Do I qualify for NHS Help with Health Costs?

Not everyone who claims Universal Credit qualifies for free NHS help. You do need to normally meet a criteria

​This depends on your personal circumstances and sometimes where you live.  For example, everyone in Scotland and Wales and Northern Ireland qualifies for free prescriptions regardless of whether they claim benefit.  The governments in these areas have scrapped the costs.  Everyone in Scotland will get a free eye examination.

You may be eligible for NHS help through another method if you do not qualify as a Universal Credit claimant.
Eligibility

You will qualify for help if you are a -
  • single or joint claimant with no children or LCW or LCWRA, if you had net earnings of £435 or less within your LAST assessment period.
  • single or joint claimant with children or LCW or LCWRA, if you had net earnings of £935 or less in your LAST assessment period.
Net earnings are referred to as 'Take Home Pay' on your Universal Credit payment breakdown.  
If you are part of a joint claim, it includes earnings from both people.  If you do not work and your partner earns above the threshold, you do not meet the eligibility.
If you or your partner have no earnings at all, then you do meet the criteria.
Your assessment period runs for one calendar month and it set by your claim date.  It repeats between the same dates each time.

Due to Universal Credit being assessed each month, it could mean that you are eligible one month and not eligible the next month.  Please remember it is based on your take home pay on your last payment breakdown.  It is your responsibility to check and ensure that you are entitled.
If the declaration form you are signing does not have an option for Universal Credit, you should tick the box for income-based Jobseekers' Allowance.  This is box K.
You should pay for any health costs if you're unsure whether you meet the eligibility criteria. You can claim a refund once you're able to confirm your entitlement.
This might be the case because:
  • ​your Universal Credit claim is still being assessed
  • you're waiting for a decision about your Universal Credit claim that might change the threshold that applies to you
  • you're uncertain whether your earnings are within the threshold
You need to have met the eligibility criteria either in the Universal Credit period before you paid, or in the same assessment period in which you paid, to qualify for a refund.
Make sure you ask for and keep receipts. If you pay for a prescription, you must get a receipt and refund form (FP57) at the time you pay, as you won't be able to get one later.

What help is available?

Most people have to pay for a charge for certain things on the NHS.  If you are eligible for help then you can claim for free - 
  • NHS prescriptions
  • NHS dental check-ups and treatment
  • sight tests
  • new glasses or contact lenses
  • repairing or replacing glasses or contact lenses
  • NHS wigs
  • NHS fabric supports – things like surgical bras, support tights and spinal supports
  • travel for NHS treatment​

Have you received a penalty notice?

Some people to receive penalty notices because they have ticked the wrong box or not shown evidence of entitlement or due to clerical error.  

If this happens you can call the number in the letter you receive.  You will be asked for a copy of the relevant payment breakdown to appeal it and the penalty and any charges will be removed if you can show you were entitled.

If you do not qualify as a Universal Credit claimant

You may still through another exemption or through the Low Income Scheme.

You can check any other eligibility with NHSBSA

​Alternatively, you may benefit from NHS Prescription Prepayment Certificate.

Do you have a valid Tax Credit Exemption Certificate?  You can still use it even when you claim Universal Credit until it expires - more information here.

​Also explore...
Basic info and new claims
Working and Earning on UC
Claimant Commitment