Millions of British expats face having to pay for hospital health care if they return home and others will only get free treatment if they can provide a health care card, it has been confirmed.

Those living within the European Economic Area will have to show a European Health Insurance Card health card issued by the country where they live to avoid charges. Emergency treatment and GP visits will remain free.


But it is those living in countries such as the United States and Canada that face the biggest change. They will be denied free hospital care while in the UK except for short term emergency treatment and face a 50% surcharge on top of this for treatment.

This means that British expats living in the US and Canada who need to have hospital treatment when they are home on a trip to visit family and friends would be billed 150% of the cost of the treatment if they have no private insurance.

The new rules represent a significant change and expat groups are concerned about the cost impact, especially for pensioners. They even argue that expat pensioners have often paid into the UK system for many years and should therefore be entitled to free health treatment.

But the new Conservative government is determined to stamp out what is regarded as ‘health tourism’ where people arrive thinking they can get costly treatment for free. Alongside the changes for expats will be a migrant health charge to prevent other nationalities accessing free health care without having ever paid into the UK system.

According to the Foreign Office there are 2.3 million Britons living in the US and 611,000 in Canada, two countries which have no reciprocal health care agreements in place, unlike Australia where the 1.2 million expats will have at least some cover because of arrangements put in place by the two governments.

Expats in the US feel that it is unfair that those who have worked for 30 years or more in the UK and paid their National Insurance stamps can be not just denied free hospital treatment but also face a punitive surcharge.

‘International visitors are welcome to use the NHS, provided they pay for it. With the NHS busier than ever, our plans to recoup more costs will help keep services sustainable,’ said a Department of Health spokesman.

He pointed out that ‘deliberate’ use of the NHS, that is, use by those who arrive in England specifically to receive free treatment or who come for other reasons but take advantage of the system when they’re here, is thought to be cost roughly between £110 million and £280 million a year.

‘Normal’ use of the NHS by foreign visitors who’ve ended up being treated while in England, is estimated to cost about £1.8 billion a year. The majority of these costs aren’t currently charged for. Only about £500 million is thought to be recoverable or chargeable at the moment.