What should a migrant do when they need medical treatment?

Being on assignment can be a very exciting time with a new environment, culture and colleagues to explore. Most assignments occur without issue, but what happens on the occasion when an individual requires medical treatment? Most individuals on assignment have a form of medical insurance or policy in place which would support non-urgent care effectively and efficiently, indeed some countries stipulate the same as a requirement of being awarded a visa, but what about if insurance is not held or it is an emergency which cannot wait for treatment via private providers? 

The rules surrounding the use of a country’s medical facilities can be confusing, and due to the sheer nature of when they are required, can cause a lot of anxiety and concern. As a general blanket rule, countries will provide urgent emergency care when required without question. The issue of eligibility and potential payment however can come into effect once the immediate need is passed. Where does this leave those without medical insurance?

Localised Options

In some countries, such as Spain, as long as the individual is making local social security contributions, typically done when local employment contracts are held, then access to the full healthcare system is free of charge.

For countries such as the UK, visa holders have typically already paid the healthcare surcharge in case use of the National Health Service (NHS) is required. This allows full use of the NHS and any treatments it provides, although dental services and prescriptions are still payable, the same as for the majority of residents of the UK. The charge is a set amount with the only variance in the charge amount being due to age of applicant, or if the applicant is applying for a student or youth mobility scheme visa (a working holiday / backpacker type visa).

The amount paid is a set annual amount at time of application with no refunds should medical treatment not being sought during the individual’s time in the UK. With the current charge set at £470 per year of visa for those aged under 18 or student / youth mobility applicants and £624 per year for the remaining; the fee can be high should a five-year visa be applied for however are generally lower than the cost of major treatment.

Healthcare Surcharges

The introduction of the healthcare surcharge has removed the ability for a visa holder to incur significant healthcare debt. However being a relatively recent introduction, there remains those that still have a debt to pay for their medical care. Those that hold such debt can be prevented from qualifying for any new visa or for permanent residency in the UK, something that can be incredibly impactful on an individual’s future plans.

Interestingly, at face value the US’s stance varies in that use of government funded healthcare does not impact immigration status for those that are eligible for the same, however this seems to be more due to practicalities of systems as opposed to government attitude. The majority of healthcare is provided by private providers and insurance typically held when utilising such services. The provision of government funded healthcare does however very much exist, albeit in very limited circumstances which are generally not applicable to assignees. 

Much has been made of the Public Charge rule that came into effect in December 2022. This rule essentially reaffirms previous guidance on the matter and confirms that immigrants can utilise healthcare provisions for which they qualify, such as Medicaid, without impact on their immigration status. Eligibility for Medicaid, an umbrella term for government funded medical care assistance, is dependant on numerous factors including geographic location, salary and family status however is typically provided to low-income individuals.

Care however should be taken as those that could be deemed as being dependant on long term care at government expense could be denied any future immigration status. In May 2023, the US Senate expressed disapproval of   the new Public Charge rule via a resolution under the Congressional Review Act. The House of Representatives is expected to echo the US Senate’s sentiments, after which it is for the President to either agree or object the resolution. President Biden has stated he would not agree the resolution thereby rendering the current rule valid and in effect .

With most countries not operating a free for all healthcare system or a health surcharge; instead tending to operate on the basis that treatment is provided and an invoice issued for the cost of the same where does this leave those planning on going on assignment. Without wanting to incur additional cost, it would always be recommended to have adequate medical insurance to ensure the required medical treatment is provided efficiently and economically, and for those relocating to more developing locations, ensuring that the standard of care is at the level most similar to that of the home country.

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