UK Expat Health Insurance: What the NHS, the S1 and the GHIC Leave Uncovered

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 28, 2026Facts checked: October 28, 2026

Key facts: UK expat health insurance in 2026

These are the rules a British citizen meets when moving abroad, as read on official UK pages and the insurer's terms in October 2026.

Sources: NHS website; Department of Health and Social Care; NHS Business Services Authority; HMRC and DWP; FCDO; Care Concept / Barmenia terms VB-KV 2026_05 and premium table (read 2026-10-27).

Does the NHS cover you once you move abroad?

No: the NHS is a residence-based system, so once you move abroad on a permanent basis you are no longer automatically entitled to treatment under normal NHS rules, whatever your passport says.

A lifetime of National Insurance does not change this. The deciding question is not whether you are British, whether you paid tax or whether you still own a house in Kent. It is whether you are "ordinarily resident" in the UK. The Department of Health and Social Care defines that as living in the UK lawfully, voluntarily and for settled purposes, and says plainly that it does not depend on nationality. Earlier Department guidance added that paying UK taxes or National Insurance, being registered with a GP, having an NHS number or owning property do not make you ordinarily resident on their own.

So the day you leave to live in Spain, Dubai or Chiang Mai, the NHS stops being your health system. The NHS website asks you to tell your GP practice that you are moving abroad so that you and your family can be removed from the register. It is a good moment to ask for copies of your records: any private insurer will want to see your recent history, and so will your new doctor.

Source: DHSC, "Charging overseas visitors in England: guidance for providers of NHS services" (updated 20 May 2026); NHS website, "Planning your healthcare" when moving abroad; NHSBSA. Rates differ for people covered by the Withdrawal Agreement (100%).

If you are looking for "NHS health insurance abroad", there is no such product. The NHS does not sell cover for life overseas. What exists is the S1 for State Pensioners in Europe, explained below, and the private market. For everyone else, the plan you choose abroad is your health system. Our pillar guide to expat health insurance explains the main plan types, and healthcare systems by country shows what each destination offers residents.

What happens on visits home, and if you move back to the UK?

On visits you are an overseas visitor, so NHS hospital care can be charged, while a permanent return normally restores free care from the day you arrive.

Visiting family in the UK

As a British expat back for Christmas or a family event, you can see a GP without charge, and A&E is exempt unless the purpose of your trip was to get treatment. Anything beyond that, such as a hospital admission after a fall, can be billed at 150% of the national NHS rate. There are exemptions: people who moved to the EU before 2021 and hold a UK-issued S1, for example, are entitled to free hospital treatment in England on a temporary return, and war pensioners have their own exemption. If you moved to the EU from 2021 onwards, the UK government says you should not expect free hospital care on a visit unless one of the exemptions applies to you.

This matters for your insurance choice. Care Expat World never covers a British citizen in the UK, in any zone: its binding terms give home-country cover only where the home country is an EU or Schengen state, and the UK is neither. Its 42-day emergency rule for travel outside your zone does not apply in your home country either. A Briton living in Portugal or Thailand therefore needs separate trip cover for visits home. Our guide to international health insurance with home-country cover explains who does get home cover.

Moving back for good

The Department of Health and Social Care guidance for NHS providers, updated in May 2026, says former UK residents who come back to live here will most likely meet the ordinary residence test from the date of their arrival. In practice that means bringing proof that the move is settled: a tenancy or house purchase, a job, children in school, accounts closed abroad. If you held an S1, NHS guidance says returning to the UK ends it, and you contact NHS Overseas Healthcare Services to cancel it. A private international policy also ends on your final return home, so plan the two dates together.

Does the immigration health surcharge apply to Britons?

The immigration health surcharge is part of a visa or immigration application: GOV.UK says it is usually paid by people applying for more than six months from outside the UK, or for any length of time from inside it. GOV.UK's list of who pays does not mention British citizens moving back, and we found no official page that addresses them directly; if your return involves no visa or immigration application, there is no application for the surcharge to attach to. A foreign spouse coming with you is a different matter and should check the visa rules for their route.

Who can get an S1, and where does it work?

An S1 is available to people who already receive a UK State Pension (or certain exportable benefits, or who are posted or frontier workers), and it works only in the EU, Switzerland, Norway, Iceland and Liechtenstein.

The S1 is the one piece of the NHS that travels. NHS Business Services Authority describes it as giving you the same state healthcare as a resident of your new country, with the UK paying. It does not cover private care. You can apply online up to 90 days before you move to an EU country if your State Pension is already being paid; Switzerland, Norway, Iceland and Liechtenstein need a call or letter instead. Once issued, you register it with the local authority, and only then are you covered. A registered S1 also brings a UK-issued GHIC or EHIC for trips to other EU countries.

• Not for early retirees. We found no official S1 route for people who retire before State Pension age on a workplace or private pension.
• Not outside Europe. NHSBSA states that you are not entitled to state care paid for by the UK if you move outside the EU, Switzerland, Norway, Iceland or Liechtenstein. Montenegro, St Helena, Ascension and Tristan da Cunha are named as places where no S1 can be issued.
• Ireland works differently. UK citizens living in Ireland need no S1: they are entitled to state healthcare on the same basis as Irish citizens.
• Dependants. You can list a partner, but the host country decides whether they meet its definition of a dependant, and a partner who can get their own S1 must apply for it.

Our S1 form guide covers the application and registration country by country, and our S1 gap guide works through the years before the S1 starts.

When is your State Pension age, and how long is your gap?

State Pension age is currently 66 and will rise to 67 between 2026 and 2028, so a Briton who retires to Europe at 60 usually waits six or seven years before an S1 is possible.

HMRC guidance updated in October 2026 states that State Pension age for men and women is currently 66 and will rise to 67 between 2026 and 2028. The exact date depends on your date of birth, under the DWP timetable set by the Pensions Acts of 2007 and 2014:

Source: DWP State Pension age timetable; HMRC Employment Income Manual EIM76160 (updated 21 October 2026). GOV.UK notes that State Pension age is regularly reviewed; a review was under way in 2026 with no change in law found.

The gap is the time between your move and the month your State Pension is actually paid (you claim it through the International Pension Centre, within four months of reaching State Pension age). In the EU that gap needs private cover or a local public scheme; outside Europe there is no S1 at the end of it. The table shows the gap for someone born between 1961 and 1977, whose State Pension age is 67.

Notice the mismatch: the private plan closes at 64, but the S1 opens at 67. Anyone who wants long-term private cover through the gap has to buy it before the S1 is even in sight. The age-limit guide explains how the entry rule is counted.

Can you use a UK GHIC or EHIC while living abroad?

Only for temporary visits: the NHS describes the UK GHIC as cover for necessary state treatment during a temporary stay, not for the country you live in.

The UK Global Health Insurance Card is free and valid for up to five years. It replaced the old EHIC after Brexit, except for people protected by the Withdrawal Agreement, who can hold a UK EHIC. Both cards give access to necessary state healthcare on a temporary stay. GOV.UK's travel-insurance guidance states that neither card replaces travel insurance, because they do not cover private treatment, repatriation or extra costs such as mountain rescue.

Once you live abroad, the card stops being the right tool. GOV.UK's guidance on living in Portugal, for example, says residents cannot use or renew a UK GHIC unless they are students, State Pensioners with a registered S1 or frontier workers with a registered S1. A card you were issued while living in the UK must not be used once your S1 is registered; you return it and apply for a new one. For a long stay without an S1, the card is not your health cover.

Is British expat travel insurance enough to live abroad?

No: the Foreign, Commonwealth and Development Office states that travel insurance is not intended for permanent residence abroad, and it suggests private medical insurance for UK expatriates.

It is tempting to look for one "British expat travel insurance" policy for a new life abroad. Travel policies are built around trips: they pay for emergencies and getting you home, they ask you to declare pre-existing conditions, and they often carry age limits, especially on annual policies. They usually do not pay for the routine care, check-ups and long-term conditions that make up most of a resident's medical life. A long-term international plan is a different contract: it follows you for years inside an area of cover and has no trip limit.

Travel insurance still has two clear jobs for a British expat. The first is a visa application that needs insurance from the application date or before arrival, which a long-term plan that starts only after you cross the border cannot provide: use travel or visa insurance for the application, then start long-term cover on arrival. The second is visits back to the UK. Our guide to visa health insurance requirements by country collects what each visa asks for, and digital nomad health insurance covers people who keep moving.

How do the top destinations for Britons handle health cover?

Inside the EU an S1 eventually helps, though each country has its own route before that; outside Europe you rely on local schemes or private cover for as long as you live there.

Spain, information only. Spain's non-lucrative visa wording points to an insurer authorised to operate in Spain, so we make no claim that Care Expat World meets Spanish residence requirements. Ask the Spanish consulate which policies it accepts for your file; a registered S1 or, after a year, the convenio especial are the other documented routes. UAE. The UAE lies in Zone 1, but Dubai and Abu Dhabi law make residents hold a policy from a UAE-licensed insurer authorised by the emirate regulator, and the Ministry of Human Resources and Emiratisation has made employers in the other emirates buy one for their staff since 1 January 2025. Care Expat World does not meet that rule and the insurer itself says it cannot promise to meet a local compulsory-insurance requirement, so treat it only as extra cover. If your employer provides cover, check what it includes before you add anything. Germany is the one EU country where Care Expat World is closed to residents: people living there more than 180 days a year cannot be insured. Comparing countries first? See retirement visas by country and best countries to retire.

What does UK expat health insurance cost at 50 to 64?

Care Expat World in Zone 1 costs from €200 a month at 55–59 and from €325 at 60–64, up to €800 for Premium with no deductible at 60–64.

Monthly, in euros, Zone 1 (worldwide except the USA, China and Singapore), premium table read 2026-10-27. You move up a band on 1 January of the year of your 55th, 60th, 65th or 70th birthday, and the insurer's yearly price review also takes effect each 1 January. Premiums are charged in euros, so the cost in pounds moves with the exchange rate.

Three choices drive the price. The age band comes from your year of birth. The level sets the benefits: Basic pays for hospital stays and doctors but not the dentist; Comfort brings in dental care, screenings, physiotherapy, glasses and up to 15 outpatient psychotherapy sessions a year; Premium adds 25 sessions, higher refunds and no cap on cancer treatment. The deductible is what you pay yourself each calendar year before the plan pays; in the first year it is reduced pro rata by month. Our international health insurance cost guide lists every combination and the worst-case year, and the Care Expat World guide explains each level.

What Care Expat World does and does not do for Britons

It gives long-term cover with no exit age wherever you live in your zone, but it never covers you in the UK, makes no visa promise and closes to new members from the year they turn 65.

The full benefit list is on the plan details page. If you have a long-term condition, read our guide to international health insurance with pre-existing conditions before you book the interview.

How to set up health cover before you leave the UK: 5 steps

Work out your State Pension date and plan deadline, check your destination's insurance rules, collect your NHS records, arrange visa and trip cover, and only then apply for a start on the 1st of the month after you arrive.

1. 1
   Find your two dates

   Use the tool at the top of this page: your State Pension age (when an S1 becomes possible in Europe) and the last start date for Care Expat World (1 December of the year you turn 64).

2. 2
   Read the insurance rules of your destination

   Check what the visa and the residence permit ask for. Spain points to an insurer authorised in Spain; Thailand’s O-A asks for an insurer-signed certificate; Portugal’s D7 accepts travel insurance or an S1 for the application.

3. 3
   Collect five years of NHS records and tell your GP

   Ask your GP practice for copies of reports and test results, then tell them you are moving so you are removed from the register.

4. 4
   Arrange cover for the visa and the move

   If your visa needs insurance before you arrive, buy travel or visa insurance for that period. Long-term cover starts only after you cross the border.

5. 5
   Apply up to four months ahead

   Choose level, deductible and zone, take the video interview and start on the 1st of the month after you arrive. You can withdraw within 14 days of signing.

• State Pension age checked for my exact date of birth
• Care Expat World deadline noted (1 December of the year I turn 64)
• Destination’s visa and residence insurance wording read
• GP told about the move; copies of records requested
• Travel or visa insurance bought for the application period, if needed
• Trip cover planned for visits back to the UK
• Partner’s own deadline and S1 position checked
• State Pension claim planned with the International Pension Centre

Worked examples: three British households

A single retiree in Portugal, a couple in Thailand and a British-American couple in France show how the same rules land differently; all prices are today's Zone 1 prices.

Susan, from Bristol, born 14 August 1964, moving to Portugal

Susan moves to the Algarve in March 2027, aged 63 under the plan's calendar-year rule. Born in 1964, her State Pension age is 67, which she reaches in August 2031. Until then no S1 is possible. For the D7 application she buys travel insurance, then starts Care Expat World Comfort with a €1,200 deductible on 1 April 2027, well before her deadline of 1 December 2028. She pays €655 a month for 21 months and €955 a month from 1 January 2029 for 32 months until August 2031: €44,315 in premiums at today's prices. Once resident she also takes an SNS user number. When her State Pension is paid she applies for an S1 and registers it; whether she keeps the private plan afterwards is her choice, and it has no end age. Visits to her sister in Bath are not covered by the plan. See expat health insurance in Portugal and S1 gap health insurance.

Brian and Carol, from Manchester, born 1966 and 1968, moving to Thailand

Thailand is outside Europe, so neither of them will ever get an S1 there, and Thailand has no public scheme for foreign retirees: private cover is their only health system for as long as they stay. They start Care Expat World Basic with a €3,600 deductible on 1 June 2027. Brian is 61 and Carol 59 that year, so together they pay €525 a month; from 1 January 2028, when Carol moves into the 60–64 band, the total is €650 at today's prices. Brian's deadline (1 December 2030) comes before Carol's (1 December 2032), so his date sets the couple's timetable. The O-A visa needs at least USD 100,000 of cover with an insurer-signed certificate; they check the current wording on the Thailand retirement visa page and make no assumption that any plan is accepted. More in retire in Thailand.

Rachel and Tom, from Leeds, born 1970 and 1969, moving to France

Rachel is British; Tom is American. They move to Brittany and start Care Expat World Comfort with a €1,200 deductible on 1 September 2027, aged 57 and 58: €1,010 a month for both. The plan covers neither of them at "home": Rachel is never covered in the UK and Tom never in the USA, because home cover exists only for EU or Schengen home countries. After three months of stable residence they can apply to join PUMa, the French public system. Rachel reaches State Pension age at 67 in 2037; from then an S1 is possible, and Tom may be listed as her dependant if France accepts him under its own definition. Tom's own deadline for the plan is 1 December 2033. American readers can compare health insurance for Americans living abroad; see also expat health insurance in France and international family health insurance.

What if you are already 65 or older?

Care Expat World is closed to anyone who turns 65 or older in the year cover would start, so the realistic routes are the S1, local public schemes and plans without an entry-age limit.

For a British State Pensioner moving to the EU, EEA or Switzerland, the S1 is the main route, applied for up to 90 days before the move. In Spain, residents aged 65 and over who have lived there for a year can buy into the public system through the convenio especial for €157 a month; S1 holders are not eligible for it. Outside Europe there is no UK-funded cover at any age. Our guides to expat health insurance over 65 and health insurance for retirees abroad set out the options.

Already 65 or older in the year cover would start? This plan is closed to you; we are preparing a comparison of plans without an entry-age limit.

Still working abroad rather than retiring? See health insurance for freelancers abroad.

Where these facts come from

• NHS website, "Planning your healthcare" when moving abroad (last reviewed 2 May 2023, read October 2026); NHS website, UK Global Health Insurance Card
• Department of Health and Social Care, "Charging overseas visitors in England: guidance for providers of NHS services" (updated 20 May 2026); earlier DHSC guidance "How the NHS charges overseas visitors for NHS hospital care" (2020, since withdrawn)
• GOV.UK, "Pay for UK healthcare as part of your immigration application: who needs to pay" (read October 2026)
• NHS Business Services Authority, S1 pages and knowledge-base articles on healthcare when moving abroad, Ireland and countries without an S1 (read October 2026)
• DWP, State Pension age timetable; HMRC Employment Income Manual EIM76160 (updated 21 October 2026); GOV.UK, "State Pension if you retire abroad"
• Foreign, Commonwealth and Development Office: "Foreign travel insurance" (updated 2 August 2024); UAE travel advice, health section (read October 2026)
• Government of Dubai: Law No. (11) of 2013 Concerning Health Insurance in the Emirate of Dubai; Department of Health Abu Dhabi: Law No. 23 of 2005; Ministry of Human Resources and Emiratisation: basic health insurance scheme from 1 January 2025 (read 28 October 2026)
• GOV.UK healthcare and "Living in" guides for Spain, Portugal, France, Italy, Greece, Cyprus and Ireland (2021–2026)
• Spain: Spanish consulate in London, non-lucrative visa requirements (6 July 2026); Ministry of Health, convenio especial. Portugal: gov.pt on SNS access for migrants (23 June 2026). France: service-public.fr, PUMa. Thailand: O-A visa insurance guideline. Mexico: IMSS voluntary scheme rules
• Care Expat World (Care Concept AG, insurer Barmenia): binding German terms VB-KV 2026_05, consumer information, English product page and premium table (read 2026-10-27)

The premium sums are our own arithmetic on the insurer's premium table. We found no official statistic on which cover British expats buy, and none is used on this page.