What's it like getting help with health costs?
One in five people in the UK lives on a low income. In this article, we will look at the:
What support with health costs is available?
If you have little money, the costs associated with healthcare can put you off seeking help.
Our research into the impact of the cost of living on people's health found some people avoid getting medications, visiting the dentist, or travelling to care appointments because of the cost.
Support does exist. If you have a low income, the NHS Low Income Scheme can help you pay for prescription costs, dental charges, eye care costs, travelling to receive treatment, and wigs and fabric supports.
To qualify, you must receive certain means-tested benefits or fill out a 19-page form asking for information about your personal situation, income, and savings.
A separate NHS scheme also provides free prescriptions to specific groups based on age, pregnancy, recent maternity, or certain medical conditions. Some of the same groups are also entitled to free dental care.
Are people aware of the available support?
The experiences people have shared with us suggest that awareness of help with NHS costs, especially help with travel and prescriptions, is low.
Healthwatch Blackburn with Darwen's study of people living in deprived wards found a lack of awareness about the NHS Low Income Scheme to help cover prescription costs.
A third of local people surveyed said the cost of prescriptions was a barrier to accessing healthcare support.
Healthwatch Croydon's research on access to NHS dentistry had similar findings. Nearly one in five surveyed didn't know that people receiving certain benefits were entitled to free NHS dental care.
Last year, over 37,000 people accessed our online advice about getting help to travel to NHS services. When seeking advice from Healthwatch, people are often unaware of the help available for travel costs to hospital.
Caller stated their GP had referred them to a local hospital for an MRI scan, which had been booked in for the end of the week. The caller was feeling very stressed because they have no money and no access to a car, yet they need to make this appointment. They wanted to know what they could do about it.
Healthwatch Hertfordshire was able to provide the caller with information about patient transport, community transport and the NHS Low Income Scheme. The caller was very grateful for the information.
Limitations of the help available with NHS costs
The NHS Low Income Scheme doesn't cover all costs incurred.
This issue particularly affects people who need new glasses. The NHS froze the value of optical vouchers to pay for frames and lenses from 2010 to 2012 and 2016 to 2021.
The voucher system has not been updated in the past twenty years to accommodate developments such as varifocals for people who need distance and near sight correction, special coatings, and thinner lenses. This has compounded the affordability problem.
This issue affects people with more complex eye conditions who struggle to afford the glasses they need. People describe having to make do with the discomfort of wearing glasses with heavy lenses, getting into debt, finding money elsewhere, or going without.
One person in their early 40s told us about dealing with worsening eyesight. They said they can no longer afford the special glasses they need due to financial issues caused by ill health, retirement, and rising living costs.
"Since the cost-of-living crisis, everything else is so expensive that even with my NHS voucher I simply can't afford new glasses. I've had my current pair now for five years and I've had to stop driving because my eyesight is so bad."
"I can no longer watch the big TV at home as I can't see it. I can't go out alone as I've lost my confidence as I can't see properly.
"I'm worried that I'm no longer regularly monitored for my eye health despite a family history of conditions like glaucoma.
The cost of purchasing glasses had gone up astronomically but the voucher value hasn't kept up, hence I'm now effectively priced out of having eye care and being able to see.
People have reported similar problems with dental care. For example, the NHS Low Income Scheme does not cover the cost of visiting a dental hygienist. Although this is not a problem for most people, it can be costly for people with gum disease.
One woman with severe gum disease who contacted us said she was entitled to full exemption from NHS dental costs on income grounds. Her dentist told her she needed to visit the hygienist every fortnight. Each session cost £60, which she couldn't afford.
Complex and confusing rules can result in debt
The rules about which benefits entitle people to help with health costs are confusing.
This is partly because some benefits (Employment and Support Allowance and Jobseekers Allowance) can be either means-tested or contribution-based. People receiving either Tax Credits or Universal Credit are only automatically entitled to help if they have no income or earnings below certain limits.
The rules of entitlement are particularly complex at the moment, as large numbers of people still receive legacy benefits such as income-based Employment and Support Allowance and Working and Child Tax Credits that have yet to transition to Universal Credit.
People tell us they aren't always sure whether they are receiving contribution-based Employment and Support Allowance or earn below the relevant limit for Universal Credit or Tax Credits, and therefore aren't automatically eligible for help with health costs.
Dental surgery and pharmacy staff aren't always aware of the subtleties of the scheme, either, and they often tell patients they are entitled to help when they aren't.
When people claim they are exempt from health costs when they are not, they may receive a letter from the NHS Business Services Authority asking them to pay the relevant NHS charge plus a penalty of £100, putting people into debt.
The cost of not being aware
A lady called Healthwatch Staffordshire about her adult son and his wife. She mentioned that her son was currently on Universal Credit, as he was out of work and claiming for his family and wife. Recently, his wife had attended a dental practice and needed additional treatment.
When asked by dental staff if she received any benefits, the wife confirmed that she was on Universal Credit. The dental practice staff informed her that the treatment would be free. However, after the treatment, the couple received a letter from the NHS Business Service Authority stating that they owed £300 for the treatment and a £100 fine for claiming.
When they contacted the service, the NHS told them that because this scheme has a threshold attached, the wife would have to pay due to her earnings, which were over the monthly threshold of £935.
Feeling misled, the couple immediately returned to the dental practice to complain. The practice claimed they were unaware of the threshold.
We also heard about people on means-tested benefits who were out of pocket because they couldn’t get a refund of the travel to hospital costs that they were entitled to.
“It’s so difficult to get any return bus fares covered by any NHS hospital in Liverpool. It costs me nearly £5 when I'm unwaged. On at least one occasion hospital staff refused to refund my travel costs to get to my appointment even though I had a travel slip from the outpatients receptionist and had on me the only proof of benefit I had to show I am in receipt of ESA! “ Story shared by Healthwatch Liverpool
Problems faced by asylum seekers
Our evidence suggests that asylum seekers face additional challenges. They are not entitled to work or claim benefits until a decision is made about their asylum claim.
While they wait, they receive asylum support, are entitled to free NHS care, and should be automatically issued with an HC2 certificate by the NHS Low Income Scheme. This certificate entitles them to the full help offered by the scheme, such as free NHS prescriptions, dental treatment and sight tests, and help with the costs.
But we have heard that:
- Some asylum seekers have not received one or received any information about it. Consequently, they do without prescriptions or free dental treatment.
- The certificate is only valid for six months and is not automatically renewed. Asylum seekers must complete a 19-page form to renew their certificate, and often need help completing it.
- Even if someone's English is proficient enough to complete the NHS Low Income Scheme application, they still need internet access to apply, which some people do not have.
- Once someone has applied, the HC2 certificate can take up to six weeks to arrive. In the meantime, people must do without.
How can policymakers help fix the issues?
Health and care decision-makers can take steps to help people on low incomes overcome the costs that can stop them getting the care they need.
Awareness of the support available needs to increase. Greater promotion by NHS England of the NHS Low Income Scheme could significantly reduce the number of patients missing out on help with dental charges, prescriptions and travel costs.
There are also practical steps that the Government, NHS England and others can take to reduce the financial costs people face and increase the take-up of support. For example:
- Increase funding for pharmacies to sell physical copies of prescription pre-payment certificates. Not all pharmacies offer certificates, which, if used, can save patients hundreds of pounds a year.
- Introduce a freeze on the cost of NHS dental treatment, which rose by 4% in April 2024, following an 8.5% increase in 2023.
- Expand the NHS Healthcare Travel Costs Scheme to cover trips to general practice, as well as hospital appointments. This would take into account the movement of services from hospitals into the community.
- Work with Ofcom and telecommunication providers to create Freephone NHS numbers for GPs, hospitals and other services.
- Commission a national helpline to improve access to health and care benefits.
- Extend statutory sick leave beyond the current time limit of 28 weeks to support people who can't work because they have been waiting for care on NHS elective waiting lists.
- Ensure that NHS Integrated Care Systems have enough funding to meet people's transport and accommodation costs when the NHS offers quicker elective treatment away from their local hospital.
- Tackle the issue of hospital parking affordability by funding NHS trusts to waive charges for low-income individuals and reduce fees for all.
