Brexit: Will Britons in the EU have to pay for NHS treatment?

We were asked by Doug Young, a British citizen who lives in the Czech Republic, if British citizens who live in the European Union (EU) would have NHS healthcare when visiting the UK, once the European Health Insurance card (EHIC) becomes invalid after Brexit.

The number of UK-born people living in the EU – workers and their dependants, pensioners, students and others – is estimated at 1.3 million.

The EHIC card would no longer be valid if there was a no-deal Brexit.

The short answer to Doug’s question is: some British citizens in the EU would still get free NHS healthcare if this were to happen – and some would not.

What are their rights now?

All UK citizens in the EU are entitled to state-provided healthcare in the country they live, on the same terms as the nationals of that country.

They are also all entitled to a European Health Insurance Card (EHIC), which enables them to use state-provided emergency medical treatment if they travel to another EU country (or Switzerland, Norway, Iceland and Liechtenstein, where the scheme also applies). The EHIC covers pre-existing medical conditions and routine maternity care as well.

If you are a UK citizen and permanently resident in the EU, you need this card to access NHS treatment for free.

There are exemptions to this though:

  • UK pensioners living in the EU
  • UK students in the EU (for example, doing a year abroad)
  • “posted workers” – UK workers sent by their UK employer to work in the EU

These groups don’t need an EHIC card for free NHS treatment in the UK.

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The EHIC covers routine maternity service and pre-existing conditions as well as emergencies

What does the government say?

If there’s a no-deal Brexit, your EHIC card will no longer be valid.

So, what about those existing rights to free NHS treatment?

The government says that if you are a UK pensioner, student or posted worker in the EU, your rights would not change.

A Department of Health and Social Care official said: “We want to reassure UK nationals living in the EU whose healthcare costs are currently met by the UK government that they will be able to use NHS services for free in the same way as they do now.”

But, when it comes to UK citizens in the EU who rely on the EHIC card for free NHS treatment – their rights would not be protected. The UK government website, updated on 28 August 2019, says: “You should not expect to be able to use NHS services for free when visiting the UK.

“You should take out appropriate travel insurance when visiting the UK, as you would when visiting any other country.”

Jeremy Morgan QC, vice-chair of British in Europe, a group representing British citizens living and working in Europe, said: “For UK citizens living in the EU, this will erect yet another barrier cutting us off from our families and friends in the UK. Those with pre-existing health conditions will be able to get insurance… only for inflated premiums and those on low incomes will struggle to afford the ordinary premium.”

How many could be affected?

There’s no official breakdown of the 1.3 million figure.

Estimates suggest about 250,000 are over the age of 65 and about 50,000 are posted workers.

More than 15,000 UK students go to the EU as part of the Erasmus scheme every year and thousands more do a degree in another EU country.

This suggests most UK citizens resident in the EU need an EHIC to access the NHS while visiting and would lose that right if there was no deal.

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Getty Images

Would they get any NHS treatment?

The government says: “Urgent or immediately necessary treatment (including A&E and maternity services) will always be provided free at the point of delivery first in the UK, with entitlement to NHS care determined afterwards.”

So, you would still be treated but there might be a bill to be paid later.

The government says: “The EHIC scheme cannot be protected unilaterally as it requires reciprocity from either the EU or individual member states.”

It stresses it is “working with a number of member states on legislation to protect healthcare rights of UK nationals abroad” but there is no such agreement in place with any of the countries yet.

What about Britons who return from the EU to the UK?

Some UK citizens might decide to return to the UK after Brexit.

The government says if you were to return to the UK permanently and meet the ordinary residence test, you would be able to access NHS care without charge.

The government website says: “Ordinary residence means, broadly, living in the UK on a lawful, voluntary and properly settled basis for the time being.”

What about UK citizens living in non-EU countries?

If you are a British national but long-term resident in a non-EU country, you and your dependents are already ineligible for free NHS healthcare.

The UK has reciprocal health insurance deals with a few non-EU countries, including Australia and New Zealand, under which visitors can receive urgent treatment at a reduced cost or for free.

These reciprocal deals will be unaffected by Brexit or future UK-EU negotiations.

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