NHS Costs — What's Free and What You Pay For

1. What the NHS Provides Free

The NHS was founded on the principle that healthcare should be available to everyone, free at the point of use. The vast majority of NHS services remain completely free — you pay nothing at all when you use them. Understanding this is important so that you are never put off seeking care because of worry about costs.

The following services are always free to all UK residents, regardless of age, income or benefit status:

• GP appointments — seeing your family doctor, nurse or healthcare assistant at a GP surgery is free. This includes telephone and video consultations.
• Hospital treatment — emergency surgery, planned operations, outpatient clinics, follow-up appointments and day procedures are all free on the NHS.
• Accident & Emergency (A&E) — attending an emergency department is free. You should never avoid A&E because you are worried about a bill.
• NHS 111 — the 24-hour telephone helpline (call 111) and the online version at 111.nhs.uk are both completely free to use.
• Mental health services — referrals to community mental health teams, IAPT/talking therapies and crisis services are free on the NHS.
• Maternity care — antenatal appointments, scans, labour and postnatal care are free.
• Children's healthcare — treatment for under-18s in hospital or GP settings is free.
• District nursing and community care — NHS-provided nursing care at home is free, though means-tested social care is a separate matter covered in our funding your care guide.
• Blood tests and most diagnostic tests — when ordered by an NHS clinician, these are free.

Where costs do arise, they are typically for prescriptions, dental treatment and eye tests — and even then, a large proportion of the population qualifies for free or reduced charges, as we explain below.

2. Prescription Charges 2025/26

In England, a single NHS prescription charge for 2025/26 is £9.90 per item. This charge applies to each item on a prescription form — so if your doctor prescribes three separate medicines, you would pay £9.90 × 3 = £29.70 in total, unless you are exempt (see below).

It is worth knowing that a prescription "item" refers to each individual medicine or appliance listed on the form, not the number of tablets in a box. A prescription for paracetamol 500mg and ibuprofen 200mg counts as two items — £19.80 in charges.

Prescription charges apply only in England. Prescriptions are free in Scotland, Wales and Northern Ireland. If you live in England but are not exempt, you will pay the standard charge at the pharmacy counter.

How prescriptions work in practice

Your GP, hospital doctor, nurse prescriber or pharmacist issues a prescription. You take this (or the electronic prescription is sent directly) to any registered pharmacy. If you are exempt from charges, you tick the relevant box on the back of the paper prescription (or the pharmacist records this digitally). If you are not exempt, you pay at the pharmacy. Keep your receipts — if you pay in error when you should be exempt, you can reclaim the charge.

3. Who Gets Free Prescriptions in England

A very significant proportion of prescriptions in England are dispensed free of charge. You do not pay the £9.90 per item charge if you fall into any of the following categories:

Age-based exemptions

• Under 16 — children and young people below the age of 16 always get free prescriptions.
• Aged 16, 17 or 18 and in full-time education — if you are in this age group and are still at school or college full-time, prescriptions are free.
• Aged 60 or over — everyone aged 60 and over in England is automatically entitled to free prescriptions. This is one of the most significant entitlements for older people.

Medical condition exemptions

If you have a permanent physical disability or certain long-term medical conditions, you can apply for a Medical Exemption Certificate (MedEx), which gives you free prescriptions. Qualifying conditions include:

• Diabetes mellitus (requiring medication for blood sugar control)
• Epilepsy requiring continuous anticonvulsive treatment
• Hypothyroidism (underactive thyroid, requiring thyroid hormone)
• Cancer — including the effects of cancer, or the effects of current or previous cancer treatment
• Hypoparathyroidism
• Diabetes insipidus and other forms of hypopituitarism
• Myasthenia gravis
• Myxoedema (requiring thyroid hormone replacement)
• Addison's disease and other forms of hypoadrenalism
• Fistula requiring continuous surgical dressing
• A permanent disability that prevents the patient leaving home without the help of another person
• Continuing physical disability that prevents the patient from going out without the help of another person

To apply for a Medical Exemption Certificate, ask your GP to complete form FP92A. The certificate is valid for five years and covers all your NHS prescriptions — not just those for the condition itself.

Benefit-based exemptions

You are entitled to free prescriptions if you or your partner receives any of the following:

• Universal Credit (in most cases — see note below)
• Pension Credit (Guarantee Credit)
• Income Support
• Income-based Jobseeker's Allowance (JSA)
• Income-related Employment and Support Allowance (ESA)
• NHS Low Income Scheme certificate HC2 (covers full charges)

Note on Universal Credit: The exemption for Universal Credit was updated in recent years. You must have had a UC award in the past 12 months that includes either no earnings, or earnings from employment that included a period within that assessment period. Always check your current entitlement on the NHS website or ask at your GP surgery.

Pregnancy and maternity exemptions

• Pregnant — if you are pregnant, you qualify for a Maternity Exemption Certificate (MatEx), which gives free prescriptions throughout your pregnancy.
• Recently gave birth — your MatEx is valid for 12 months from the date your baby was due or born (whichever is later), covering the year after childbirth.

Apply for a MatEx through your midwife or GP on form FW8.

4. Prescription Prepayment Certificate (PPC)

If you pay for NHS prescriptions and need more than a small number of items per year, the NHS Prescription Prepayment Certificate (PPC) can save you a considerable amount of money. Think of it as a season ticket for prescriptions — you pay a flat fee and then get unlimited items free for the duration of the certificate.

PPC costs 2025/26

• 3-month PPC: £31.25 — covers all prescription items for three months. Saves money if you need four or more items in that period (4 × £9.90 = £39.60).
• 12-month PPC: £111.60 — covers all prescription items for one year. Saves money if you need 12 or more items in that year (12 × £9.90 = £118.80).

For anyone with a long-term condition requiring regular medication — for example, blood pressure tablets, inhalers, antidepressants and a blood glucose monitor — the annual PPC almost always represents excellent value. Someone who collects a prescription every month and pays without a PPC would spend £118.80 per year; with a PPC, they pay only £111.60, saving £7.20 — and of course the saving grows significantly if they collect more than one item per visit.

How to buy a PPC

You can purchase a PPC in the following ways:

• Online at nhsbsa.nhs.uk/ppc
• By phone — call the NHS Business Services Authority on 0300 330 1341
• At a pharmacy — ask the pharmacist for a PPC application form (FP95)

You can pay for the annual PPC by monthly direct debit, spreading the cost over 10 months (approximately £11.16 per month). This makes it very affordable even for people on tight budgets.

If you buy a PPC and then later become exempt from charges (for example, you turn 60, or you start claiming Pension Credit), the NHSBSA will refund the unused portion of your PPC. Keep your certificate and contact them to arrange the refund.

5. NHS Dental Charges 2025/26

NHS dental treatment in England is provided through a banded charging system. There are three bands, and you pay a fixed charge for all treatment within that band during a course of treatment — regardless of how many individual procedures are needed in that visit or series of visits.

This means that if you need a check-up, a scale and polish, and a cavity filled in the same course of treatment, you pay Band 2 (because the filling puts it in that band) — not Band 1 plus the filling charge separately. The banded system is designed to make costs predictable.

A "course of treatment" typically runs for two months. If you need a second appointment to complete treatment that began in the same course (for example, a fitting appointment for a denture that was made after your initial visit), you do not pay again — it is all covered under the one band charge.

Orthodontics

If you or your child need braces, orthodontic treatment is provided free on the NHS for children and young people under 18 who meet the clinical criteria (usually an IOTN score of 3.6 or higher). Adults generally cannot access free NHS orthodontics and would need to pay privately or as a Band 3 charge if a dentist agrees to provide it.

Finding an NHS dentist

Finding an NHS dentist that is taking on new patients can be challenging in some parts of the UK. Search at nhs.uk/nhs-services/dentists or call NHS 111 for help locating an NHS dentist near you.

6. Who Gets Free NHS Dental Treatment

You are entitled to free NHS dental treatment (you pay nothing at all, not even Band 1) if you fall into any of these groups:

• Under 18 — children and young people under 18 always receive free NHS dental treatment.
• Under 19 and in full-time education — if you are 18 but still in full-time education, you remain entitled to free treatment.
• Pregnant — all dental treatment during pregnancy is free on the NHS.
• Within 12 months of giving birth — free dental treatment continues for a full year after your baby is born (or the due date, if later).
• NHS hospital dental treatment — any dental treatment carried out in an NHS hospital (as opposed to a dental practice) is free.
• Receiving certain benefits:
  • Universal Credit
  • Pension Credit (Guarantee Credit)
  • Income Support
  • Income-based Jobseeker's Allowance (JSA)
  • Income-related Employment and Support Allowance (ESA)
  • NHS Low Income Scheme certificate HC2 (full exemption)

If you are unsure whether you qualify, tell your dentist before treatment begins. If you claim exemption incorrectly, you may receive a penalty charge notice — so it is important to check your eligibility beforehand.

7. Eye Tests and Optical Costs

Most people in the UK pay privately for eye tests and glasses. However, a significant number of people are entitled to a free NHS sight test, and some are also entitled to help towards the cost of glasses or contact lenses through NHS optical vouchers.

Private versus NHS eye tests

Many High Street opticians offer both NHS and private eye tests. A private eye test typically costs between £25 and £40, although prices vary widely — some opticians charge more for enhanced testing. NHS eye tests are always free if you meet the eligibility criteria, and they cover everything a standard test needs to assess.

Who qualifies for a free NHS sight test

You are entitled to a free NHS sight test if any of the following apply:

• Aged 60 or over
• Under 16
• Aged 16, 17 or 18 and in full-time education
• Diagnosed with diabetes (any type)
• Diagnosed with glaucoma
• Aged 40 or over and have a direct family member (parent, sibling or child) with glaucoma — the increased risk means you qualify for a free test
• Registered as partially sighted or blind
• Recommended for a complex lens by an ophthalmologist
• Receiving certain benefits:
  • Universal Credit
  • Pension Credit (Guarantee Credit)
  • Income Support
  • Income-based JSA
  • Income-related ESA
  • NHS Low Income Scheme certificate HC2 or HC3
• A prisoner on day release

You can have an NHS sight test as often as your optician recommends — usually every two years for most adults, or more frequently if you have a condition that warrants closer monitoring. The optician will advise how often you should return.

8. Optical Vouchers for Glasses and Contact Lenses

If you qualify for a free NHS sight test (under the benefits/income criteria, or you are a child), you may also be entitled to an NHS optical voucher to help pay for glasses or contact lenses. These vouchers are set at fixed values depending on your prescription strength.

Voucher values for 2025/26 range from approximately £39.10 to £220.50, depending on which lens type you need (the higher the prescription complexity, the higher the voucher value). You can use the voucher at any registered optician and top it up yourself if you choose a more expensive frame.

Children who need glasses always receive an optical voucher. Children in certain circumstances (looked-after children, children receiving certain benefits) may receive a higher-value voucher.

You do not need to apply separately for the voucher — your optician will issue it automatically if you qualify after your eye test. Present it when selecting your glasses or contact lenses.

9. Wigs and Fabric Supports

NHS wigs and fabric supports (such as abdominal supports, spinal supports and surgical brassieres) can be supplied free or at a reduced cost for people who need them following illness, surgery or as part of medical treatment.

Wigs

If you need a wig due to a medical condition — most commonly following chemotherapy treatment for cancer, or due to conditions such as alopecia areata — an NHS wig may be available:

• Free of charge if you are exempt from NHS charges (same criteria as prescriptions and dental — benefits, age, low income certificate)
• At a subsidised charge of approximately £70–£270 for those who are not exempt, depending on the type of wig (acrylic, part-human hair or full human hair)

Ask your hospital consultant or specialist nurse about obtaining an NHS wig. Some hospitals have dedicated wig services, and some charities (including Macmillan Cancer Support) offer additional help with wig costs for people undergoing cancer treatment.

Fabric supports

Surgical supports such as abdominal belts, spinal supports and similar items are provided on NHS prescription. The same exemption rules apply — you pay the standard prescription charge (£9.90) per item unless you are exempt, in which case they are free.

10. HC1/HC2 Low Income Scheme

The NHS Low Income Scheme is specifically designed for people who do not receive a qualifying benefit but whose income and capital are low enough that paying NHS charges would cause genuine financial hardship. It is an important but frequently overlooked route to help with costs.

How it works

There are two certificates available:

• HC2 Certificate — provides full help with NHS charges. You pay nothing for prescriptions, dental treatment, eye tests and optical vouchers. Equivalent in effect to receiving a qualifying benefit exemption.
• HC3 Certificate — provides partial help. You receive a reduced charge rather than complete exemption. The amount of help is calculated based on how much you can reasonably afford to pay.

How to apply

1. Get form HC1 from your GP surgery, hospital, Jobcentre Plus, or download it from nhsbsa.nhs.uk
2. Complete the form — it asks about your income, savings, capital and outgoings
3. Post or submit it to the NHS Business Services Authority
4. You will receive either an HC2 or HC3 certificate by post

Certificates are usually valid for 12 months and must be renewed annually. If your circumstances change during the year, you can apply again at any time.

Who might benefit from HC1/HC2

The scheme is particularly useful for people who:

• Are just above the income threshold for Universal Credit or Pension Credit
• Have recently stopped claiming a qualifying benefit
• Are self-employed with a low income
• Are a student aged over 19
• Are on a low income but do not qualify for any means-tested benefit

11. Quick Reference: NHS Charges at a Glance (2025/26)