If you’re thinking of moving to the UK, you’re in for a proper treat. There’s quaint green countryside, beautiful old pubs, oodles of history, and of course the National Health Service (NHS). 

But can American expats in the UK use the NHS? Is it worth getting private health insurance for when you’re out there? In this article, we’ll tell you everything you need to know about healthcare in the UK.

If you’ve already decided that private medical cover in the UK is a good idea (it’s a sensible precaution, to say the least), you can start building a customised plan with Cigna, who currently protect more than 95 million customers all over the world.

UK healthcare: key stats

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    Average life expectancy
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    millions of people on the waiting list for NHS surgery
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    % of population with health insurance

How does the UK healthcare system work?

Compared to America, healthcare in the UK is a very different kettle of fish. 

First and foremost, it is completely socialized meaning it comes directly from the British government. All treatments and appointments are free at the point of use, but it is all paid for through taxation on income. Medicines, on the other hand, have to be paid for (although some people can get them for free). 

The NHS has become so fundamental to the UK that it is now the country’s largest employer, and the fifth largest employer in the world. 

What does the NHS cover?

Unfortunately, you can’t get every kind of treatment or medicine from the NHS, although its services are fairly comprehensive. They include:

  • Consultations with your doctor/general practitioner (GP)
  • Treatment in Accident & Emergency (A&E) this is what the British call ‘ER’
  • Treatment by specialists/consultants (if given a GP referral)
  • Sexual health services
  • Maternity services
map showing health insurance coverage in the UK by region

What doesn’t the NHS cover?

On the flip side, here are the medical services that you will have to pay for (either directly or through private health insurance):

  • Dental care (£250+ for complex procedures)
  • Eye tests (roughly £25 per test, although free for children and over-60s)
  • Physiotherapy (around £50 per appointment you can get this free via the NHS, but waiting lists are particularly long)
  • Tests/scans (can cost £100s scans are only available via the NHS with a GP referral)
  • Chiropractic (approximately £30-£80 per appointment again, this is free via the NHS, but it’s limited and the waiting lists are long)

Prescription medicines are also not free under the NHS in England, currently costing £9.15 (roughly $11.30) per item. However, certain people can get them for free, including under-16s, over-60s, pregnant women, new mothers (up to 12 months after giving birth), and those suffering from a specific disability. 

Meanwhile, prescription medicines are free in Wales, Scotland, and Northern Ireland.

How is the NHS funded?

It all comes from tax, and a bit of government borrowing (sometimes). 

According to the independent factchecker fullfact.org, 80% of the NHS budget is funded by general taxation (mainly income tax), while the remainder is mostly covered by National Insurance contributions which is basically just another form of income tax. 

So what are the income tax rates in the UK for 2019/20?

£0 – £12,500: 0%

£12,501 – £50,000: 20%

£50,001 – £150,000: 40%

£150,000+: 45%

However, the income tax rates for Scotland are slightly different you can see them here.

What about National Insurance rates?

If you’re employed in the UK, you’ll most likely be in Class 1 for National Insurance (NI) contributions, which means:

  • If you earn between £792 – £4,167 per month, you pay a 12% rate
  • If you earn over £4,167 per month, you pay an extra 2% on top of the 12%

Meanwhile, here are the various NI rates for self-employed people

skyline of London at dusk

A panoramic view of London, where 22% of the population have health insurance

UK healthcare vs US healthcare

So, how does the NHS stand up to the American healthcare system? 

Well, generally speaking, the NHS significantly outperforms it. Life expectancy is higher, the infant mortality rate is lower, there are more acute-care beds per capita, and the spend on healthcare is lower – around $2,500 per person, compared to $6,000 in the US (according to Time). 

However, in certain specific categories, the US outdoes the UK for example, in the case of cancer mortality rates.

What are the NHS waiting times?

The NHS is exceedingly popular in the UK both in the sense that it is loved by the public, but also in extremely high demand. This pressure on the service has gradually reduced its effectiveness since it came into being in 1948, and relatively tight funding over the past few years hasn’t helped either. 

Here are the ‘maximum waiting times’ for certain kinds of treatment, along with a verdict on whether the NHS has stuck to these targets (according to a 2019 study by the Health Foundation). 

 

Treatment after being admitted into A&E: 4 hours

The NHS aims to see at least 95% of A&E patients no more than 4 hours after admission, but this target hasn’t been met since the middle of 2014. In October 2019, the percentage of patients seen within four hours fell to 83.6% a record low. 

 

Treatment after an urgent cancer referral: 62 days

The Health Foundation report states that this target “has not been met for over five years”. 

 

Non-urgent treatment by consultants/specialists: 18 weeks

By the end of 2019, 86.7% of people waiting for non-urgent treatment had been waiting for 18 weeks or less which is a drop from 94% back in 2013. This 18-week target was scrapped in 2017 for a range of treatments, including cataract surgery and hip/knee replacement surgery. 

Additionally, the number of people on the NHS waiting list for elective surgery has grown exponentially over the past few years. Basically, people are being added to the list quicker than the NHS is capable of dealing with it. 

For example, back in April 2010, there were 2.5 million people on the list. By the end of 2019, there were 4.5 million.

The NHS was founded in July 1948 by Clement Attlee’s government, after the UK’s system of volunteer hospitals had become inadequate. The service was spearheaded by health minister Aneurin “Nye” Bevan.

Private medical cover in the UK

As you can see, given the strain on the NHS and the number of services it doesn’t cover, private health insurance is a decent way to supplement your healthcare in the UK. Around 13% of people in the UK have some form of health insurance, ranging from 11% of people in the East Midlands to around 22% in London. 

That’s why we’ve partnered with Cigna for private medical insurance in the UK. With four levels of annual cover to choose from and extra modules for more flexibility, Cigna will sort you out with a plan that suits your needs.

Start building a customised plan with a free quote to protect your most important assets you and your family.

A panoramic view of Wensleydale, North Yorkshire

Wensleydale in North Yorkshire – regular strolls round here will keep you in healthy shape!

Can American expats use the NHS?

In short: yes

There are certain aspects of the NHS that are available to everyone in the country, irrespective of their residential status. For instance, primary care (e.g. treatment in A&E, treatment for most infectious diseases, and family planning services) is available to all. 

Likewise, anyone is able to register themselves at a local doctors practice and see a GP, although they will likely be asked for proof of identity and proof of UK address. 

However, in the case of secondary care (e.g. consultations with specialists) and hospital treatment (e.g. non-emergency surgery), free NHS services are only available to European Economic Area (EEA) nationals, and people who are ‘ordinarily resident’.

Being ‘ordinarily resident’ has nothing to do with whether you’re paying income tax in the UK, or whether you own property in the UK. It just means that you need to be living lawfully in the UK on a properly settled basis, with Indefinite Leave to Remain (ILR). 

If you don’t have ILR, you will have to pay for NHS secondary care or hospital treatment, should you require it. Anyone from outside the EEA (i.e. anywhere other than the EU, Switzerland, Iceland, Norway, and Lichtenstein) is charged 150% of the national NHS rate

How do you get Indefinite Leave to Remain (ILR)?

The main routes to acquiring ILR include:

  • UK ancestry visa (after the first five years of holding the visa)
  • Tier 1 visa/work permit (after the first five years of holding the visa)
  • Spouse visa (after the first two and a half years of holding the visa)
  • EU nationality (after five years of living in the UK)
  • After ten years of living legally in the UK

However, if you are moving to the UK from a non-EEA country (e.g. the USA) and you’re unable to acquire ILR, the compulsory Immigration Health Surcharge (IHS) means you’ll still be able to access all parts of the NHS. 

The IHS is a levy that everyone has to pay if they’re coming to the UK from outside the EEA for more than six months. The rates are as follows:

  • Students / Youth Mobility Visa: £300 per year
  • All other visa / immigration applications: £400 per year
  • Any dependents on these visas also have to pay the IHS

Once you’ve paid the IHS, you can access the full range of NHS care, just like a UK citizen. 

If you’re moving to the UK for less than six months, you won’t have to pay the IHS and so your NHS coverage will be limited. Therefore, it’s advisable that you get some private medical cover sorted before your move

Do foreign residents have to pay income tax?

You’re probably wondering when you’ll start funding the NHS in the same way native Brits do. 

Well, once you’re a bona fide UK resident, you will have to start paying tax on all your income, which will in part go to fund the NHS. 

You are technically a UK resident if you spend at least 183 days in the country during the tax year, or if you own/rent a property there for at least 91 days of the tax year. 

Otherwise, you are a non-resident. This means you only pay tax on the income you earn within the UK (which, again, goes in part towards the NHS).

Is it worth having private health insurance in the UK?

We think so, yes. 

As we’ve explained in a fair amount of detail, the NHS is an impressive healthcare system founded on honourable principles, but it is becoming increasingly strained as the UK population grows. 

Here are some reasons you should consider taking out private medical cover in the UK before your move:

  • You expect to require regular treatment for something the NHS doesn’t cover (or doesn’t cover very extensively), such as dental care, eye care, physiotherapy, or very specialist medicine
  • You normally require second opinions and additional scans for peace of mind
  • You aren’t used to waiting very long for treatment in your home country
  • You are used to being able to choose your hospital and doctor, and consider this a priority
  • You value having a private room in a hospital
a view of dornie in scotland

It’s not all about England! This is the stunning village of Dornie in Scotland

What does health insurance not usually cover in the UK?

It’s important to be aware of what you’re not likely to be covered for, should you take out a private health insurance policy in the UK. Common exclusions from policies include:

  • Cosmetic surgery (with no medical need)
  • Pregnancy/childbirth 
  • Injuries from dangerous sports or war
  • Pre-existing medical conditions
  • Certain chronic illnesses, e.g. HIV or diabetes

However, it’s not impossible to find policies that cover some of the above issues they are just fairly rare, and more expensive. 

How do you get health insurance in the UK?

Some people in the UK have private health insurance coverage through their employer, but this isn’t particularly common. Plus, the standard of employer-provided medical cover in the UK has faced criticism in recent years for not being extensive enough. 

If your future UK employer does not offer health insurance and you would like some private medical cover, you will have to go directly to an insurance provider and take out a policy yourself.

How many people in the UK have private health insurance?

Around 13% of the UK population have some form of private medical cover, with demand having risen significantly over the past decade

The proportion of people with private coverage varies region by region, such as 11% in the East Midlands, 12% in Scotland, 18% in Northern Ireland, and 22% in London. 

In case you missed it, we made a lovely map showing private medical insurance coverage in the UK it’s near the top of the page!

How much does health insurance cost in the UK?

The typical premium for private health insurance for an individual in the UK is £1,435 (or roughly $1,785) per year (according to finder.com/uk). This equates to around £120 (or $150) per month. 

To find out exactly how much a private health insurance policy will cost you and your family in the UK, you can start building a customised plan via Cigna. With over 95 million customers worldwide, Cigna has the reliability and the know-how to get you sorted with the right policy.

Advice for American expats in the UK

Hopefully you’re feeling well and truly clued up on the UK’s healthcare system. If that’s whet your appetite for reading more about Britain, check out these other articles: