Healthcare is one of the most significant practical concerns for anyone retiring abroad. The NHS, which most British nationals have relied upon throughout their working lives, ceases to be freely available once you become non-resident. Understanding what replaces it — and what gaps need to be filled by private insurance — is essential financial and practical planning for any international retiree.
The S1 Form: Healthcare for UK State Pensioners in the EU and EEA
The S1 certificate (formerly the E121 form) is issued by the UK Government to individuals in receipt of a UK state pension who move to live in an EU or EEA country. It certifies that the UK is responsible for covering your healthcare costs, and allows you to register with the host country's state health system as if you were a local national.
Who Qualifies
You qualify for an S1 if you are receiving a UK contributory retirement pension (state pension) and are moving to reside in an EU or EEA member state or Switzerland. The certificate is also available to those in receipt of certain other DWP benefits.
How to Apply
Apply through the DWP's International Pension Centre before you leave the UK. The process involves completing a form and providing evidence of your pension entitlement. Processing times vary; apply several months before your move.
How to Use It
Once you receive the S1, register it with the healthcare authority in your destination country:
- Spain: Instituto Nacional de la Seguridad Social (INSS)
- France: CPAM (Caisse Primaire d'Assurance Maladie)
- Portugal: SNS registration at your local health centre
- Greece: EOPYY
- Cyprus: GESY registration via the district health office
After registration, you access healthcare on the same basis as local nationals — same co-payments, same access rights. The UK Government reimburses the host country for the costs of your treatment.
Limitations
S1 does not cover private treatment, dental care in many countries (beyond emergency extractions), long-term residential or nursing home care, or treatment received in countries other than your country of registration. If you travel within the EU while registered in Spain, your Spanish S1 registration provides emergency cover via the GHIC mechanism, but not routine treatment.
The Global Health Insurance Card (GHIC)
Post-Brexit, the UK's European Health Insurance Card (EHIC) was replaced by the Global Health Insurance Card (GHIC) for new applicants. The GHIC is valid in EU countries and covers medically necessary treatment during temporary visits — not routine treatment, not long-term care, and not repatriation.
For retired British nationals who are visiting the EU (rather than living there), the GHIC is useful for holiday or short-visit cover. It is not a substitute for a comprehensive health insurance policy.
A UK GHIC is free to apply for through the NHS website. Cards are valid for five years.
International Private Health Insurance
For retirees living outside the EU (UAE, Thailand, Bali) or those seeking coverage beyond state healthcare in EU countries, international private medical insurance (IPMI) is the cornerstone of healthcare planning.
Main Providers
The principal IPMI providers serving British expat retirees include:
- AXA PPP International / AXA Global Healthcare: One of the largest and most established providers. Broad network of hospitals, generally good claims handling.
- Cigna Global Health Benefits: US-owned, strong network in Asia and the Middle East.
- Bupa Global: UK-heritage brand, good reputation for expat coverage in Europe and beyond.
- Allianz Care: European insurer, strong in Continental Europe and emerging markets.
- Now Health International: Strong in Asia-Pacific, competitive pricing.
What Policies Typically Cover
A comprehensive IPMI policy for retirees typically covers:
- Inpatient hospital treatment (surgery, procedures, specialist care)
- Outpatient consultations (GP, specialists, diagnostics)
- Prescription medication (often with a separate limit or annual sub-limit)
- Emergency evacuation and repatriation (see below)
- Cancer treatment (often subject to an overall annual maximum)
Dental and optical coverage is usually an optional add-on. Long-term care (residential or nursing care) is not covered by standard IPMI policies.
Pre-Existing Conditions
This is the most important and frequently misunderstood aspect of IPMI. All major providers will ask about pre-existing medical conditions on the application. They may:
- Exclude specific pre-existing conditions permanently (a common approach for chronic conditions such as diabetes, heart disease, or COPD)
- Apply a moratorium: exclude conditions for the first two years of the policy; cover them thereafter if you have not had treatment, medication, or advice for that condition for two consecutive years
- Full medical underwriting (FMUI): assess your full medical history at outset and agree on exactly what is and is not covered
Full medical underwriting provides certainty, though the process takes longer and may result in some conditions being permanently excluded. A moratorium is simpler but leaves more uncertainty in the early years.
Cost for Retirees
IPMI premiums increase significantly with age. Very approximate benchmarks (mid-2026, subject to individual circumstances and coverage level):
- Age 60, non-smoker, no major pre-existing conditions: £2,000–£4,000 per year
- Age 65: £3,000–£6,000 per year
- Age 70: £5,000–£10,000+ per year
Pre-existing conditions, destination country (US coverage dramatically increases premiums), and coverage limits significantly affect the premium. Always compare policies through an independent specialist broker.
Emergency Evacuation and Repatriation Cover
Standard IPMI policies typically include emergency medical evacuation — transport from a location where appropriate treatment is unavailable to a suitable medical facility. This is particularly relevant in less well-served locations (rural Thailand, Bali, Egypt) where a serious acute event might require transfer to a specialist hospital.
Evacuation cover should include:
- Air ambulance to a treatment facility
- Medical escort if required
- Repatriation to the UK if treatment is best delivered there
- Return of mortal remains if the worst occurs
Stand-alone evacuation memberships (such as those from International SOS or Global Rescue) supplement IPMI and are particularly used by those living in remote or higher-risk locations.
Long-Term Care Insurance Abroad
Long-term care — residential care or nursing home care in later old age — is not covered by IPMI policies and is largely not addressed by state healthcare systems for non-citizens abroad.
In the UK, the problem is well known: average care home costs are approximately £45,000–£60,000 per year (as of 2025), and local authority support is only available where assets are below a relatively low threshold. Abroad, the picture varies:
- Cyprus: GESY covers some in-home nursing care but not full residential care. Private care home costs in Cyprus are substantially lower than in the UK.
- Spain/Portugal: State-funded residential care exists for legal residents but waiting lists are long and the standard in state facilities varies. Private residential care in Spain can cost €2,000–€5,000/month.
- Thailand: High-quality private residential care is available at costs significantly lower than the UK — a major advantage for retirees on fixed incomes.
- UAE: Private residential care exists but is expensive; state provision for non-nationals is limited.
Dedicated long-term care insurance policies are available but specialist, expensive, and complex. The more practical approach for many HNW retirees is to ensure sufficient liquid capital is retained specifically to fund potential care needs, separate from lifestyle expenditure.
NHS Access on Visits to the UK
Once you become ordinarily non-resident in the UK, your entitlement to free NHS treatment reduces. The following applies as of 2026:
- Emergency treatment: Free, regardless of residency status.
- Urgent treatment for immediate need: Free.
- Routine or planned treatment: Chargeable at 150% of NHS tariff rates for overseas visitors.
Some groups retain free access:
- Those receiving treatment for certain communicable diseases
- Those accessing some mental health treatment in certain circumstances
- Individuals who genuinely re-establish ordinary residence in the UK
In practice, many British expats visit the UK regularly and may access routine GP or specialist consultations during these visits. This is technically chargeable for non-residents seeking planned treatment, though enforcement varies in primary care settings. The DWP recommends honesty with your GP about your residency status.
Planning Summary
- Apply for an S1 form before leaving the UK if moving to an EU/EEA country — it is valuable and free.
- Carry a GHIC for use during EU visits after you leave.
- Take out comprehensive IPMI as soon as you become non-UK resident.
- Disclose all pre-existing conditions fully — non-disclosure can invalidate a policy.
- Ensure your policy includes emergency evacuation and repatriation cover.
- Plan separately for long-term care costs — standard IPMI does not cover this.
- Consider how any care needs abroad might interact with means-testing for UK benefits if you ever return.
Nothing in this article constitutes personal advice. Insurance and healthcare rules change — seek independent specialist guidance.
How Global Investments Can Help
Global Investments advises internationally mobile individuals on the full spectrum of financial planning for retirement abroad, including guidance on insurance structuring and long-term care financial planning. We can introduce you to specialist IPMI brokers and help you assess the cost of healthcare across our key markets. Contact us to start a conversation.
This article is for general information only and does not constitute financial, legal or tax advice. Rules, prices and regulations change; verify current requirements with a qualified adviser before acting.