Expats healthcare problems post Brexit
13 August 2019
How can British expats in the EU, either already there or wanting to move, plan for their health insurance after Brexit? Ed Watling, employee benefits consultant, Mattioli Woods looks at EU healthcare and what clients need to bear in mind.
According to UN figures, there are an estimated 1.3 million British citizens living in (European Union) EU countries.By far the biggest community is in Spain with just under 310,000, followed by Ireland at 280,000 and France at 180,000.
So how will these expats ensure they have access to healthcare following Brexit?
Although we talk about the EU as a single entity/market, from a healthcare point of view each member country has its own unique healthcare system in terms of delivery of care, how care is funded and how care is accessed. Currently that is 28 different systems.
In addition, like in the UK, there are often regional variations and idiosyncrasies that make accessing care even more complicated. In most EU member countries healthcare is provided via both State funded and private facilities. In some cases, this means that social security (National Insurance) contributions fund the bulk of care costs but a balance of each treatment needs to be settled by the individual either through self-pay or via top-up insurance. In other systems, basic care is provided by the State but more involved and costly treatments have to be funded privately or insured.
These multiple systems mean that there won’t be just one solution to the ‘post-Brexit’ health issue. Indeed, even with the current reciprocal arrangements how a specific individual accesses care and funds treatment will be based on several factors; the EU countries involved, their healthcare regulation, the individual’s residency/tax status, participation in the local system or via reciprocation, employment status and in some cases income levels.
For UK expats employed in the EU after Brexit, healthcare shouldn’t be particularly problematic and shouldn’t change from their current situation. If they are employed locally then they should already be complying with local social security and healthcare regulations that provide them with access to the local healthcare systems. Depending on their situation and location, they may have supplementary health insurance to provide additional options, including treatment in other countries or back in the UK.
The big issues arise for UK expats who aren’t employed in the EU.
Considerable numbers of UK nationals have used the freedom of movement to live in Europe either retired or semi-retired. There are an estimated 200,000 plus such individuals in Spain alone. The freedom of movement allows these people to reside often without any formal status, in effect almost long-term visitors. This situation means that many of these individuals don’t pay into the local system but rely on reciprocal arrangements using either EHIC or S1 forms that provides them with access to treatment locally with the costs being borne by the UK’s NHS.
Even at this late stage there is no clarity on exactly what will happen post-Brexit. UK and EU Governments have confirmed that there won’t be mass, forced repatriations but there may be a requirement to “normalise” residency in the EU. This may force UK nationals to join the local social security system or, if that isn’t an option, arrange private insurance. The EHIC/S1 arrangements may no longer be valid in the EU and again, UK expats may be need to look at private health insurance.
For these individuals there are several significant issues:
What should expats do?
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