The NHS for Americans: paying the health surcharge and registering with a GP

Most Americans on a UK visa prepay for the NHS through the Immigration Health Surcharge, and then the trick is simply getting registered with a doctor.

The short version

• The Immigration Health Surcharge (IHS) is £1,035 a year for most visa holders, or £776 a year for students, Youth Mobility Scheme visa holders and under-18s [1]. You pay it up front for the whole visa.
• Some people are exempt, including Health and Care Worker visa holders, people applying for indefinite leave to remain, and visitors [2].
• Register with a GP (family doctor) as soon as you have an address. You don't need ID, proof of address or proof of immigration status to register [3].
• Your NHS number is your patient ID. You don't need one to register, and you'll get one once you're in the system [3].
• GP visits and hospital care are free at the point of use, but prescriptions and dentists in England have fixed charges [4][5].

USD conversions in this guide use the Federal Reserve H.10 rate of October 30, 2026 (USD 1.3398 per GBP), rounded.

The Immigration Health Surcharge: what you'll pay in 2026

If you apply for a UK visa for more than six months from outside the UK, or for any visa from inside the UK, you'll usually pay the IHS as part of your application [2]. It's on top of the visa fee itself, and it's not optional: having private health insurance doesn't get you out of it [2].

Rates as published on GOV.UK in late 2026 [1]. Adult dependants usually pay the same rate as the main applicant [1].

How the math works for partial years

The IHS is charged per year of your visa, with some rounding rules [1]:

• Six months or less, applying from inside the UK: half the yearly amount (£517.50, about USD 695, at the standard rate).
• More than six months but under a year: the full yearly amount.
• Over a year, up to 18 months: one and a half years' worth.
• Over 18 months: rounded up to the next full year.

So a three-year Skilled Worker visa costs £3,105 (about USD 4,160) in IHS for the main applicant [1]. For a family of two adults and two kids under 18 on a three-year visa, that's £10,866 (about USD 14,560) before a single visa fee. Sticker shock is normal. The flip side: once you're in, there are no premiums, copays or deductibles for most care.

GOV.UK explains on a separate page when the IHS can be refunded, so check it if your plans change or your application doesn't go through [1].

Who doesn't pay

The full list is on GOV.UK [2]. The exemptions most relevant to Americans:

• Visitors, and anyone applying from outside the UK for six months or less [2]. They pay for NHS care they use instead, unless it's free.
• Indefinite leave to remain applicants. Settlement applications are exempt [2].
• Health and Care Worker visa holders and their dependants [2].
• Diplomats and visiting armed forces members not subject to immigration control [2].
• Dependants of UK armed forces members [2].

A US military family stationed in the UK under the Status of Forces arrangements isn't applying for a visa in the usual way, so check with your installation's medical office rather than GOV.UK.

Registering with a GP

In the UK, your GP (general practitioner) is your gateway to almost everything: prescriptions, referrals to specialists, blood tests and mental health services. There's no booking a dermatologist directly the way you might back home with a PPO plan.

The NHS is clear on a point that surprises many newcomers: you do not need ID, proof of address or proof of immigration status to register [3]. Some front desks still ask, out of habit. You can politely point them to the NHS guidance.

Step by step

1. Find practices near you using the NHS "Find a GP" service. Search by your new UK address and look for practices accepting new patients.
2. Register online if the practice offers it. It takes about 15 minutes per person, and you should hear back within about five days [3].
3. Register everyone separately, including kids.
4. Download the NHS App once you're registered. You can use it to book appointments, order repeat prescriptions and see your NHS number.
5. Bring your US records. Ask your stateside doctor for a summary and vaccination records before you leave; there's no automatic transfer.

Most people register with a practice near home. Some practices accept patients from outside their area, but home visits and some community services may then be limited [3]. A practice can refuse you if it's full, if you live outside its area or if you've been removed from its list before, and it must explain why in writing within 14 days [3].

Just arrived and not settled yet? You can register as a temporary resident for up to three months [3].

Your NHS number

Your NHS number is a 10-digit patient ID used across the NHS in England. It's not the same as your National Insurance number, which is for tax and benefits. You don't need an NHS number to register with a GP, but having it makes it easier to find your records [3]. Once you're registered, you'll find it in the NHS App or on letters from your practice.

What's free and what isn't

Free at the point of use: GP appointments, hospital treatment, emergency care at A&E (accident and emergency, the UK's ER), maternity care and NHS 111, the advice line you call when it's urgent but not an emergency. For emergencies, call 999.

What you'll pay in England:

Charges as listed on NHS.UK in late 2026 [4][5]. Some groups get free prescriptions, and some items, such as contraception, are free for everyone [4]. If you need several prescriptions a month, a prepayment certificate can work out cheaper.

The dentist catch: NHS dental practices are separate from GP registration, and finding one in London taking new adult NHS patients can be slow. Many Americans end up paying a private dentist, at market rates.

Should you keep private insurance?

Many Americans in London add private medical insurance, often through an employer, for faster access to specialists and elective procedures. It sits on top of the NHS rather than replacing it, and it doesn't exempt you from the IHS [2]. Look closely at pre-existing condition exclusions in the fine print.

A heads-up for retirees: Medicare generally doesn't cover care outside the US. If you're 65 or nearing it, think carefully before skipping Part B enrollment, since late penalties can follow you home.

Questions about which practices in your area are taking patients? Ask in our community group for Americans in the UK.

Sources

1. Pay for UK healthcare as part of your immigration application: how much you have to pay, GOV.UK
2. Pay for UK healthcare as part of your immigration application: who needs to pay, GOV.UK
3. How to register with a GP surgery, NHS
4. NHS prescription charges, NHS
5. Understanding NHS dental charges, NHS

Keep reading

• Healthcare and health insurance in London
• Moving to London as an American: visa routes
• Indefinite leave to remain and British citizenship for Americans
• Medicare when you live abroad