Health
Health cover when you move abroad
What happens to your NHS or Medicare cover when you move, the S1 form for UK pensioners, what the GHIC card does and doesn't do, how to join the public system in ten countries, and when you still need private insurance.
Checked on 17 October 2026. From the NHS, NHSBSA, DHSC, Medicare.gov, CMS, the IRS and the health ministries and agencies of each country, with a few gaps filled by other sources named in each row. Rules on NHS charges in this guide are for England; Scotland, Wales and Northern Ireland have their own. This is general information, not medical or insurance advice.
The short version
- The NHS is based on where you live. Move abroad for good and you're no longer automatically entitled to treatment under normal NHS rules. On visits home, hospital care can be charged, though GP and A&E care stay free. NHS, planning your healthcare when living abroad, GOV.UK, healthcare in Switzerland, November 2021, DHSC, charging overseas visitors in England, May 2026
- People getting the UK State Pension who live in Europe may be able to bring cover with them. An S1 gives you the same state healthcare as residents in the EU, Switzerland, Norway, Iceland or Liechtenstein, paid for by the UK. NHSBSA, healthcare cover if living abroad
- Your GHIC stops working when you emigrate. It's for temporary stays, isn't travel insurance, and NHSBSA says you must return it when you move. NHS, apply for a free UK GHIC, December 2023, NHSBSA, GHIC if you move to another country
- Medicare usually doesn't work abroad. And if you drop Part B while you're away and sign up again later, you usually pay 10% more for each full 12 months you could have had it, for as long as you have Part B. Medicare.gov, travel outside the U.S., Medicare.gov, Welcome to Medicare (living abroad), January 2026, Medicare.gov, avoid late enrollment penalties
- Most of the ten countries here let new residents into the public system. The route and cost vary. Spain's convenio especial costs €60 a month under 65 (€157 at 65 or over) after a year's residence, and Dutch insurance is compulsory if you live or work there. Several visas ask you to show health insurance first. Spanish Ministry of Health, convenio especial, Government.nl, when to take out health insurance, August 2026, Spanish consulate in New York, telework visa, Italian consulate in New York, digital nomad visa
Leaving the NHS
- Who gets it free
- Free NHS hospital care in England depends on being "ordinarily resident": living in the UK lawfully, voluntarily and for settled purposes. Nationality doesn't decide it. DHSC, charging overseas visitors in England, May 2026
- When you move
- If you move abroad permanently, you're no longer automatically entitled to treatment under normal NHS rules. Tell your GP practice, so you and your family can be removed from the NHS register. NHS, planning your healthcare when living abroad
- On visits home
- Hospital treatment can then be charged: GOV.UK says people who move to the EU "should not expect to be able to use NHS services for free when visiting the UK". GP appointments are free for anyone in England, and you can register as a temporary patient for up to 3 months. A&E is free too, as long as the trip wasn't to get treatment. GOV.UK, healthcare in Switzerland, November 2021, DHSC, charging overseas visitors in England, May 2026, NHS, how to register with a GP surgery, July 2025
- Your medicines
- One local NHS policy says NHS prescriptions must not be issued for patients who are already abroad, and that for a move practices usually give enough (often a month) to bridge you to a new doctor. For controlled drugs, carry a letter from your doctor and check the rules of the country you're moving to. Frimley ICB, prescribing for patients travelling abroad, July 2025, GOV.UK, controlled drugs: personal licences
- Coming back
- British citizens returning to live in the UK will most likely count as ordinarily resident from the day they arrive, the current guidance says. DHSC, charging overseas visitors in England, May 2026, NHS, visitors from EU countries and Switzerland
The S1 form for UK pensioners
- Who gets one
- People getting the UK State Pension may be entitled if they live in, or are moving to, an EU country, Switzerland, Norway, Iceland or Liechtenstein, plus their dependants. Workers temporarily posted there by a UK company apply through HMRC instead. NHSBSA, healthcare cover when moving abroad, NHS, planning your healthcare when living abroad, NHSBSA, posted workers and exportable benefits
- What it gives you
- The same state healthcare as a resident of that country, with the UK paying. It doesn't cover private healthcare. You must register it with the health authority where you live. NHSBSA, healthcare cover if living abroad, NHSBSA, healthcare cover when moving abroad
- Applying
- Online up to 90 days before you move, except for Switzerland, Norway, Iceland and Liechtenstein, where you apply by phone or with help from NHSBSA. NHSBSA, healthcare cover if living abroad
- Visiting the UK
- Since 1 January 2024, people with a valid registered UK-issued S1 can get state-funded NHS care in England when visiting. Planned treatment has to be arranged with providers in England, and normal charges such as prescription charges apply. Scotland, Wales and Northern Ireland have their own rules. NHSBSA, S1 holders visiting the UK, NHS, planning your healthcare when living abroad
- When it ends
- Your S1 ends if you return to live in the UK. NHS, planning your healthcare when living abroad
The GHIC card
- What it's for
- UK residents get medically necessary state healthcare on temporary stays in the EU, care that can't reasonably wait until you're home. It isn't a replacement for travel insurance. NHS, apply for a free UK GHIC, December 2023, NHSBSA, where you can use your card
- If you move
- A UK GHIC or EHIC is no longer valid once you've moved to another country, and NHSBSA says you must return it when you emigrate. NHSBSA, GHIC if you move to another country
- Living in the EU with an S1
- You may get a UK GHIC if you live in the EU, Switzerland, Norway or Iceland with a registered UK-issued S1 (or work in the EU for a UK company with a valid A1), but not for care in the country you live in. NHSBSA, GHIC if you live overseas
- Students
- UK students studying in the EU or Switzerland need a Student GHIC instead. NHS, apply for a free UK GHIC, December 2023
- Switzerland
- A UK card only works there for certain groups, including UK nationals, and you may be asked to prove your nationality. NHSBSA, where you can use your card
For Americans: Medicare and US cover
- Medicare abroad
- Medicare usually doesn't cover care outside the US. The exceptions are narrow: an emergency while travelling through Canada by the most direct route between Alaska and another state, when a Canadian hospital is closer; being in the US (or living in the US) when a foreign hospital is closer than the nearest US hospital that can treat you; and ships in, or within 6 hours of, a US port. Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Islands and American Samoa count as the US. Medicare.gov, travel outside the U.S., Medicare.gov, coverage outside the United States, April 2026
- Medigap
- Plans with foreign travel emergency cover pay 80% after a $250 yearly deductible, up to $50,000 in a lifetime, for care that starts in the first 60 days of a trip. Medicare Advantage cover abroad depends on the plan. Medicare.gov, coverage outside the United States, April 2026
- Keeping Part B
- The standard Part B premium is $202.90 a month in 2026. You can drop it, but if you sign up again later you pay 10% more for each full 12 months you could have had it, usually for life, and you may have to wait for the 1 January to 31 March sign-up window. Medicare.gov suggests keeping it if you plan to come back to the US for care. CMS, 2026 Part A and B premiums, November 2025, Medicare.gov, Welcome to Medicare (living abroad), January 2026, Medicare.gov, avoid late enrollment penalties, Medicare.gov, how to drop Part A and Part B, Medicare.gov, ready to sign up
- Part A
- About 99% of people on Medicare pay no premium for Part A. CMS, 2026 Part A and B premiums, November 2025
- Marketplace plans
- You must live in the US to buy one, and they cover care in the US. There's been no federal penalty for going without cover since 2019, though some states charge their own. HealthCare.gov, Marketplace eligibility, IRS, individual shared responsibility, October 2026, HealthCare.gov, no health insurance (2025 tax year)
- Veterans
- The VA's Foreign Medical Program only pays for care for service-connected conditions (and conditions that make them worse). VA, Foreign Medical Program, October 2026
- The State Department's advice
- Get health insurance that covers you abroad, including medical evacuation to the US. US State Department, retirement abroad, US State Department, medicine and health
Joining the public system in 10 countries
For someone moving to work remotely, work for themselves or retire, alphabetical. "Not found" means we couldn't confirm it from an official source; "not researched" means we didn't look into it. We couldn't confirm current official rules for Greece, Mexico or Thailand, so they aren't listed.
| Country | How you get in | What it costs | Waiting period | Insurance for the visa |
|---|---|---|---|---|
| Australia | Permanent residents (and some applicants) can enrol in Medicare. UK residents visiting get medically necessary care under a reciprocal agreement; there's none with the US | Not researched | None stated for permanent residents | Not researched. Temporary residents not covered by a reciprocal agreement aren't eligible for Medicare and are told to arrange private cover |
| Canada | Each province runs its own plan for residents who qualify | Ontario: no premium stated | Ontario: none. British Columbia: the rest of your arrival month plus 2 months | Not researched. British Columbia advises arranging insurance before you arrive (advice, not a visa rule) |
| Cyprus | Non-Cypriots who work there legally and are ordinarily resident, or have permanent residence | Self-employed 4% of income; pensions, rent, interest and dividends 2.65%; on up to €180,000 a year (agency figures, undated) | Not found | Not researched |
| France | PUMa, if you work there or live there stably and regularly | Through contributions on work income. People earning under €9,612 from work (2026) with investment income over €24,030 may pay up to 6.5% of the investment income above €24,030, an accounting software firm says; a new charge for residents who don't work and don't pay French social charges (CSG/CRDS) or contributions under an international agreement awaits a decree setting the amount | None if you work; otherwise 3 months | The visitor residence card needs insurance for your whole stay |
| Germany | Employees earning under €77,400 a year (2026) must join a public fund; the self-employed can choose private cover, and joining a public fund voluntarily generally needs earlier public cover | Public funds: 14.6% plus an average 2.9% top-up (2026); the self-employed pay all of it, from €222.80 a month for health alone (€230.71 with sick pay) | None found | The freelance visa needs cover valid in Germany until German insurance starts |
| Ireland | Public services if you're "ordinarily resident": living there, or intending to, for at least a year | No public in-patient charges; €100 at A&E without a GP referral; GP visits have no set fee, typically around €45 to €65 (2024 figure), unless you have a GP visit card | None beyond the residence test | Not researched |
| Italy | Compulsory registration if you're legally resident and working, employed or self-employed. Others, such as retirees, can register voluntarily | Voluntary: at least €2,000 a year, for the calendar year, not reduced for part years | None found | The digital nomad visa needs travel medical insurance of at least €30,000 (consulate page, 2024) |
| Netherlands | Dutch basic insurance is compulsory if you live or work there (if your employer is abroad, check with the SVB whether you need it) | About €157 a month on average in 2026, plus an income-related contribution; €385 yearly deductible (not for GP care) | Take it out within 4 months; it's then backdated to arrival | Not researched |
| Portugal | Legal residents can get an SNS user number; your tax number, address and residence permit must be linked for the SNS to pay | No registration fee found; charges only at hospital A&E, and not if referred or admitted | None stated | Not found: the official visa pages wouldn't load |
| Spain | Paying social security, for example as self-employed (autónomo); or, if you don't work, the "convenio especial" with your regional health service | Self-employed: about 31.5% of a base linked to your income, by our sum of the published rates (lowest base €653.59 a month in 2026); new autónomos get a reduced fee for 12 months. Convenio especial: €60 a month under 65, €157 at 65 or over | Convenio especial: after a year's continuous residence, and you must be on the padrón when you apply | The digital nomad visa needs public or private cover from an insurer authorised in Spain, unless you're covered by Spanish social security |
Sources: Services Australia, Medicare for permanent residents, Services Australia, visiting from the UK, June 2024, Australian Department of Health, MBS note GN.3.9, Ontario, apply for OHIP, July 2025, British Columbia, MSP wait period, June 2026, Cyprus Health Insurance Organisation, enrolment guide, Cyprus Health Insurance Organisation, financing, Service-Public.fr, PUMa, May 2026, Indy, PUMa contribution, September 2026, Service-Public.fr, visitor residence card, June 2026, German Health Ministry, who is insured, September 2026, German Health Ministry, contributions, September 2026, German Embassy Canberra, freelance visa, Citizens Information, healthcare in Ireland, Citizens Information, hospital charges, August 2026, Citizens Information, GPs and private patients, June 2024, Citizens Information, GP visit cards, October 2026, Italian Ministry of Labour, healthcare for foreigners, ASL 1 Sassari, voluntary registration, Italian consulate in New York, digital nomad visa, Government.nl, when to take out health insurance, August 2026, Rijksoverheid, premium 2026, Rijksoverheid, deductible 2026, gov.pt, migrants: healthcare in Portugal, June 2026, gov.pt, SNS user number, May 2026, Decreto-Lei 37/2022, Spanish Social Security, self-employed contributions 2026, Spanish Social Security, self-employed rates and reduced fee, Spanish Ministry of Health, convenio especial, BOE, Real Decreto-ley 7/2018, Spanish consulate in New York, telework visa
When you still need private cover
- For the visa
- Spain's digital nomad visa, Italy's remote worker visa, Germany's freelance visa and France's visitor card all ask for health insurance. Spanish consulate in New York, telework visa, Italian consulate in New York, digital nomad visa, German Embassy Canberra, freelance visa, Service-Public.fr, visitor residence card, June 2026
- Before public cover starts
- France makes people who don't work wait 3 months, British Columbia up to 3, and Spain's convenio especial needs a year's continuous residence first. Service-Public.fr, PUMa, May 2026, British Columbia, MSP wait period, June 2026, Spanish Ministry of Health, convenio especial
- If you can't join
- Temporary residents in Australia who aren't covered by a reciprocal agreement aren't eligible for Medicare. In Germany, joining a public fund voluntarily generally only follows earlier compulsory or family public cover, so a self-employed newcomer may need private cover (we haven't checked how earlier cover in another EU country counts). Australian Department of Health, MBS note GN.3.9, German Health Ministry, who is insured, September 2026
- Getting home
- The US State Department says most health plans don't pay for an air ambulance back to the US, and recommends cover that includes medical evacuation. US State Department, medicine and health, US State Department, retirement abroad
Related: Visa checker