Healthcare in England: you pay the IHS upfront, then the NHS is free — apart from prescriptions and the dentist

In England you don't take out health insurance. Whoever comes on a visa pays the Immigration Health Surcharge (IHS) with the application: £1,035 per adult per year, £776 per child under 18, and all of it upfront for the whole length of the visa. With that you use the NHS free of charge from the day your visa starts. Private insurance does not exempt you from the surcharge. What you do keep paying yourself are prescriptions, the dentist and eye tests, and that's where the recurring amounts are.

How much is the IHS exactly?

The bill depends on the length of your visa, and that is often longer than your contract. A three-year visa costs an adult £3,105 in IHS. The family from the Skilled Worker article, two adults and two children for five years, pays over £18,000. Fixed rules apply to parts of a year.

Visa length (application from the Netherlands)	Adult	Child under 18
per full year	£1,035	£776
6 months or less	nothing	nothing
more than 6 months, less than 1 year	one full year	one full year
more than 1 year, up to and including 18 months	one and a half years	one and a half years
more than 18 months, less than 2 years	2 years	2 years

You get the surcharge back in full if the visa is refused or you withdraw the application before the decision, and partly if you get less time than you asked for. If you leave before your visa ends, you get nothing back. You don't have to claim a refund: it goes to the account or card you paid with.

How do you get to a GP?

This is the simplest counter of your first weeks. Anyone can register with a GP surgery free of charge, usually online, in about a quarter of an hour per person, and the NHS says it in so many words: you don't need ID, proof of address or proof of your immigration status. Nor an NHS number. You usually hear within five days that you're registered. A surgery may only refuse you if it isn't taking new patients, you live outside its area or you were removed from its list before, and it must explain that in writing within fourteen days. For children under 16 a parent fills in a separate form, and there the surgery may ask for proof of ID and address for the child, such as a birth certificate.

If you don't have a permanent address yet, you may register with a temporary address or with the address of the surgery itself. So do it in the first week, not only once someone is ill.

What do you pay yourself?

Item	Amount	Note
Prescription	£9.90 per item	three medicines on one prescription means paying three times
Prepayment certificate 3 months	£32.05	worth it with more than 3 items in 3 months
Prepayment certificate 12 months	£114.50	worth it with more than 11 items a year
Dentist band 1	£27.90	check-up, X-rays, scaling
Dentist band 2	£76.60	fillings, root canal, extractions
Dentist band 3	£332.10	crowns, bridges, dentures, braces
Urgent dental treatment	£27.90	including one urgent filling

At the dentist you pay once for the highest band of your treatment; follow-up treatment within two months in the same or a lower band costs nothing extra. Whoever takes medicines long term buys the prepayment certificate online; it is valid from the day you apply and covers unlimited prescriptions.

Are you coming with a Dutch pension?

Then things are different, and more favourable than most people expect after Brexit. The United Kingdom is still on the CAK's list of treaty countries. With a pension or benefit from the Netherlands you register with the CAK; the CAK advises starting three months before the move and handles the application within four weeks. You then pay the CAK a treaty contribution, in the CAK's own words a kind of healthcare premium. GOV.UK states explicitly that whoever has had an S1 registered with the NHS Business Services Authority can get the IHS paid refunded in full or in part. How the AOW and the pension themselves work out is covered in the article on that.

If you leave before your AOW age, watch 1 November 2026. As things stand, the CAK expects that from that date treaty healthcare will only be open to new registrants with a statutory benefit: AOW, Anw, WAO, WIA or Wajong. Early retirement pension, RVU and wachtgeld fall outside it. The announcement mentions the EU, the EEA and Switzerland; whether it also applies to the UK is not stated. Put your situation to the CAK before that date.

What doesn't the surcharge cover?

Paying is not priority: doctors assess the urgency of your condition as they do for anyone, and waiting lists apply to you too. A new course of fertility treatment falls outside the cover. And if the Home Office ends your visa early, the hospital can charge again from that date.

A child born in the UK is covered free of charge for the first three months; apply for a visa for the child within those three months, with its own IHS if required. Factor that into the family budget, alongside the item nobody sees coming: the dentist, who here charges per treatment in a band.

In Vertrekklaar this is phase 5 of 5 of the journey, step 5.4: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to England or go straight to step 5.4 in the open plan.