Understanding the Immigration Health Surcharge (IHS): What It Covers

Moving to the UK is a whirlwind of excitement, adventure, and... paperwork. So much paperwork. As you navigate the visa applications and checklists, you’ll inevitably come across a hefty, non-negotiable fee: the Immigration Health Surcharge, or IHS.

For many of us, seeing that multi-thousand-pound charge added to our visa cost is a real gut-punch moment. It can feel like just another hurdle in a long and expensive journey. But what are you actually paying for? Is it a magic key to free healthcare for all, or are there hidden costs and exceptions waiting to surprise you?

As an expat who’s been through the process and navigated the system, I get it. The confusion is real. So let's break it down together. This guide will demystify the IHS, clarifying exactly what it covers, what it doesn’t, and how you can make the most of the UK’s National Health Service (NHS) once you’ve paid your dues.

What Exactly is the Immigration Health Surcharge (IHS)?

Think of the IHS as a mandatory upfront contribution to the UK's healthcare system. It was introduced to ensure that migrants contribute to the cost of the NHS, which is a residency-based service primarily funded by UK taxes and National Insurance contributions.

By paying the IHS, you gain access to the NHS on broadly the same basis as a permanent UK resident. You pay it as part of your immigration application for yourself and any dependants joining you.

The cost is a significant factor in any relocation budget. As of a major increase in February 2024, the standard fee for 2025 is:

• £1,035 per year for most adult visa applicants.
• £776 per year for students, their dependants, and those on the Youth Mobility Scheme.

You have to pay for the entire duration of your visa upfront. So, for a five-year Skilled Worker visa, you’re looking at a £5,175 IHS fee per person. It’s a substantial investment, which makes it even more important to understand the return.

Who Needs to Pay the IHS (And Who Is Exempt)?

The rule of thumb is that if you're applying for a UK visa to live, work, or study for more than six months, you will almost certainly have to pay the IHS. This includes popular routes like:

• Skilled Worker visas
• Student visas
• Spouse and Family visas
• Youth Mobility Scheme
• Start-up and Innovator Founder visas

However, there are some important exemptions. You will not have to pay the IHS if you are:

• Applying for a visitor visa (as you’re expected to have travel insurance).
• Applying for indefinite leave to remain (ILR).
• A diplomat or a member of a visiting armed forces and their dependants.
• Applying for the Health and Care Worker visa (and your dependants). This is a key exemption for those coming to work within the NHS or eligible social care roles.
• An asylum seeker or applying for humanitarian protection.

Always use the official GOV.UK IHS checker tool to confirm your specific situation, as rules can have nuances.

The Big Question: What Does My IHS Fee Actually Cover?

Okay, you've paid the fee. The good news is that it covers a vast range of healthcare services, giving you and your family incredible peace of mind. Here’s a detailed look at what’s included.

What's INCLUDED:

• GP (General Practitioner) Services: This is your primary point of contact with the NHS. Once you register with a local GP surgery, you can book appointments for general health concerns, receive medical advice, and get referrals to specialist services. This is completely covered.
• Hospital Treatment (In-patient and Out-patient): If you need to see a specialist (a consultant) at a hospital, undergo tests, have surgery, or be admitted for care, this is covered by the IHS.
• Accident & Emergency (A&E) Services: If you have an accident or a medical emergency, you can go to any A&E department and receive treatment. This is available to everyone in the UK, regardless of immigration status, but your IHS payment covers any follow-up care you might need.
• Maternity Services: This includes all antenatal care, the birth itself (in a hospital or midwife-led unit), and postnatal care for both mother and baby.
• Mental Health Services: Access to NHS mental health support, including counselling, therapy, and psychiatric services, is covered. However, it's crucial to note that waiting lists for these services can be very long, which is a reality across the UK.
• Contraception Services: Most contraceptive services and products are available for free through the NHS.

To make it clearer, here’s a quick-glance table:

The Common Surprises: What Is NOT Covered by the IHS?

This is where many expats get caught out. While the IHS covers your core medical needs, several key areas incur extra costs. Budgeting for these is essential.

1. Prescriptions (in England)

If a GP or hospital doctor prescribes you medication in England, you will have to pay a set charge for each item. As of 2025, this charge is £9.65 per item. If you require multiple medications regularly, this can add up.

• Pro Tip: If you need more than three prescribed items in three months, or more than 11 in a year, it's cheaper to buy a Prescription Prepayment Certificate (PPC). This "season pass" for prescriptions can save you a significant amount of money.
• UK Devolved Nations: Crucially, if you live in Scotland, Wales, or Northern Ireland, prescriptions prescribed by the NHS are completely free of charge. This is a major difference in how healthcare is managed across the UK.

2. Dental Care

This is perhaps the biggest misconception. The IHS does not cover dental treatment. While you are entitled to use NHS dental services, they are heavily subsidised, not free. Furthermore, finding a dental practice that is accepting new NHS patients can be incredibly difficult in many parts of the country.

NHS dental charges in England are based on a three-band system:

• Band 1: Covers an examination, diagnosis, and advice. This includes X-rays and a scale and polish if needed. (Cost: ~£26.80)
• Band 2: Covers everything in Band 1, plus further treatment like fillings, root canal work, or tooth removal. (Cost: ~£73.50)
• Band 3: Covers everything in Bands 1 and 2, plus complex procedures like crowns, dentures, and bridges. (Cost: ~£319.10)

These are the 2024/2025 rates; always check the official NHS website for the latest figures. Many expats find the wait for an NHS dentist is so long that they opt for private dental care, which is significantly more expensive.

3. Optical Services

Routine eye tests and the cost of glasses or contact lenses are not covered by the IHS. You will have to pay for these services privately. High-street opticians like Specsavers, Boots, and Vision Express offer competitive pricing for eye tests (typically £20-£30), and there are often deals on glasses. Some people may be eligible for a free NHS eye test or optical vouchers (e.g., those with certain medical conditions like glaucoma), but this is not the norm.

Practical Steps: How to Use the NHS After Paying Your IHS

Paying the fee is just the start. To actually use the system, you need to take a couple of simple but vital steps as soon as you arrive and have a permanent address.

1. Register with a GP: This is your number one priority. You cannot access non-emergency services without it. Use the NHS Find a GP service to find surgeries in your local area. You’ll need to fill out a form and provide proof of your address (like a utility bill or tenancy agreement) and your ID (your passport and BRP). You do not need an NHS number to register.
2. Get Your NHS Number: Once you register with a GP, you will be assigned an NHS number. This is your unique patient identifier. The surgery will usually send this to you in the post within a couple of weeks. While you don't need it for every interaction, it's very helpful to have.
3. Understand the System: The GP is your "gatekeeper." For any non-emergency health issue, you contact your GP first. They will then refer you to a specialist at a hospital if they think it's necessary. This referral process can sometimes involve long waits, which is a much-debated aspect of the NHS.

Is Private Health Insurance Still Worth It?

This is a question many expats grapple with. Given the high IHS fee, is it worth paying even more for private insurance? The answer is: it depends on your priorities and financial situation.

The NHS is fantastic for emergencies, serious illnesses, and standard GP care. Its quality of care is world-renowned. However, its main drawback is waiting times for non-urgent procedures and specialist appointments.

Reasons to consider private health insurance:

• Shorter Waiting Times: This is the biggest advantage. You can often see a specialist and receive treatment within weeks, rather than the months (or longer) it might take on the NHS.
• Choice and Comfort: Private insurance gives you more choice over the specialist you see and the hospital you're treated in. You are also more likely to get a private room.
• Access to Services with Long NHS Waits: It can be particularly useful for things like physiotherapy, mental health support, and diagnostics like MRI scans, where NHS waits can be frustrating.
• Cover for Dental and Optical: Many insurance plans have add-ons that can help cover the costs of dental and optical care.

Many expats adopt a hybrid approach: they rely on the NHS for GP visits and emergencies but maintain a basic private insurance plan to bypass queues for specific treatments or to cover dental costs.

Final Takeaway

The Immigration Health Surcharge is a significant, unavoidable cost of moving to the UK. While the price tag is steep, it grants you access to one of the most comprehensive public healthcare systems in the world. It provides a vital safety net, ensuring that you and your family are covered for everything from a minor illness to a major medical emergency without the fear of catastrophic bills.

However, it's not an "all-inclusive" package. To avoid unwelcome financial surprises, remember to budget separately for prescriptions (in England), dental care, and eye tests. By understanding both the incredible benefits and the specific limitations of the IHS, you can navigate your new life in the UK with confidence and peace of mind. Welcome to the UK – now go register with a GP