In England, the NHS is required to charge ‘overseas visitors’ for secondary healthcare provided in hospitals or delivered in the community. Patients who are classed as overseas visitors are required to pay the full cost of treatment up front, unless the care they require is deemed by clinicians to be urgent or immediately necessary. A person who is required to pay for secondary healthcare will need to pay upfront for treatment or to re-pay a NHS debt after receiving urgent treatment, including maternity care. Overseas visitors are charged at 150% of the standard treatment rate.
Many overseas visitors will be exempt from charging, including people who paid the NHS surcharge when they applied for their visa and people with a pending asylum claim.
A person will usually be required to pay for secondary healthcare in England if they have:
- Overstayed their visa
- Become appeal rights exhausted (ARE) following an unsuccessful asylum claim, and are not receiving support from the Home Office or accommodation from their council under the Care Act 2014
- Leave to enter as a visitor for six months or less
There is no charging exemption for people in these groups who are supported by their council, unless they are an ARE asylum seeker accommodated under the Care Act. Therefore, charges for NHS treatment will still be made where a family, adult with care needs, or care leaver (aged 18+) is being provided with accommodation and financial support by their council because they have insufficient income to meet their basic living needs.
When a person is unable to receive the treatment they need because they cannot afford it, this can exacerbate any care needs they already have, creating an increased need for social care intervention, and may present a public health risk.
When a NHS debt is accrued, this could lead to a refusal of leave to remain and people can experience financial pressures making repayments. Guidance for NHS providers on charging overseas visitors in England states that when a person is destitute or at imminent risk of destitution, the NHS can chose not to chase the debt, although the debt cannot be cancelled.
Similar charging rules apply in Scotland, Wales and Northern Ireland, although people may not be charged up front for treatment and different exemptions apply.
Parents or carers will also have to pay for secondary care for children who are not exempt from charges. Some migrant families are also unable to access the healthy start scheme in England, Wales and Northern Ireland, to help with the costs of formula milk, vitamins, and healthy food for pregnant women and young children. Currently, parents with no recourse to public funds can only access the healthy start scheme if their child is British. The government has consulted on extended the scheme to all children but has not yet changed the qualifying criteria or published a response.
Content updated: 29 October 2025
