Have you ever wondered what would happen if you had a serious illness or accident? Who will pay the medical bill. It is easy to think the state will be there, but it is not always the case. 

National Health Service

State healthcare is common to all EU countries but what is the entitlement for Expats Living and Working Abroad in the EU. 

Each state runs its own national healthcare from Social Insurance (National Insurance) contributions. State healthcare is not free it is a funded services from social insurance taxes. 

Working Abroad

For working expats the situation is clear, pay social insurance in the country of residence where you work and you will have an entitlement. For Expats this may include family , but not always. 

Noting there are different rules for different countries. 

Retired Living Abroad

If you are retired and receiving a state pension and Living Abroad then the EU has a common Social and Healthcare scheme.  

Essentially if you are receiving a state pension you can relocate to another EU country and transfer your state health care to your country of residence. 

Note this is not like for like.  

State of Good Health

Different state health schemes have different qualities and covers. You could move from a poor state health care scheme (eg east and south European countries ) to a good state health scheme (eg uk, Germany, France, Denmark, Sweden)

This transfer is not automatic and you need to be legally registered in your country of residence. This is important. 

UK NHS

The UK are very clear on eligibility for the NHS. You must be ordinarily resident in the UK to qualify for health care given by the NHS. This means living lawfully in the uk voluntarily and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration. 

Being a British citizen, a UK taxpayer, or a UK pensioner does not qualify you for NHS unless you live in the UK. 

Hence a Polish or Italian EU Expat can (before Brexit) relocate to the UK, find work, find accommodation and qualify for the NHS. 

A non EU expat would still have to pay a Health Care surcharge of £200 per year per family member for health care. 

After Brexit EU citizens relocating to the UK could suffer this charge. 

Bilateral Treaties

We discussed previously the difference between Bilateral treaties for tax , visas, social and healthcare between two countries. 

The EU is not a country but a transnational organisation providing common standards and freedoms to ‘EU Citizens’. 

The EU have in place a ‘Common’ reciprocal agreement for member states on Social and Health Care. 

This allows retired Expats to transfer their healthcare when Living and Working Abroad in the EU. 

For countries outside the EU they must have an agreement in place with the EU to allow access to any of the EU 27 remaining countries.

Other wise the 3rd country could have a bilateral treaty with an individual EU member state on social, health and tax. 

Bilateral treaties by-pass the EU.

Brexit Impact

After Brexit and without any new UK agreement with the EU regarding Expat access to the common social and health care , then bilateral treaties become enforced. 

Counties like the UK and Cyprus have a bilateral social and healthcare agreement that can continue after Brexit. 

Retired UK Expats with state pensions will qualify for state healthcare in Cyprus and vice versa. 

Spain and UK don’t have a bilateral treaty at this time. Without an EU common agreement the 300,000 uk expats, a 100,000 of which are pensioners in Spain could lose access to state health care, in Spain because there is no bilateral agreement. 

Noting that returning to the UK is not that simple. Expats are currently required to be resident for 6 months before qualifying for NHS 

Plan Ahead

All EU Expats should review their state health care cover. 

Depending upon health, family and business situation, you could consider:-

1. Private Healthcare
2. Relocating to a Country with a Reciprocal agreement eg Cyprus 
3. Relocating to a UK base and using the overseas property as a extended holiday home 
4. Provide a rainy day fund to cover your family in an emergency

ProACT Partnership Expatriate Advice

ProACT offer a free review and advice online for EU expats. 

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