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 give you some information about healthcare in the UK.

If you’ve already decided that private medical cover in the UK is a good idea, you can check out our list of healthcare providers. From there, you can request free quotes from whichever company suits your needs.

UK healthcare: key stats

  • 0
    Average life expectancy
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    million people on the waiting list for NHS surgery
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    % of population with health insurance

What’s on this page?

01 | How does the UK healthcare system work?
02 | UK healthcare vs US healthcare
03 | Can American expats use the NHS?
04 | Is it worth having private health insurance in the UK?
05 | How much does health insurance cost in the UK?
06 | Advice for US expats in the UK

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. Many treatments and appointments are free at the point of use, but it is all paid for through taxation on income. However, you do have to pay a flat prescription fee for each item you’re prescribed (although some groups of people can get them subsidised or for free). Additionally, most people will need to pay for their own dental care. 

Instead of parting with a fee for each prescription you fill, you can also get a pre-payment certificate in which you pay an annual amount that can add up to a lower total overall.

The NHS is so fundamental to the UK that it’s the country’s largest employer, and one of the largest employers 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), with the correct prices as of October 2022:

Prescription medicines are also not free under the NHS in England, currently costing £9.35 (roughly $10.80) 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, and a pre-payment plan is available for some people.

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

How is the NHS funded?

It all comes from general taxes, National Insurance contributions, and patient charges. 

According to the independent factchecker fullfact.org, 80% of the NHS budget is funded by general taxation (mainly income tax) and National Insurance payments. 

So what are the income tax rates in the UK for 2022/23?

£0 – £12,570: 0%

£12,571 – £50,270: 20%

£50,271 to £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 £1,048.01 – £4,189 per month, you pay a 13.25% rate
  • If you earn over £4,189 per month, you pay an extra 3.25% 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, the maternal mortality rate is significantly below that of the US, and the spend on healthcare is lower – $4,300 per person, compared to $10,900 in the US. 

In certain specific categories, the US outdoes the UK – but not many.

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 targets for ‘maximum waiting times’ for certain kinds of treatment in England, along with a verdict on whether the NHS has stuck to these targets. 

Additionally, the COVID-19 pandemic caused the backlog of people waiting for treatment to increase immensely. As of 2022, waiting times for patients seeking treatment have reached their highest ever levels.

You can check your local hospital’s waiting times here.

 

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 according to the Nuffield Trust, as of October 2022, this target hasn’t been met in more than a decade.

In October 2022, the percentage of patients seen within four hours fell to just 57.3%. 

 

Consultant appointment after an urgent cancer referral: 14 days

The government aims for 93% of patients to be seen by a specialist within two weeks following an urgent cancer referral from their GP.

This standard hasn’t been met since 2018, according to the Nuffield Trust. As of August 2022, this figure lay at 80.1%.

 

Elective treatment by consultants/specialists: 18 weeks

As of October 2022, there is a statutory requirement that at least 92% of patients experience a referral-to-treatment time that’s under 18 weeks, and NHS England aims that no patient wait more than 52 weeks.

As of February 2022, 2.01 million people had been on the waiting list for elective treatment for between 18 and 52 weeks, and 299,000 patients had been on the waiting list for longer than 52 weeks, according to the Nuffield Trust.

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 September 2015, there were 3.3 million people on the list. By August 2022, there were seven million.

The top reasons Brits are unsatisfied with the NHS are:

  1. The long waiting times (65%)
  2. The lack of staff (46%)
  3. The lack of funding (40%)

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 could be a 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. 

And if you think you’d be better off investing in private medical cover, check out our list of healthcare providers. From there, you can request free quotes from whichever company suits your needs.

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’.

For more information, please read the government’s page on accessing healthcare if you’re a citizen from an EU country, Norway, Iceland, Liechtenstein, or Switzerland who’s living in or moving to the UK.

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.

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 / children’s visa: £470 per year
  • All other visa / immigration applications: £624 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, you may consider getting some private medical cover sorted before your move. Luckily we can help you with that. All you have to do is check out our list of healthcare providers. From there, you can request free quotes from whichever company suits your needs.

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, chiropractic treatment, 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. 

How many people in the UK have private health insurance?

10.3% of the UK population have some form of private medical cover, according to Statista, with demand having risen significantly in recent years. 

The proportion of people with private coverage varies region by region.

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 a single 50-year-old person in the UK is £792 (or roughly $910) per year as of September 2022, according to Nimblefins. This equates to around £66 (or $76) per month. 

To find out exactly how much a private health insurance policy will cost you and your family in the UK, check out our list of healthcare providers. From there, you can request free quotes from whichever company suits your needs.

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:

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