Health insurance between countries and the NHS

The NHS goes with your address, not your passport. While you live abroad you're a visitor at home, and that can sting.

The short version

The NHS is residence-based. Move abroad for good and you lose free NHS hospital care, and you'll usually be charged on visits home unless you're exempt [1][2].
If you hold a UK-issued S1 and live in the EU, Iceland, Liechtenstein, Norway or Switzerland, NHS treatment during temporary visits to England is free [1].
The GHIC is for people living in the UK (and UK S1 holders in Europe). It covers medically necessary state healthcare on trips, not private care or repatriation [3].
Move back for good and NHS hospital care in England is normally free from the day you arrive, though hospitals may ask for proof [2][4].
The riskiest weeks are the move itself: your foreign cover can end before the NHS clearly applies, and travel insurance often won't cover someone who's emigrating.

Why the NHS stops being free

The NHS is a residence-based system, so if you move abroad permanently you lose automatic entitlement and should tell your GP practice so you're taken off the register [1]. In England, hospitals charge people who aren't "ordinarily resident" 150% of the cost of treatment unless an exemption applies [2]. Paying UK tax or National Insurance while you're away, or having paid in for 30 years before you left, doesn't change that.

Some care stays free for everyone: A&E, GP consultations, and the treatment of certain infectious diseases [2][5]. Being admitted from A&E, or follow-up outpatient appointments, can be charged [5].

Visiting the UK while you live abroad

What you'll pay on a visit home depends on where you live and what paperwork you hold:

Your situation	NHS hospital care on a visit to England
UK-issued S1 registered in the EU, Iceland, Liechtenstein, Norway or Switzerland	Free during temporary visits [1]
Living in the EU with a local EHIC from your new country	Medically necessary treatment, billed to that country
Living in a country with a UK reciprocal healthcare agreement	Some urgent treatment may be free, depending on the agreement
Living anywhere else, no exemption	Charged, usually at 150% of NHS cost [2]

The S1 exemption covers England. Scotland, Wales and Northern Ireland set their own charging rules, so check with the relevant NHS body before a planned trip [1].

Most international health insurance policies let you choose whether to include the UK. Leaving it out keeps the premium down, which is fine until you need a hip done during a long summer at your sister's. If you visit for weeks at a time, or might want treatment at home, pay for UK cover.

The S1 and the GHIC

The S1

The S1 lets you register in an EU country, Iceland, Liechtenstein, Norway or Switzerland and get state healthcare there paid for by the UK. Most Brits who get one are receiving a UK State Pension, but some benefits and posted or frontier work also qualify. You can't get one if you also get a state pension from the country you live in [1].

With a registered S1 you're treated like a local in the country you live in, and you get free NHS treatment on temporary visits to England [1]. While an S1 is being registered, you're responsible for having suitable cover in the meantime [1]. Our guide to the NHS when you live abroad and the S1 covers applying.

If you move back to the UK with an S1, tell NHS Overseas Healthcare Services. Your S1 stops, your registration abroad ends, and you use the NHS like any other UK resident [6].

The GHIC

The UK Global Health Insurance Card is free and lasts up to five years. You're entitled if you're ordinarily and legally resident in the UK, or if you live in the EEA or Switzerland with a UK-issued S1 or A1 [3]. Brits covered by the Withdrawal Agreement can get a UK EHIC instead [3].

It covers state healthcare that can't reasonably wait until you get home, including treatment for pre-existing conditions, at the same cost locals pay. It doesn't cover private treatment, medical repatriation or mountain rescue, and it isn't a substitute for travel insurance [3].

Two traps for people between countries:

A GHIC issued while you lived in the UK isn't yours to use after you've emigrated. If your circumstances change, you may not be entitled to keep using the card [3].
It only works abroad. It does nothing for you in the UK.

International health insurance in general terms

If you live somewhere without a public system you can use, or where newcomers need private cover for a visa, you'll probably buy international private medical insurance. Policies vary a lot. The questions that matter:

Area of cover. Worldwide, worldwide excluding the US (a big price difference), or a region. Check whether the UK is included.
Underwriting. Pre-existing conditions aren't usually covered, or can be added at a higher price [7]. Full medical underwriting lists exclusions up front; moratorium underwriting excludes recent conditions for an initial period. Be honest on the application, because insurers check your history when you claim and can refuse it if your answers were inaccurate [7].
What's excluded. Chronic conditions, routine maternity care and some mental health treatment are common exclusions [7].
Inpatient vs outpatient. Cheaper plans may cover hospital stays only, not specialist appointments or scans.
Evacuation and repatriation. Being flown somewhere better, or home, is usually a separate benefit.
Portability. Can you keep the policy if you move country, or when you return to the UK?

Local policies in your new country can be cheaper, but usually only cover you there and on short trips. A local or international policy taken out in your fifties, after a diagnosis, can be hard to replace later, so think before cancelling.

The gap during the move

This is where people get caught. Picture the sequence: you give notice on your flat in Lisbon, your local cover ends with your registration or your employer, you fly home, and you spend a month at your parents' before signing a lease. Who pays if you break an ankle in week two?

Travel insurance usually requires you to be UK resident and to start and end your trip in the UK. A one-way move abroad or home often isn't a "trip" it covers. Read the residence wording.
Your foreign state cover usually ends when you deregister or leave a job.
The NHS should treat you as ordinarily resident from the day you arrive to live here for good, but you may be asked to show it [4].

How to close the gap:

Keep your existing policy running until after you land, or at least until your UK proof of residence is sorted. Cancelling a month late costs less than one hospital bill.
If you're cancelling international cover, check its UK area of cover for the overlap weeks.
Pack the evidence. GOV.UK suggests showing at least two documents, such as a tenancy, a council tax bill, an employer's letter, and proof you've given up your home or job abroad [4].
Register with a GP straight away. It's free, and you don't need ID or proof of address [8]. If you're staying with family, you can register as a temporary patient for up to three months [8].
Bring medication and records. Enough regular prescriptions for the first weeks, and copies of your notes from abroad.
If you're an S1 holder, ring Overseas Healthcare Services before you move, not after [6].

Back home: do you still want private cover?

Once you're settled the NHS covers you like everyone else. Some returners keep private medical insurance to avoid waiting lists, or convert their international policy to UK-only cover. MoneyHelper notes that people tend to consider private cover when NHS waits run beyond about six weeks, and gives a typical family premium of £700 to £1,800 a year [7]. Whether it's worth it is a personal call. If you have a condition that's covered now, ask whether a new UK policy would exclude it before you switch.

For everything else on the move home, read Moving back to the UK: NHS, benefits, school places and home fees.

Health cover between countries: insurance abroad and the NHS on your return