Having lived in the UK for ~6 years, I'm now preparing to move to the US. As a corporate director, I've contributed to UK's National Insurance at basic rates, but made minimal investments above that. Not planning on receiving any benefit, or pension from the UK; however, I do appreciate their national healthcare services, when compared to the US counterparts.

Question for the contingency of getting Really Sick (non-emergency medical operations):

  • Can I keep paying National Insurance at given rates, and keep the medical coverage?
  • Would that coverage be exercisable by traveling to the UK?
  • Do I need to communicate "moving to another country" to the UK government for NI coverage continuity?

3 Answers 3


I think you should move to a US-based healthcare plan as soon as possible.

Access to the NHS services are not linked National Insurance payments, since otherwise it would leave unemployed people without medical cover.

Instead, access to the NHS is linked to you being ordinarily resident in the UK. On leaving the UK for the USA, you would no longer be eligible for NHS care even if you flew back to the UK for treatment, since you wouldn't be a UK resident.

Some doctors enforce a 3 month waiting period so as to ensure people are not abusing the system. During that time, you would have to pay for consultations privately.

NHS hospitals will occasionally treat foreigners for free for life-threatening and urgent cases without charge. (An acquaintance suffered an extreme allergic reaction while visiting and was charged nothing for their hospital stay.) However, for these sorts of situations you would have to be treated in the US anyway, and would need comprehensive cover there.

The Advice Guide on NHS Charges for People from Abroad page has more information on this, as does this Parliament Briefing Paper


It is my understanding that the National Insurance payments, despite the misleading name, are put towards one's State Pension, so upon retirement you would have something to fall back on if you had not made other arrangements. However, I am not sure how one's country of residence affects the ability to claim a state pension.

If you were only hoping to use NI payments to keep up the 'safety net' of NHS coverage (and the earlier answer points out that NHS coverage has nothing to do with NI payments) in case of something horrible befalling you in the future, then you probably don't need to continue making NI payments.

If something horrible were to befall you medically, you could still return to the UK and become resident there once more, and then you would automatically qualify for NHS coverage again.

  • 1
    Although you might not be refused, planning to come back for treatment but not keeping up the minimum national insurance payment is a very dishonest scumbag move. We pay taxes so that the less fortunate have something to fall back on, not for freeloading opportunists. Plus the goverment are looking to close loopholes on this kind of medical tourism so you might find yourself being caught out.
    – JamesRyan
    Commented May 21, 2014 at 11:46

If you are non-resident, you can opt to continue to pay Voluntary National Insurance. This has the advantage of avoiding any 'gaps' in your NI payment history (should you decide to return to the UK at a later date), and given that the UK has reciprocal agreements with many other countries, you may find that at retirement you can 'combine' your local and UK pension entitlements.

There are two classes of Voluntary National Insurance: class 2 and class 3 (class 1 is what people in the UK pay). The details are available from the page linked above, but basically you pay class 2 if you are employed or self-employed abroad, and class 3 if you are unemployed abroad.

(Aside: The annual fees are derisory for class 2, no-one has ever been able to explain to me how the sums add up)

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