receive treatment on the same basis. Regardless of status, all patients are entitled to free GP services, A&E treatment, and treatment for specified infectious diseases.
Q. Can non-citizens get free healthcare in the UK?
A. Non-citizens with settled status or Indefinite Leave to Remain are treated identically to British citizens for NHS purposes. Non-citizens on long-term visas who have paid the IHS receive the same entitlement for the duration of their permission to stay. Visitors without IHS status are charged for hospital care.
Q. Does the NHS offer visa sponsorship?
A. NHS trusts are licensed sponsors under the Health and Care Worker visa route, meaning they can sponsor overseas doctors, nurses, and allied health professionals to work in the UK. Health and Care Worker visa holders are also exempt from paying the IHS. NHS employment and NHS treatment entitlement are two distinct topics.
Q. Can I register with a GP before my BRP or eVisa status is confirmed?
A. GP practices cannot refuse registration on grounds of an absent BRP or unconfirmed immigration status. Primary care access does not require proof of immigration status. More information is available at nhs.uk/nhs-services/gps/how-to-register-with-a-gp-surgery.
Q. Is NHS dental treatment free if I have paid the IHS?
NHS dental charges apply to all patients in England regardless of IHS status. In England, Band 1 treatment costs £27.40, Band 2 costs £75.30, and Band 3 costs £326.70. Exemptions exist for children under 18, pregnant women, and those who gave birth in the last 12 months, as well as patients on certain qualifying benefits.
Q. Does the IHS cover mental health and maternity services?
A. Both fall within NHS services accessible to IHS payers on resident-equivalent terms. Maternity care, including antenatal appointments, labour and delivery, and postnatal follow-up, is fully covered. Mental health services, including inpatient psychiatric care, community mental health teams, and talking therapies, are covered in the same way.
Final Thoughts
The National Health Service remains one of the defining institutions of life in the United Kingdom. For foreigners moving to the country, access to NHS healthcare largely depends on visa status and payment of the Immigration Health Surcharge. Once registered and eligible, international residents, especially students and workers can benefit from comprehensive medical care throughout their stay in the UK.
