Brexit Ended Free NHS Access for EU Students
Before January 2021, EU students studied in the UK with their EHIC and paid nothing for NHS healthcare. That is over. Since the end of the Brexit transition period, EU students arriving on a Student visa pay the Immigration Health Surcharge (IHS) of £776/year — the same fee as students from India, Nigeria, or China. Your French, German, or Spanish EHIC no longer gives you automatic NHS access during a degree programme. EU enrolments at UK universities have fallen sharply since Brexit, and the new costs are part of the reason.
This guide explains exactly what changed, who is exempt, how the IHS reimbursement scheme works, and what you need to do before arriving in the UK.
Before vs After Brexit: A Direct Comparison
Here is what changed on 1 January 2021:
| Before Brexit (pre-2021) | After Brexit (2021 onwards) | |
|---|---|---|
| NHS access | Free via EHIC — no extra payment | Requires IHS payment (£776/year) |
| EHIC validity | Full coverage for study stays | Medically necessary treatment only — basis for an IHS refund |
| Visa requirement | No visa needed | Student visa required |
| IHS cost (3-year degree) | £0 | Usually £2,716 |
| Tuition fees | Home rate (£9,250/year in England in 2019) | International rate — set by each university, usually much higher |
| Student finance | Eligible for UK loans | Not eligible |
| Right to work | Unrestricted | 20 hrs/week during term |
| Total extra cost (3 years) | — | International tuition + £2,716 IHS + visa fee |
A French student starting a 3-year degree at Manchester in 2019 paid the home fee of £9,250/year and £0 for healthcare. The same student starting in 2026 pays the international fee and usually £2,716 in IHS fees. The tuition difference is the single biggest financial impact of Brexit on EU students.
The Immigration Health Surcharge (IHS): What EU Students Pay Now
Every EU student arriving on a Student visa must pay the IHS. There is no opt-out, and private insurance does not replace it.
Current IHS rates (2026)
| Visa type | Annual rate | 3-year degree total |
|---|---|---|
| Student visa | £776/year | Usually £2,716 (3 years + up to 6 months) |
| Student visa (remaining part-year of 6 months or less) | £388 (half-year) | — |
| Graduate Route visa (post-study) | £1,035/year | £2,070 (2 years; 18 months for applications from 1 January 2027) |
How payment works
- You pay during your online Student visa application — before you arrive
- Payment covers the full visa duration upfront (not monthly)
- A 3-year course with a 4-month buffer = 3 years and 4 months of visa, charged as 3 × £776 + £388 = £2,716
- You receive an IHS reference number — keep it with your visa documents (you need it for the EU refund, not for GP registration)
- If your visa is refused, you get a full refund — but not if you leave the UK early
For a complete breakdown of NHS coverage, waiting times, and supplementary insurance options, see our UK student health insurance guide.
The IHS Reimbursement Scheme for EU Students
This is the most important exception most EU students miss. If you hold a valid EHIC from an EU/EEA country or Switzerland, you can apply for an IHS reimbursement — a full refund if your EHIC is valid for your whole visa, otherwise a partial one.
Who qualifies
You are eligible if you meet all of these conditions:
- You hold a valid EHIC issued by an EU country, Switzerland, Norway, Iceland, or Liechtenstein
- You are in full-time higher education in the UK and have paid the IHS
- You live in the UK with a UK address (student accommodation counts)
- You do not work in the UK — no part-time jobs, no paid internships, no casual work (unpaid work and unpaid placements are allowed)
How to apply
- Online: Through GOV.UK at gov.uk/apply-student-immigration-health-surcharge-refund (opens in a new tab)
- Deadline: As soon as possible and within 12 months of arriving in the UK
- Documents needed: your IHS number (from the payment confirmation email), your share code, your UK address, a copy of your EHIC, and your CAS or a letter confirming enrolment
- Processing time: If approved, the NHSBSA sends the refund within 3 months to the account used to pay the IHS
The critical trade-off
If you receive the reimbursement, you can only use your EHIC for “medically necessary” treatment. That means:
| Full NHS (with IHS) | EHIC-level (after reimbursement) | |
|---|---|---|
| GP care | Yes | Only if medically necessary |
| Routine appointments | Yes | No — only medically necessary |
| Hospital treatment | Full access | Only if medically necessary |
| Mental health services | Yes | Only if medically necessary |
| Referrals to specialists | Yes | Only if medically necessary |
| A&E | Yes | Yes |
| Maternity care | Full | Only if medically necessary |
The work restriction is absolute
You are only eligible if you don’t work during the period the IHS covers. If you start paid work — even a few shifts at a coffee shop — your EHIC may become invalid for UK healthcare, and you lose your reimbursement eligibility.
A student from Italy at the University of Leeds who takes a paid library job in her second term after being reimbursed could end up on a Student visa with neither IHS protection (reimbursed) nor valid EHIC cover. That is a dangerous gap.
Our recommendation
Keep the IHS. Do not apply for the reimbursement unless you are 100% certain you will never do paid work during your entire stay. The £776/year buys you full NHS access, plus the freedom to earn money alongside your studies.
EU Settlement Scheme: Who Still Gets Free NHS Access
Some EU citizens in the UK have a separate route to healthcare through the EU Settlement Scheme (EUSS). This applies to you if you were living in the UK before 31 December 2020.
Settled Status
- You lived in the UK for 5+ continuous years before the deadline
- NHS access: Full and free — identical to a British citizen
- No IHS payment required
- No visa required — you have indefinite leave to remain
- You can work, study, and access all public services without restriction
Pre-Settled Status
- You lived in the UK but had not reached 5 years by the deadline
- NHS access: Full and free while your status is valid
- No IHS payment required
- Leads to Settled Status after 5 years of continuous residence
- The Home Office now extends pre-settled status automatically and moves eligible holders to settled status — you no longer need to renew it yourself
Who this does NOT cover
If you first arrived in the UK after 31 December 2020, you cannot apply for the EU Settlement Scheme. You need a Student visa and must pay the IHS. The EUSS application deadline was 30 June 2021, though late applications are accepted if you have reasonable grounds.
A German student who started at UCL in September 2020 and applied for Pre-Settled Status gets full NHS access for free. A German student who starts at UCL in September 2026 pays the IHS like any other international student.
GHIC: What It Is and What It Is NOT
The Global Health Insurance Card (GHIC) replaced the UK-issued EHIC after Brexit. Many EU students confuse it with their home country’s EHIC. They are different things.
The UK GHIC
- Issued to UK residents for travel to the EU
- Covers medically necessary treatment during temporary visits to EU countries
- Does NOT cover study-abroad residency (for that, you need a Student GHIC — a separate application)
- Does NOT give EU students any rights in the UK
Your home country’s EHIC
- Issued by your EU home country
- Covers medically necessary treatment during temporary stays in other EU/EEA countries
- After Brexit, it has limited use in the UK — it covers medically necessary treatment, not routine NHS care during a degree
- It is the basis for the IHS reimbursement scheme (see above)
Key point
Neither the GHIC nor your EU EHIC replaces the IHS for studying in the UK. Your EHIC covers short visits (holidays, conferences). It does not cover a 3-year degree programme. Even the IHS reimbursement scheme, which uses your EHIC as a basis, only provides limited “medically necessary” coverage — not full NHS access.
For a complete breakdown of EHIC coverage across Europe, see our EHIC & GHIC guide for EU students.
Irish Students: The Exception
Irish citizens are completely exempt from Brexit healthcare changes thanks to the Common Travel Area (CTA) — a bilateral agreement between the UK and Ireland that predates both the EU and the NHS.
What the CTA means for Irish students
- No visa required — Irish citizens can live, work, and study in the UK without immigration permission
- No IHS payment — full NHS access as if you were British
- Home fee status — Irish students still pay home tuition rates
- Student finance eligible — can apply for UK student loans
- No EHIC needed — the CTA provides healthcare rights directly
The CTA was reaffirmed in a 2019 Memorandum of Understanding between the UK and Irish governments. It is not part of the EU framework, so Brexit did not affect it.
An Irish student at the University of Edinburgh pays home-rate tuition and £0 for healthcare. A French student at the same university pays international tuition plus £776/year IHS. Same classroom, very different costs.
Swiss Students: Bilateral Agreement
Switzerland is not an EU member but had a bilateral healthcare agreement with the UK. After Brexit, Swiss students are treated similarly to EU students:
- Student visa required (same as EU students)
- IHS must be paid upfront
- IHS reimbursement available — Swiss students with a valid Swiss EHIC can claim back the IHS under the same conditions as EU students (no work, apply within 12 months of arriving), if their visa started on or after 1 November 2021
- The same trade-offs apply: reimbursement = EHIC-level coverage only
Switzerland negotiated a continuation of healthcare coordination with the UK post-Brexit, so Swiss EHIC holders retain the reimbursement option that EU students have. The rules and process are identical.
Norwegian, Icelandic & Liechtenstein Students
Students from the three EEA countries outside the EU — Norway, Iceland, and Liechtenstein — follow the same rules as EU students:
- Student visa required
- IHS must be paid upfront (£776/year)
- IHS reimbursement available if they hold a valid EHIC and do not work (Norway: visas from 1 January 2021; Iceland and Liechtenstein: refunds backdated to 1 January 2024)
- Same application process through GOV.UK
These countries were included in the UK’s post-Brexit healthcare coordination agreement, which is why their students have the same reimbursement rights as EU nationals.
Transition Period Students vs New Arrivals
Your arrival date determines which rules apply to you. Here is the breakdown:
Arrived before 31 December 2020
- Eligible for EU Settlement Scheme (Settled or Pre-Settled Status)
- Free NHS access without IHS if you have EUSS status
- No Student visa needed
- Home tuition fees may still apply (depends on when your course started)
- Action needed: If you have not applied for EUSS yet, apply for a late application immediately
Arrived 1 January 2021 – present
- Student visa required with IHS payment
- International tuition fees
- IHS reimbursement available if you meet EHIC + no-work conditions
- No access to EU Settlement Scheme
- Full NHS access as long as IHS is paid
Key dates
| Date | What happened |
|---|---|
| 23 June 2016 | Brexit referendum |
| 31 January 2020 | UK left the EU |
| 31 December 2020 | Transition period ended — free movement ended |
| 1 January 2021 | EU students need Student visa + IHS |
| 30 June 2021 | EU Settlement Scheme application deadline |
| Autumn 2021 | First academic year with full post-Brexit rules |
What EU Students Need to Do NOW: Step-by-Step
If you are an EU student planning to study in the UK in 2026 or 2027, here is your action plan:
Step 1: Apply for your Student visa
You need a Confirmation of Acceptance for Studies (CAS) from a UK university, proof of funds, and English language evidence. Apply online through GOV.UK, well before your course starts.
Step 2: Pay the IHS
This happens during the visa application. You pay £776/year for the full visa duration. For a 3-year degree with a 4-month buffer, that is £2,716 upfront. Save your IHS reference number.
Step 3: Decide on IHS reimbursement (before you arrive)
Before arriving, decide whether you will work in the UK:
- Planning to work part-time? Keep the IHS. Do not apply for reimbursement.
- Certain you will not work? You can apply for a reimbursement after arriving (within 12 months).
Step 4: Arrive and register with a GP
Within your first week, register at a GP surgery near your university. You don’t need ID, proof of address or immigration status to register, but bringing your passport and an address document can speed things up. Your GP registration is your gateway to all NHS services.
Step 5: Register with an NHS dentist
This is separate from GP registration. NHS dentists are scarce — register early even if you do not need treatment. If no NHS dentist is accepting new patients, consider a private dental plan.
Step 6: Keep your EHIC active
Even if you keep the IHS, maintain a valid EHIC from your home country. You will need it when travelling to other EU countries during holidays. It also provides a safety net if your immigration status ever changes.
For the full NHS registration process, see our step-by-step UK guide.
Cost Comparison: EU Student in 2019 vs 2026
Here is the real financial impact, using a 3-year undergraduate degree at a mid-range English university:
| Cost item | 2019 (pre-Brexit) | 2026 (post-Brexit) |
|---|---|---|
| Tuition per year | £9,250 (home rate) | International rate — set by each university |
| Tuition total (3 years) | £27,750 | Usually much higher |
| IHS total | £0 | £2,716 (typical 3-year degree) |
| Visa application fee | £0 | Student visa fee (see GOV.UK) |
| Student loan available | Yes | No |
| Healthcare refund possible | — | Only with an EHIC and no paid work |
| Extra cost post-Brexit | — | Tuition difference + IHS + visa fee |
Healthcare (IHS) is a small part of the total increase — the real cost driver is international tuition fees. But the IHS is still £2,716 that did not exist before.
For students considering alternatives, our country comparison tool can help you weigh options across multiple destinations.
Frequently Asked Questions
Do EU students still need to pay the IHS after Brexit?
Yes. Since 1 January 2021, all EU students arriving on a Student visa must pay the Immigration Health Surcharge of £776/year. This applies to students from all 27 EU member states, plus Norway, Iceland, Liechtenstein, and Switzerland. The exceptions are Irish citizens, who are exempt under the Common Travel Area agreement, and people with settled or pre-settled status under the EU Settlement Scheme.
Can I use my EHIC instead of paying the IHS?
No. Your EU EHIC does not replace the IHS for study residency in the UK. You must pay the IHS during your visa application — there is no alternative. However, full-time students with a valid EHIC who do not work can apply for a full or partial IHS reimbursement within 12 months of arriving. This reverts your NHS coverage to “medically necessary” treatment only.
What is the IHS reimbursement scheme and should I use it?
The IHS reimbursement scheme lets EU/EEA/Swiss full-time students with a valid EHIC claim back the IHS for the period their EHIC is valid. You apply through GOV.UK within 12 months of arriving in the UK. The catch: you must not do paid work during your stay, and you are then limited to medically necessary treatment with your EHIC. For most students, keeping the IHS and working part-time is the better financial and medical choice.
Are Irish students affected by Brexit healthcare changes?
No. Irish citizens have full NHS access and pay no IHS thanks to the Common Travel Area (CTA) between the UK and Ireland. They also pay home tuition fees and can apply for UK student loans. The CTA predates the EU and was unaffected by Brexit.
What happens if I get the IHS reimbursement and then start working?
The reimbursement is only for students who don’t work. Once you start paid work in the UK, your EHIC may become invalid for UK healthcare and you are no longer eligible for the reimbursement — which can leave you on a Student visa without healthcare cover. Contact the NHSBSA straight away if your situation changes. If there is any chance you might work, do not apply for the reimbursement.
Do EU students with Pre-Settled Status need to pay the IHS?
No. If you have Pre-Settled or Settled Status under the EU Settlement Scheme, you have full NHS access without paying the IHS. However, EUSS status is only available to EU citizens who were living in the UK before 31 December 2020 and applied by 30 June 2021 (or made a successful late application).
Is the GHIC the same as the EHIC?
No. The UK Global Health Insurance Card (GHIC) is issued to UK residents for healthcare during temporary visits to EU countries. Your home country’s EHIC is a separate card issued by your EU country. Neither card replaces the IHS for studying in the UK. The EHIC is used as proof of eligibility for the IHS reimbursement scheme, but it does not give you NHS access on its own.
How much does the IHS cost for a 3-year degree?
For a standard 3-year undergraduate degree, you pay £776/year for the visa duration (typically 3 years plus a 4-month buffer). The total is usually £2,716 (3 × £776 + £388); the application shows your exact amount. This is paid upfront as part of your visa application — not monthly. If your visa is refused, you receive a full refund.
Can I get private insurance instead of paying the IHS?
No. The IHS is mandatory for all Student visa applicants. No private insurance policy can replace or waive the IHS requirement, regardless of how comprehensive it is. Private health insurance in the UK is always supplementary — it enhances your NHS access but cannot substitute it.
Will EU students ever get free NHS access again?
There is no current plan to restore pre-Brexit healthcare rights for EU students. The UK government has not proposed any changes to the IHS requirement for EU nationals, and student mobility programmes do not change healthcare or immigration rules. Any future change would require new legislation.
Related Articles
- Student Health Insurance in the UK: NHS, IHS & What You Actually Need — Complete UK guide covering IHS payment, NHS coverage, dental gaps, and supplementary options
- EHIC & GHIC: Can EU Students Use It Instead of Health Insurance Abroad? — Full breakdown of EHIC coverage, limitations, and when you need more
- Best Student Insurance for Erasmus 2026 — What EHIC covers during Erasmus exchanges and what supplementary plans you need
The Bottom Line
Brexit turned UK healthcare from a non-issue into a significant cost for EU students. You now pay £776/year in IHS fees, need a Student visa, and face international tuition rates. The IHS reimbursement scheme exists but comes with severe restrictions — no work, limited coverage. For the vast majority of EU students, paying the IHS and keeping full NHS access is the right call.
Compare insurance options for your study destination and find the right coverage. Use our country comparison tool to see how the UK compares to Germany, Australia, and other popular study destinations.
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