UK, NHS Charging, updated guidance

[Jaggg88]

11 hours ago, polpott said:

If you are a British citizen and a British passport holder, its not open to interpretation, its down to your declaration, just tell anyone who asks (I have never been asked) that your return is permanent. The same day you arrive in the UK, you can register with a GP and avail yourself of the full benefits of the NHS. IME all you need is an address and two proofs of that address. I have always kept a postal address in the UK. I took 2 bank statements from 2 separate banks to my GP, no further questions asked.

That's exactly what I thought but I'm currently in the UK and having treatment and before you go for your appointment you have to fill in a questionnaire. This is mostly about your current medical condition and any prescription drugs you take etc..... but there was a question that asked have I been outside of the UK for more than one year. I presume if you answer yes it will trigger further investigations. I'm going to return every year and see my family plus pop in my GPs for a health check. As a retiree I'm perfectly entitled to be on permanent holiday.

[polpott]

6 hours ago, Jaggg88 said:

That's exactly what I thought but I'm currently in the UK and having treatment and before you go for your appointment you have to fill in a questionnaire. This is mostly about your current medical condition and any prescription drugs you take etc..... but there was a question that asked have I been outside of the UK for more than one year. I presume if you answer yes it will trigger further investigations. I'm going to return every year and see my family plus pop in my GPs for a health check. As a retiree I'm perfectly entitled to be on permanent holiday.

That's the tack I took 7 years ago when I first moved here. I visited my GP (and family) every year and get my repeat prescription every 8 weeks which my friend posts to me every 16 weeks. I use his address as my postal address for bank accounts, driving licence, state pension and any official communications. My friend is instructed to say that I'm away on holiday if any official calls round, which they have never done.

[bodga]

On 10/16/2020 at 10:59 AM, stouricks said:

So I arrive at Heathrow after 10 years in Thailand with a bad disease (not Covid), and tell the Border man that I am here to stay. What criteria do I need to meet to be allowed in as a settled resident please?

why  tell  them  anything  at  all?

[polpott]

40 minutes ago, bodga said:

why  tell  them  anything  at  all?

In all the years of travelling in and out of the UK I don't think I've ever spoken one word to UK immigration.

[sandyf]

20 hours ago, polpott said:

If you are a British citizen and a British passport holder, its not open to interpretation, its down to your declaration, just tell anyone who asks (I have never been asked) that your return is permanent. The same day you arrive in the UK, you can register with a GP and avail yourself of the full benefits of the NHS. IME all you need is an address and two proofs of that address. I have always kept a postal address in the UK. I took 2 bank statements from 2 separate banks to my GP, no further questions asked.

Quite, If I was in need of the NHS I would take the same approach. I have been here over 12 years and up until fairly recently had a GP. A few years back they came out with the policy that if you moved you could stay with the same practice so I changed my address to that of my son. I lived in a small village and always feared one day the pharmacy would call out the address and 2 people would stand up. Unfortunately the practice refused saying it was not an entitlement and the decision rested with the practice so currently without. I know I can re-register but I would need to be in the UK for over a month to do that so waiting for the opportunity.

The point was that the term "settled purposes" is open to interpretation but I fail to see how it can be defended. I would also think that there is a legal issue over being forced to pay for something that is not available so there should be greater clarification. On the government website, those that pay tax are described as UK residents, when is a resident not a resident, when it suits the government.

 

UK residents

You may have to pay UK tax on your State Pension if you live abroad but are classed as a UK resident for tax purposes. The amount you pay depends on your income.

https://www.gov.uk/state-pension-if-you-retire-abroad/tax-on-your-state-pension

[Mike Teavee]

19 minutes ago, sandyf said:

Quite, If I was in need of the NHS I would take the same approach. I have been here over 12 years and up until fairly recently had a GP. A few years back they came out with the policy that if you moved you could stay with the same practice so I changed my address to that of my son. I lived in a small village and always feared one day the pharmacy would call out the address and 2 people would stand up. Unfortunately the practice refused saying it was not an entitlement and the decision rested with the practice so currently without. I know I can re-register but I would need to be in the UK for over a month to do that so waiting for the opportunity.

The point was that the term "settled purposes" is open to interpretation but I fail to see how it can be defended. I would also think that there is a legal issue over being forced to pay for something that is not available so there should be greater clarification. On the government website, those that pay tax are described as UK residents, when is a resident not a resident, when it suits the government.

 

UK residents

You may have to pay UK tax on your State Pension if you live abroad but are classed as a UK resident for tax purposes. The amount you pay depends on your income.

https://www.gov.uk/state-pension-if-you-retire-abroad/tax-on-your-state-pension

 

Being resident for Tax Purposes is not the same as being Ordinarily Resident which is what (free) access to NHS is based upon but almost nobody pays tax on their State Pension as it's not enough to take you over your personal allowance (I say almost nobody because in some circumstances it's possible to have no Personal Allowance in the UK so you could end up paying tax on your State Pension but this would result in greater tax savings elsewhere unless you've got your maths wrong). 

 

 

So unless you're paying AVCs then you're not being forced to "Pay for something that is not available", of course if you are paying AVCs (like me) then you are "Paying for something that is not available" ???? - But I take this as part of the trade-off of paying £154 pa (Class 2) for something that will get me an extra (approx) £252 pa (£170 x 52 / 35) for every year that I live beyond 67 + the other tax benefits that being non-resident (for tax purposes) brings. 

 

  

 

 

 

Edited October 21, 2020 by Mike Teavee

[sandyf]

30 minutes ago, Mike Teavee said:

 

Being resident for Tax Purposes is not the same as being Ordinarily Resident which is what (free) access to NHS is based upon but almost nobody pays tax on their State Pension as it's not enough to take you over your personal allowance (I say almost nobody because in some circumstances it's possible to have no Personal Allowance in the UK so you could end up paying tax on your State Pension but this would result in greater tax savings elsewhere unless you've got your maths wrong). 

 

 

So unless you're paying AVCs then you're not being forced to "Pay for something that is not available", of course if you are paying AVCs (like me) then you are "Paying for something that is not available" ???? - But I take this as part of the trade-off of paying £154 pa (Class 2) for something that will get me an extra (approx) £252 pa (£170 x 52 / 35) for every year that I live beyond 67 + the other tax benefits that being non-resident (for tax purposes) brings. 

 

  

 

 

 

That is incorrect, the state pension is taxable it is just that the DWP do not collect tax.

If your state pension is your only income and over the personal allowance you must pay directly to HMRC. Normally collected through other income.

Through my income tax I fund about 12% of my own frozen state pension and contribute significantly to the NHS.

A resident should be a resident irrespective of the adjectives.

[Mike Teavee]

Just now, sandyf said:

That is incorrect, the state pension is taxable it is just that the DWP do not collect tax.

If your state pension is your only income and over the personal allowance you must pay directly to HMRC. Normally collected through other income.

Through my income tax I fund about 12% of my own frozen state pension and contribute significantly to the NHS.

A resident should be a resident irrespective of the adjectives.

Your post is a little confusing ... 

1. How does somebody get a state pension of maximum £170 pw that takes them over the £12,500 pa or so Personal Allowance? 
2. How would somebody doing so pay the HMRC out of other income when their State Pension is their only income?

 

 

Technically you are correct, the State Pension is taxed at 0% but I didn't want to get into technicalities so easier to say it's not taxed... It is always put 1st into your income column & is unlikely to ever take you over your PA so for all intents & purposes it isn't taxed.

 

 

Unless you're still working for a UK firm, are an ex-UK civil servant (including forces), have numerous UK properties that your renting out or have a 8 figure sum in a UK bank account then you shouldn't be paying any additional tax over any withheld at source (e.g. UK Dividends)... 

 

 

 

 

 

 

 

[Bogbrush]

4 hours ago, polpott said:

... get my repeat prescription every 8 weeks which my friend posts to me every 16 weeks.

Do your meds ever get stopped by Customs?

[polpott]

3 minutes ago, Mike Teavee said:

Technically you are correct, the State Pension is taxed at 0% but I didn't want to get into technicalities so easier to say it's not taxed... It is always put 1st into your income column & is unlikely to ever take you over your PA so for all intents & purposes it isn't taxed.

 

Effectively it is taxed. Its subtracted from your personal allowance. As I receive a generous company pension, I paid considerably more tax the day I started to receive my state pension. Effectively, the whole of my state pension is taxed at 20%.

[polpott]

3 minutes ago, Bogbrush said:

Do your meds ever get stopped by Customs?

The box is clearly marked "prescription medication". I'm careful not to put anything else in it except for a small amount of personal mail. Never been opened by customs and always arrives within a week. It even includes needles and syringes.

 

 

Edited October 21, 2020 by polpott

[Mike Teavee]

1 minute ago, polpott said:

Effectively it is taxed. Its subtracted from your personal allowance. As I receive a generous company pension, I paid considerably more tax the day I started to receive my state pension. Effectively, the whole of my state pension is taxed at 20%.

No it's not the same.. You can't choose which of your income is taxed at what rate or you could just as easily say it's taxed at 50% because your other income takes you over the Higher Rate Tax threshold.... Your State Pension goes 1st into the Income Column, if that's all you have or the rest of your income (excluding Dividends & interest from Bank Accounts) is < approx £3,500 then you're taxed at zero% on it. 

 

But, we've touched on this in other threads, as a Non-UK resident for Tax Purposes you don't have to pay tax on your Company Pension but it's up to you to weigh up the pros & cons of whether being a UK resident is more important to you than not paying tax on your private pension.  

 

 

 

What will be interesting is how/whether Brexit impacts the current status quo, I'm thinking they'll keep reciprocal health benefits for 2-3 years & then look to clamp down on non-resident access to the NHS, at which time it will impact everybody not just EU.  

 

 

 

[sandyf]

6 hours ago, Mike Teavee said:

Your post is a little confusing ... 

1. How does somebody get a state pension of maximum £170 pw that takes them over the £12,500 pa or so Personal Allowance? 
2. How would somebody doing so pay the HMRC out of other income when their State Pension is their only income?

Technically you are correct, the State Pension is taxed at 0% but I didn't want to get into technicalities so easier to say it's not taxed... It is always put 1st into your income column & is unlikely to ever take you over your PA so for all intents & purposes it isn't taxed.

 

Unless you're still working for a UK firm, are an ex-UK civil servant (including forces), have numerous UK properties that your renting out or have a 8 figure sum in a UK bank account then you shouldn't be paying any additional tax over any withheld at source (e.g. UK Dividends)... 

What part of "my own frozen state pension" did you find difficult.

You are wrong on several counts, you have distorted what I said, it was two separate sentences, the second meant that normally pensioners would pay their tax liability via other income, usually another pension.

The state pension is certainly not taxed at 0%, the implication of that would be there is no tax liability, but the liability does not disappear because of the personal allowance.

In my case the state pension is added to a small private pension and the allowance is deducted from the combined total, with all the tax(about 22%) being taken from the private pension.

You need to adjust your thinking, the allowance is applied to total income not just part of it.

I don't know where you get this from "a state pension of maximum £170 pw", if my pension wasn't frozen it would over £220 pw.

[polpott]

1 minute ago, sandyf said:

What part of "my own frozen state pension" did you find difficult.

You are wrong on several counts, you have distorted what I said, it was two separate sentences, the second meant that normally pensioners would pay their tax liability via other income, usually another pension.

The state pension is certainly not taxed at 0%, the implication of that would be there is no tax liability, but the liability does not disappear because of the personal allowance.

In my case the state pension is added to a small private pension and the allowance is deducted from the combined total, with all the tax(about 22%) being taken from the private pension.

You need to adjust your thinking, the allowance is applied to total income not just part of it.

I don't know where you get this from "a state pension of maximum £170 pw", if my pension wasn't frozen it would over £220 pw.

I have 44 years+ of NI contributions and have recently started recieving it. £170p.w. How come you would get £220?

[sandyf]

34 minutes ago, polpott said:

I have 44 years+ of NI contributions and have recently started recieving it. £170p.w. How come you would get £220?

I have 49 years and one incomplete year of NI, not that it means anything.

I got my state pension in 2012 under the old system where the pension was in 2 parts, basic plus additional which varied with how much you had earned over your working life.

I never contracted out, but those that did will have a separate private pension that was partially paid for from their NI contributions. They would in fact be receiving a lot more from their NI than I am. There is little dispute the new system screwed people into the ground.

[Mike Teavee]

1 hour ago, sandyf said:

What part of "my own frozen state pension" did you find difficult.

You are wrong on several counts, you have distorted what I said, it was two separate sentences, the second meant that normally pensioners would pay their tax liability via other income, usually another pension.

The state pension is certainly not taxed at 0%, the implication of that would be there is no tax liability, but the liability does not disappear because of the personal allowance.

In my case the state pension is added to a small private pension and the allowance is deducted from the combined total, with all the tax(about 22%) being taken from the private pension.

You need to adjust your thinking, the allowance is applied to total income not just part of it.

I don't know where you get this from "a state pension of maximum £170 pw", if my pension wasn't frozen it would over £220 pw.

Are we reading the same posts? where did I mention your frozen state pension & I find no part of it difficult to understand (I do find it difficult to understand you would have both a frozen pension & pay tax on your private pension but that's your business... Oh & I thought if you paid tax on a pension it was at 20% for the whole lot).  

 

Ok, I admit that I misread your 2 sentences "If your state pension is your only income and over the personal allowance you must pay directly to HMRC. Normally collected through other income." but that is only because the maximum state pension is £175.20 (https://www.gov.uk/new-state-pension/what-youll-get#:~:text=The full new State Pension,amount of Additional State Pension) so the 1st sentence doesn't make sense in isolation

 

 

And where did I say the allowance wasn't applied to the whole amount (even though it isn't, it's only applicable up to a maximum of whatever this year's Personal Allowance)

 

 

Edit: Have just seen your comment about people claiming pension in 2012 getting more than the current maximum of £175 pw, 1st I've ever heard of this and find it difficult to believe that they could have changed the rules so much that somebody who retired before the new rules came in (IIRC April 2015?) could now get > £250 pw but people retiring later can only get a maximum of around £175 (Obviously it was much less then). without a serious sh1tstorm kicking off but if you say so... 

 

Edit to add one last word on Pensions (This thread is supposed to be about NHS)...  

https://www.gov.uk/tax-on-pension/tax-when-you-live-abroad

Tax when you live abroad

If you live abroad but are classed as a UK resident for tax purposes, you may have to pay UK tax on your pension. The amount you pay depends on your income.

If you’re not a UK resident, you don’t usually pay UK tax on your pension. But you might have to pay tax in the country you live in. There are a few exceptions - for example, UK civil service pensions will always be taxed in the UK.

 

 

Edited October 21, 2020 by Mike Teavee

[impulse]

On 10/15/2020 at 8:57 PM, theoldgit said:

Indeed, and the guidance confirms that emergency treatment will continue to be provided to all without charge, it's the ongoing treatment that's chargable.

 

But is it provided "without charge". or is it "regardless of ability to pay"? 

 

In the first case, you don't get a bill at all.  In the latter case, you get treated regardless.  But you may be presented with a whopper of an invoice.  And they can come after your assets if you don't pay up.

 

[Pilotman]

On 10/16/2020 at 4:51 AM, thaibeachlovers said:

Years ago NZ decided to make everyone pay part of the cost of hospital care/ consultant appointment etc. The cost of collecting the money exceeded the amount collected so they abandoned the project.

 

Re the UK, if every elderly expat returned to live in the UK the cost to the NHS would bankrupt it, IMO. The elderly are the greatest burden on any health service, IMO.

the elderly are also the very people who have made the largest financial input to the NHS over their working lives  and therefore over the longest number of years.  It's a right not a privilege to be treated. 

[impulse]

8 minutes ago, Pilotman said:

the elderly are also the very people who have made the largest financial input to the NHS over their working lives  and therefore over the longest number of years.  It's a right not a privilege to be treated. 

 

That's true, unless they lived their life 28 on/ 28 off, staying outside the country for decades to avoid paying in.  Which describes a lot of expats in Thailand.

 

[Pilotman]

7 minutes ago, impulse said:

 

That's true, unless they lived their life 28 on/ 28 off, staying outside the country for decades to avoid paying in.  Which describes a lot of expats in Thailand.

 

That is easily resolved . If you have paid in UK tax and Ni for 40 years or more, there should be no argument as to your access to free medical care in the UK, regardless of where you decide to spend your retirement.  Its the usual UK worthies cop out, out of sight out of mind.  The Country makes me ashamed to be British, for so many reasons. 

[Pumpuynarak]

4 hours ago, sandyf said:

In my case the state pension is added to a small private pension and the allowance is deducted from the combined total, with all the tax(about 22%) being taken from the private pension.

You need to adjust your thinking, the allowance is applied to total income not just part of it.

Bingo

[impulse]

4 minutes ago, Pilotman said:

That is easily resolved . If you have paid in UK tax and Ni for 40 years or more, there should be no argument as to your access to free medical care in the UK, regardless of where you decide to spend your retirement.  Its the usual UK worthies cop out, out of sight out of mind.  The Country makes me ashamed to be British, for so many reasons. 

 

I don't disagree, but a pension GBP spent in the UK reverberates through the UK economy many times, creating jobs and paying taxes in the UK each time it's recirculated.  A pension GBP sent to Thailand is lost to the UK economy. 

 

It only makes sense that they offer incentives to keep those pension GBP in country.  Or disincentives to pull them out...

 

And there are plenty of expats in Thailand for the primary purpose of eliminating their back home tax liability.  Hardly seems fair that they can get tragically, expensively sick and rock up to claim their NHS entitlement right next to the guys who've paid in their entire life.

 

[Pilotman]

6 minutes ago, impulse said:

 

I don't disagree, but a pension GBP spent in the UK reverberates through the UK economy many times, creating jobs and paying taxes in the UK each time it's recirculated.  A pension GBP sent to Thailand is lost to the UK economy. 

 

It only makes sense that they offer incentives to keep those pension GBP in country.  Or disincentives to pull them out...

 

And there are plenty of expats in Thailand for the primary purpose of eliminating their back home tax liability.  Hardly seems fair that they can get tragically, expensively sick and rock up to claim their NHS entitlement right next to the guys who've paid in their entire life.

 

government will always find a reason not to do something or to give something,  it's in their DNA. Inertia is a must. 

Edited October 21, 2020 by Pilotman

[theoldgit]

12 hours ago, impulse said:

 

But is it provided "without charge". or is it "regardless of ability to pay"? 

 

In the first case, you don't get a bill at all.  In the latter case, you get treated regardless.  But you may be presented with a whopper of an invoice.  And they can come after your assets if you don't pay up.

 

 

All emergency treatment to anybody is free at the point of delivery, unlike Singapore where my then girlfriend was paying a hefty deposit on her credit card whilst I was being recuscited, ability to pay doesn't come into question.
Follow up treatment is charged in full, and for expats plus 50%, and may be witheld until the bill is paid.

[sandyf]

15 hours ago, Mike Teavee said:

Are we reading the same posts? where did I mention your frozen state pension & I find no part of it difficult to understand (I do find it difficult to understand you would have both a frozen pension & pay tax on your private pension but that's your business... Oh & I thought if you paid tax on a pension it was at 20% for the whole lot).  

You didn't, I mentioned my frozen pension and you went on to say "Unless you're still working for a UK firm, are an ex-UK civil servant etc etc."

 

It is fairly obvious you find it difficult to understand and nothing I say is going to change that.

[impulse]

10 minutes ago, theoldgit said:

All emergency treatment to anybody is free at the point of delivery, unlike Singapore where my then girlfriend was paying a hefty deposit on her credit card whilst I was being recuscited, ability to pay doesn't come into question.
Follow up treatment is charged in full, and for expats plus 50%, and may be witheld until the bill is paid.

 

That's good info.  Here in the Land of the Free, Home of the Brave, the hospitals are required to render emergency treatment regardless of ability to pay.  But then they bill you out the wazoo.  

 

 

[sandyf]

12 hours ago, Pilotman said:

the elderly are also the very people who have made the largest financial input to the NHS over their working lives  and therefore over the longest number of years.  It's a right not a privilege to be treated. 

Exactly my point, my Ni contributions are about as high as they can get and I have paid income tax throughout my working life and every year since.

Those pensioners living abroad and paying income tax are paying about 60% of that tax into pensions, health and welfare so should be entitled to some benefit from the payment.

[theoldgit]

15 hours ago, Mike Teavee said:

Edit to add one last word on Pensions (This thread is supposed to be about NHS)...  

 

Indeed it is, can we stick to the actual topic from now on please?

[Mike Teavee]

Has anybody gone through the questions in the Ordinary Residence Test? 

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/736849/Ordinary_residence_tool.pdf I've no doubts that I would come back as Not Ordinary Resident as about the only thing I have going for me is I have a few UK Bank Accounts so unless I was honestly moving back (or being "Economical with the Truth") then I'm paying for any treatment I have on the NHS...  

 

As mentioned before, I think Brexit has the potential to cause real upsets here, especially if the split is acrimonious & the UK stops providing NHS healthcare for EU citizens. 

 

Edited October 22, 2020 by Mike Teavee
Removed comments on UK Pensions... Been Done to Death...

[Eff1n2ret]

7 hours ago, Mike Teavee said:

so unless I was honestly moving back (or being "Economical with the Truth") then I'm paying for any treatment I have on the NHS...  

 

As mentioned before, I think Brexit has the potential to cause real upsets here, especially if the split is acrimonious & the UK stops providing NHS healthcare for EU citizens. 

Treatment by a GP and at A&E is still free to all, it is in-patient treatment that you would pay for - but you're right, those who haven't read the questions to which you refer may be  in for a nasty shock if they think they can just get off a plane and have themselves referred to a hospital just because they're British.

As far as Brexit is concerned, I once tried reading Mrs May's Withdrawal Agreement and got through about 60 pages before my eyes glazed over and I gave up. But all those pages were about preserved reciprocal rights between UK and EU citizens and I doubt there will be a problem about that. All EU citizens who have established permanent residence would be considered "ordinarily resident in the UK", and therefore entitled to the full benefits of the NHS. What future arrangements they have made about visitors, either from the EU to the UK or vice versa I'm not sure about, but it wouldn't be too terrible to expect those going on holiday to arrange some insurance cover.