Is NHS Free for ILR Holders? Yes — Full Guide 2026

Yes. Once you have Indefinite Leave to Remain, you can access the NHS on the same basis as a British citizen or permanent UK resident. You do not pay the Immigration Health Surcharge (IHS) after getting ILR. You still pay for things that UK nationals pay for, such as prescription charges in England, dental treatment, and eye tests.

Key Facts

Topic	Detail
NHS access with ILR	Full — same as British citizens
Immigration Health Surcharge after ILR	Not required — already paid during visa years
GP registration	Can register with any NHS GP practice
Prescription charges (England)	£9.90 per item (standard 2026 rate) — same as UK nationals
Dental treatment	Charged at NHS bands — same as UK nationals
Eye tests	Charged — some exemptions apply (low income, age 60+)
Hospital treatment	Free at point of use — same as UK nationals
Emergency treatment	Free — same as UK nationals
Children with ILR	Same access as adults with ILR

Quick Overview

✅ ILR holders have full NHS access on exactly the same basis as British citizens
✅ You do not pay the Immigration Health Surcharge once you have ILR
⚠️ You still pay prescription charges in England (£9.90 per item in 2026) — same as everyone else
⚠️ NHS dental treatment and optician appointments are charged at standard NHS rates — same as UK nationals
📌 The IHS was paid as part of your visa application — it does not apply to ILR holders
📌 If your ILR lapses (2+ years abroad), you may lose your free NHS access
💡 Scotland, Wales, and Northern Ireland do not charge for prescriptions — different from England
💡 Settling in the UK ends your immigration-related healthcare costs permanently

Introduction

One of the most practical benefits of getting ILR is the change in your healthcare position. For years, you paid the Immigration Health Surcharge alongside your visa fees — contributing a significant amount each year to NHS access. Once you have ILR, that cost disappears. This guide explains exactly what your NHS access looks like after ILR, what you still pay for, and what happens if your ILR ever lapses. To understand your ILR eligibility and timeline, use our ILR calculator.

What Does Full NHS Access Mean for ILR Holders?

Full NHS access means you can use the National Health Service in the same way a British citizen does.

In practice, this means:

Registering with a GP: You can register with any NHS GP practice. You do not need a referral and you do not need to pay to see your GP.
Hospital treatment: If your GP refers you to hospital, or if you attend A&E, your treatment is free at the point of use.
Specialist care: Referrals to specialists, physiotherapy, mental health services, and other NHS services are available on the same basis as for British citizens.
Maternity care: Antenatal and postnatal care is free for ILR holders.
NHS 111: The non-emergency health advice line is free and available to all UK residents.

The key phrase is "at the point of use." NHS care in England is funded through taxation, not through direct charges at the time of treatment.

What You Do Not Have to Pay After ILR — The Immigration Health Surcharge

The Immigration Health Surcharge (IHS) is a fee paid by visa applicants to access the NHS during their visa period.

As of April 2026, the IHS is:

£1,035 per year for most adult applicants
£776 per year for students and youth mobility visa holders

Over a 5-year qualifying period, a single applicant pays £5,175 in IHS on top of their visa fees. A family of four pays over £20,000 in IHS across 5 years.

Once you have ILR, you stop paying the IHS. This is one of the most significant financial benefits of settlement.

You do not need to apply to stop paying the IHS. It stops automatically when your visa status changes to ILR.

For more detail on the IHS and what it covered during your visa years, see our guide: Immigration Health Surcharge for ILR holders.

What You Still Pay For

ILR holders are not exempt from the charges that apply to British citizens generally. You pay exactly what a British citizen pays — no more, no less.

Prescription charges (England only) In England, prescriptions cost £9.90 per item (2026 rate). This applies to ILR holders and British citizens alike. Exemptions include:

Children under 16
People aged 60 or over
People with certain medical conditions (e.g. diabetes requiring medication, epilepsy)
People on qualifying low-income benefits
Prepayment certificates (PPC) — a flat fee covering all prescriptions for a period

Prescriptions in Scotland, Wales, and Northern Ireland Prescriptions are free in Scotland, Wales, and Northern Ireland — for everyone, including ILR holders. This applies regardless of immigration status.

NHS dental treatment NHS dental treatment is charged at set rates:

Band 1 (examination, X-ray, scale and polish): £26.80
Band 2 (fillings, extractions): £73.50
Band 3 (crowns, dentures, bridges): £319.10

These charges apply to British citizens and ILR holders equally. Exemptions include children under 18, pregnant women, and people on qualifying benefits.

Eye tests Standard NHS-funded eye tests are not universally free for ILR holders. Optician charges vary. NHS-funded free eye tests are available for:

Children under 16
People aged 60 or over
People with diabetes or glaucoma
People on certain low-income benefits

Prescription prepayment certificates (PPC) If you need multiple prescriptions per month, a PPC is significantly cheaper than paying per item. The quarterly PPC costs £32.05 and the annual PPC costs £114.50 (2026 rates).

Do Dependants With ILR Have the Same Access?

Yes. Children and other dependants who hold ILR have exactly the same NHS access as the main ILR holder.

Children with ILR can register with an NHS GP and access NHS services free at the point of use. They may also qualify for additional exemptions — such as free prescriptions (under 16) and free dental treatment (under 18) — that apply to all children regardless of immigration status.

How Does ILR NHS Access Compare to Visa Holders?

While you are on a visa, you pay the IHS as part of your visa application. This gives you NHS access during your visa period — but you still pay this lump sum annually in advance.

After ILR, the IHS payment stops entirely. There is no annual charge. You access the NHS through general taxation like any other UK resident.

The practical healthcare access is the same in both cases. The difference is that you stop paying the IHS surcharge — which for many families represents a saving of thousands of pounds per year.

How Does ILR Compare to EU Settled Status?

EU Settled Status and ILR are both forms of permanent residence, and both give the same NHS access.

Settled Status holders have full NHS access on the same basis as British citizens. They do not pay the IHS. They pay the same charges (prescriptions, dental, eye tests) as British citizens.

The one practical difference is the lapse rule: ILR lapses after 2 continuous years outside the UK; Settled Status lapses after 5 continuous years. If either lapses, you may lose your free NHS access. See our full comparison: ILR vs Settled Status.

What If Your ILR Lapses?

If you spend more than 2 continuous years outside the UK and your ILR lapses, your right to free NHS care would be affected.

As a lapsed ILR holder re-entering the UK, your immigration status would revert to visitor level until you apply for and receive a Returning Resident visa or reapply for ILR. During this period, you would not have the same free NHS access.

This is one more reason to protect your ILR by not exceeding the 2-year absence limit. Read our guide: Does ILR expire?

Do You Need to Register With a GP Again After Getting ILR?

Not necessarily — if you are already registered with an NHS GP practice, you do not need to re-register when your status changes from visa to ILR. Your GP registration continues.

However, if you have recently moved to a new area, or if you have never registered with a GP, you should register with a local practice. You can find your nearest NHS GP practice using the NHS website (nhs.uk).

Some people who held visitor visas or short-term status were not entitled to register with a GP. If ILR is your first long-term status in the UK, GP registration is a priority.

Common Mistakes

❌ Continuing to pay private health insurance when ILR gives full NHS access Some ILR holders continue paying for private health insurance thinking they still need it for NHS access. You do not. ILR gives you full NHS access from day one. Private health insurance is a personal choice — not a requirement — once you have ILR.

❌ Thinking the IHS continues after ILR is granted The IHS stops automatically when your immigration status becomes ILR. You do not need to cancel anything. If you have paid an IHS for a period that extends beyond your ILR grant date, you may be entitled to a partial refund — check GOV.UK for the current policy.

❌ Assuming prescriptions are free throughout the UK after ILR Prescriptions are free in Scotland, Wales, and Northern Ireland — but not in England. In England, ILR holders pay the same prescription charge as British citizens (£9.90 per item in 2026) unless they qualify for an exemption.

❌ Not registering with a GP promptly after getting ILR If you are not already registered with a GP, do it as soon as possible after getting ILR. GP registration can take a few weeks to process. Do not wait until you are unwell to discover you are not registered.

❌ Assuming ILR gives automatic exemption from NHS dental charges NHS dental charges apply to ILR holders on the same basis as British citizens. You are not automatically exempt. You may qualify for free dental treatment if you are on certain benefits or are pregnant — but these are the same exemptions that apply to everyone.

Expert Tips

Check whether you qualify for a prescription prepayment certificate. If you take regular medication requiring multiple prescriptions, a PPC at £114.50 per year covers unlimited prescriptions and is much cheaper than paying per item. It is available to everyone in England — British citizens and ILR holders alike.
If you had private health insurance to cover NHS access concerns during your visa period, review it after getting ILR. You may no longer need the same level of cover. This could be a meaningful monthly saving.
Register with a GP as soon as you have ILR. The NHS is most valuable when you need it urgently. Being registered in advance means you can access your GP quickly when the need arises.
If you plan to travel for extended periods after getting ILR, understand the 2-year lapse rule. More than 2 continuous years outside the UK and your ILR lapses — taking your NHS access with it. See our absence calculator to track your time outside the UK.
The path from ILR to British citizenship also secures your NHS access permanently. Once you are a British citizen, the absence rule disappears entirely. Your NHS access cannot lapse. For the full picture, see our guide: ILR vs British citizenship.

Frequently Asked Questions

Do ILR holders get free NHS treatment?

Yes. ILR holders access the NHS on the same basis as British citizens — free at the point of use for GP appointments, hospital treatment, A&E, and most specialist care. You still pay for prescriptions in England, dental treatment, and eye tests at the same rates as British citizens.

Do I still pay the Immigration Health Surcharge after getting ILR?

No. The IHS applies only to visa holders. Once you have ILR, you no longer pay the IHS. Your NHS access is funded through general taxation, like any other UK resident.

Are prescriptions free for ILR holders?

In Scotland, Wales, and Northern Ireland — yes, prescriptions are free for everyone. In England, ILR holders pay the same prescription charge as British citizens (£9.90 per item in 2026) unless they qualify for an exemption (under 16, 60+, certain conditions, or certain benefits).

What happens to my NHS access if my ILR lapses?

If your ILR lapses because you spent more than 2 continuous years outside the UK, you lose your permanent residence status. You would need to reapply for ILR or enter as a visitor. During this period, your full NHS access would not apply. See: Does ILR expire?

Does EU Settled Status give the same NHS access as ILR?

Yes. EU Settled Status gives the same NHS access as ILR. Both are forms of permanent residence in the UK, and both carry the same healthcare entitlement. The difference is the absence rule: Settled Status lapses after 5 years abroad; ILR lapses after 2 years. See: ILR vs Settled Status.

How This Aligns With Official Guidance

NHS access rights for ILR holders are set out in the National Health Service (Charges to Overseas Visitors) Regulations. ILR holders are exempt from overseas visitor charges on the same basis as British citizens. The IHS provisions are set out in the Immigration (Health Charge) Order 2015 and subsequent amendments. Prescription charge amounts are set annually by the Department of Health and Social Care. Always check GOV.UK and NHS.UK for current charges and exemptions.

Official Resources

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What to Do Next

If you have recently received ILR, register with an NHS GP practice if you have not already done so. If you are working towards ILR, our ILR calculator will confirm your qualifying date. And when you are ready, start preparing for the Life in the UK test — it is a requirement for both ILR and citizenship. Start your free practice questions today.

Last reviewed: April 2026 — figures correct at time of publication. Always check GOV.UK for the latest fees and requirements.