The NHS abroad and the S1 for pensioners

The NHS is free for people who live in the UK, not for everyone with a British passport. Move abroad for good and your automatic right to free NHS hospital care goes with your removal van.

The short version

NHS entitlement is based on where you live. Move abroad permanently and you're no longer automatically entitled to free NHS treatment [1].
UK State Pensioners living in the EU, Iceland, Liechtenstein, Norway or Switzerland may get an S1, so the UK pays for their state healthcare there [1].
S1 holders get a UK-issued GHIC or EHIC for trips to other EU countries, and from 1 January 2024 free NHS care on visits to England [1].
Without an S1, NHS hospital care on visits home is usually chargeable, though GP visits are free for overseas visitors in England, and so is most A&E care [2].
Outside Europe, plan on local insurance. Thailand and Turkey, for example, have no reciprocal health agreement with the UK [3][4].

Why the NHS stops being free when you move

The NHS isn't funded by a membership fee. It isn't based on your National Insurance record or tax either. In England, hospital care is free if you're ordinarily resident: living in the UK "lawfully, voluntarily and for settled purposes" [2]. Your nationality, an NHS number, being registered with a GP, years of National Insurance and owning a house in Hampshire don't decide it on their own [2].

So once you've moved abroad for good, you're treated as an overseas visitor when you come back, even if you paid in for 40 years. It's a common shock for people who assume the NHS is a bit like a pension they've built up.

What to do before you go:

Tell your GP practice you're moving abroad, so you and your family can come off the register [1].
Get copies of your records and a list of your prescriptions, in writing.
Stock up on prescriptions within reason, and check what you can legally take into your new country.
Sort your new cover first: an S1 if you qualify, local public healthcare, or private insurance.

The S1 for UK State Pensioners

The S1 is the big one for retirees in Europe. It means the UK pays for your state healthcare in the country where you live, on the same terms as a local [1].

Who can get an S1

You may qualify if [1]:

you live in an EU country, Iceland, Liechtenstein, Norway or Switzerland, and
you get a UK State Pension

There are catches:

You can't get a UK S1 if you also get a state pension from the country where you live [1].
If you've lived and paid contributions in several of these countries, the one where you paid for longest is responsible for your healthcare [1].
Dependants can be covered, but they must count as dependants under the host country's rules [1].

How to apply

Wait until your State Pension is in payment. If you're not getting it yet, you can't apply [1].
Apply up to 90 days before you move. The S1 starts from your move date [1].
Contact NHSBSA Overseas Healthcare Services, which issues the S1, by email at s1applications@nhsbsa.nhs.uk or by phone on +44 191 218 1999 [1].
Register the S1 in your new country straight away, with the local health or social security authority. In many countries you can't get a medical card until you've done this [1].
Bridge the gap. You're responsible for having cover while the S1 is being registered, and you may be charged for treatment if you don't [1].

In Spain, for example, a registered S1 is accepted instead of private health insurance for the non-lucrative visa. Our guide to retirement visas has the details.

If you later move back to the UK, tell the NHS Overseas Healthcare team to cancel the S1 [5].

What if you retire before State Pension age?

There's no S1 until your State Pension is in payment. Early retirees usually need private health insurance, or to join the host country's system by paying in or under its residence rules. Many countries' visa rules require private cover anyway.

The GHIC and EHIC: cover for trips, not for living

The Global Health Insurance Card (GHIC) and the UK-issued EHIC cover necessary state healthcare during temporary visits to the EU and some other countries. They are not a way to live abroad on the NHS's tab.

Your situation	Healthcare where you live	Trips to other EU countries	Visits to England
UK resident on holiday	n/a	UK GHIC or EHIC	Free NHS care
State Pensioner in the EU with an S1	Local state care, paid by the UK	UK-issued GHIC or EHIC [1]	Free NHS care since 1 January 2024 [1]
Living in the EU without an S1	Local system or private cover	Card from your country of residence, if eligible	Usually charged for hospital care
Living outside the EU	Local system or private cover	Travel insurance	Usually charged for hospital care

Planned treatment in another country is a separate scheme, the S2, which has to be agreed in advance [1]. And a GHIC never replaces travel insurance: it won't cover repatriation, mountain rescue or private clinics.

Using the NHS on visits home

This is where people get caught out over Christmas or at a family wedding.

Free for everyone in England [2]:

seeing a GP, which is free for overseas visitors
A&E, as long as you didn't travel to the UK to get treatment

Usually charged:

hospital treatment after A&E, such as an operation, an inpatient stay or outpatient appointments, unless you're in an exempt group

Exempt groups that matter for Brits abroad:

S1 holders living in the EU, EEA or Switzerland get NHS care in England on the same basis as a UK resident during temporary visits, from 1 January 2024 [1]
the charging rules list some other exemptions, for example for certain people working abroad for a UK employer. They're narrow, so ask the hospital's overseas visitors team if you think one applies to you [2]

Scotland, Wales and Northern Ireland have their own charging rules, so check with the NHS where you're staying [1].

In practice, keep comprehensive travel insurance for visits home if you don't have an S1. An unexpected hospital stay can cost thousands of pounds.

Moving back to the UK

Once you return to live in the UK for settled purposes, you're ordinarily resident again, and that, not a waiting period, is what makes NHS hospital care free. You may have to show evidence you've moved back, such as a tenancy, a job or that you've sold up abroad. Our guide to moving back to the UK covers re-registering with a GP.

Healthcare abroad can be a bit of a minefield, and swapping notes helps. Our community groups for Brits abroad are full of people who've registered an S1 or chosen an insurer. Join us here.

The NHS when you live abroad: why free care stops, and how the S1 helps pensioners in the EU