Six-month health cover for British nationals in the EU?

If you are confused by the ever-changing information about healthcare and Brexit, you are not alone. Increasingly we are seeing UK government statements that are contradicted by others in the UK and in European countries. Ian Youngman investigates the reality of the latest UK government promise of temporary cover for British nationals living in the EU.

Another day, another change to UK/EU healthcare plans.

The UK government has pledged £150m to temporarily cover (for six months only) the healthcare costs of 180,000 British nationals living in the EU, in the event of a no-deal Brexit. This cover includes pensioners, students, those on disability benefits and UK workers temporarily posted in the EU. It only applies to people who currently have their healthcare costs paid for by the UK government.

The government has also committed to covering the costs of UK nationals in the EU who are in the middle of treatment when the UK leaves the EU, for up to a year. And it will provide cover during the time it takes to be registered with a local healthcare scheme, to ensure people are not exposed to gaps in healthcare coverage and potentially high costs while they register for healthcare locally.

What will happen after six months?

Most of the several million UK nationals living and working in Europe are covered by health insurance they have bought or by the national health or health insurance system of the country in which they are living.

The problem is ongoing cover for UK nationals who are retired, not covered by national schemes and where the UK government pays for local care under existing reciprocal arrangements. This group is either ineligible to join or unable to afford private health insurance or national schemes. So, after six months, it is possible that many in this group will be left with no protection, as those not covered by the local national scheme or insurance tend to be the very old, the very ill and the poor.

Expanding on this latter point, it is likely that some British retirees in the EU are just surviving on the UK state pension, which is the lowest in the OECD. They have neither the funds to pay for private healthcare in the countries where they currently reside or cannot afford to join local healthcare systems.

This is particularly worrying for British nationals in the EU who are, for example, undergoing major treatment for cancer. Will they still be able to get this treatment a year after a no-deal Brexit?

And ironically, tighter NHS rules on treating people from overseas means that UK nationals who have moved abroad are no longer automatically entitled to return to the UK for NHS care.

Will this six month extension work?

The UK government has in the past talked up deals that will be done with individual states on healthcare, or longer-tern EU wide reciprocal deals to replace existing ones that will end on 31 October in the event of a no deal Brexit.

Separate from the long-term deals with other countries, even this six-month extension is not credible. Every EU country will need to set up systems to allow care to be provided locally to make this happen, without upfront payment and with debts settled by the UK government.

With the ongoing Brexit uncertainty, it could be suggested that the patience of European governments with Britain is stretching thin. The chances of any EU country setting up a new national system, or even the chances of local hospitals working with it, just for six months seem slim.

Spain is a good example. It relies very heavily on British tourists and there are many British nationals living in the country. According to the British government the UK and Spain have each taken steps to ensure that people living in each country can continue to access healthcare as they do now until at least 31 December 2020. Reports from Spain however have a rather different interpretation on this, as they suggest it is not yet an agreed deal but a putative one, as under EU rules they cannot make a binding deal until after the EU negotiations conclude.

The UK government has proposed continuing the reciprocal arrangement until the end of December 2020 with all EU member states, but there is a significant problem in that no country-specific bilateral deals can be signed until the outcome of Brexit negotiations is known. And individual deals only apply if the UK has a reciprocal deal too. British citizens living in Ireland however will be able to access healthcare in Ireland in the same way as before Brexit.

In practical terms, any British person covered by this six-month deal and asked by a healthcare provider to pay for treatment has to give details to the NHS Business Services Authority’s Overseas Healthcare Services. At present, payment would be made under the reciprocal arrangements between EU countries. Under the new plan it relies on individual countries accepting the plan and the individual healthcare provider being prepared to wait for payment by the NHS or their own government. In practice, what is probable is that the patient will have to pay the bill and attempt to recover all or part of the cost from the NHS.

The latest UK government information does not comment on what happens to EU residents temporarily in the UK or undergoing treatment in the UK after 31 October. Questions also remain about what will happen in the longer term, if there is no deal, to those who opted to retire abroad in the knowledge that reciprocal arrangements applied throughout the EU as part of EU membership.

And finally, it is worth reminding ourselves that these issues will not end on 31 October. Even if the UK leaves on this date, there will then be up to a decade of negotiations between the UK and the EU and between the UK and individual countries on many aspects of healthcare. Provision of healthcare in Europe for British nationals may be very low on the list of priorities for the UK government.

It could be sensible to think that UK medical tourists planning to go to Europe or Europeans considering going to the UK for treatment might well be put off by this ongoing uncertainty.

IMTJ ongoing monitoring of UK/EU healthcare

We are seeing an ongoing lack of cohesion between statements on cross-border healthcare from different UK government departments, and between politicians and civil servants.

IMTJ is monitoring these statements and assessing the changing healthcare events that are happening on a daily, and sometimes hourly, basis. We will continue to provide impartial and factual information on UK/EU healthcare on our website and in our bi-weekly e-newsletters, which will be correct at time of writing but potentially liable to be overtaken by changes and events.