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Help with health costs


by Tom_maggies

Information about help available with the extra costs of travel to hospital, prescription charges in England, dental and optical charges and the costs of wigs and fabric supports

.An area of  extra costs that can often hit home - and be a common first query from new visitors to Maggie’s Centres -  is the added expense of needing to use NHS services more. Thankfully surgeries, treatments and time with hospital staff, GPs and cancer nurses are all free at the point of delivery. 

However, travel costs – often to  a more far flung specialist hospitals - can mount up and prescription lists may lengthen. You may need dental or optical check ups anyway or perhaps in relation to your cancer , its treatments and side effects. So what help is available with such extra costs?

Some help is available regardless of your income and savings, in certain circumstances e.g. no -one with cancer need pay English prescription charges. Other help is more generally available,  but is often more on the grounds of a low - or perhaps temporarily reduced - income.

An advisor then won’t just be looking to give you the low-down on help with health costs in your circumstances. If your  income is down a bit,  they will be looking at other benefits as well, as these can also make it much easier to access help with other health costs.

And even where income is too high for any other "income related" benefits or  for much of the help with health costs, there are other benefits - too often unclaimed - that can apply regardless of your income.  See the overview in blogs in the links.

So do pop in to your nearest Maggie’s Centre and ask. You may go in with a query about fares to get to that hospital, but come out with not only ideas for helping with the travel costs, but also a cunning plan to access a number of other benefits that you may have been missing out on.

But now, let's get back to that help with health costs. As we go through them you will notice that there is a common thread of variation between the four "home nations" of the the UK. This reflects the fact that the NHS has been devolved and there are differences in approaches at a policy level e.g. as to whether to have prescription charges at all.

Help with travel costs to hospital

If you are assessed as eligible on medical grounds, you may be entitled to free transport via the NHS Patient Transport Services, regardless of income. You may want to explore that first as this will be free. Otherwise you are expected to make your own arrangements for non-urgent travel to hospital 

In general, the Hospital Trave Costs Scheme  is the same across the UK, with the exception of the Highlands and Islands of Scotland and some extra arrangements for travellers from the Isle of Wight. A case has been made for a Highlands and Island style scheme for the Scilly Isles, but when this starts will depend on funding.  Check with your GP/hospital for any progress.

The scheme is to help with travel to hospital rather than to your local GP or dentist. However, if you are receiving specialist services at a more distant primary care centre or specialist dentist, then those costs can come under the scheme.

Most hospitals will have an office able to offer cash refunds: take along  receipts, tickets and evidence of entitlement to pick up a refund of those costs. Reception or patient information points in the hospital can point you in the right direction and tell you the name of the office you need.

If there isn’t a facility to make those payments on site , then you can always claim by post using an HC5 form. You may also want to talk to them about the best way if you are doing a regular run of journeys.

Who can get help?

You qualify for help with Healthcare Travel Costs if:

  • you receive one of the qualifying benefits see below; or
  • you qualify under the NHS Low Income Scheme; or
  • anyone who lives in the Highlands and Islands whose journey exceeds 30 miles and costs exceed £10.

What can I get help with?

Fares for the cheapest means of transport that is suitable in your circumstances. This can depend on your health, what practical public transport is available:

  • standard class rail, bus and ferry fares from home to hospital and back; or
  • fuel costs if you come by car at the current rate e.g. at time of writing this was 14p /mile
  • Taxis are a last resort e.g. no public transport – BUT these must be pre-approved
  • If you need someone to accompany you, then their costs can be covered too, again with prior approval

What if I need to stay overnight?

Occasionally you may have to travel considerable distances to a national specialist centre of excellence. Or you may have quite a distance to go each way for a brief radiotherapy session.

In general, the scheme does not allow for this (except in the Highlands and islands) but hospitals with far flung catchment areas may happen to have a patient hostel available on site. Check with the hospital

What’s different for the Isle of Wight?

It’s the same basic scheme, but there are local discounts available for everyone going to hospital appointments on the ferries. For further information and links see IoW travelling for healthcare

What about the Highlands and Islands?

Here the scheme is modified as travel to your “local” hospital may be very lengthy and could well require an overnight stay. The basic scheme applies, but with important variations:

  • anyone - whether or not they can qualify for the general scheme on financial grounds - can get help if their journey is more than 30 miles, but they will be required to cover the first £10
  • help is also available – for those qualifying on income grounds – for overnight b&b accommodation

More details at NHS Highland - Patient Travel

Help with prescription costs

Generally, NHS prescriptions are free for those resident in Scotland, Wales and Northern Ireland and are free for those aged over 60 in England.

Free prescriptions - in England - for those with a cancer diagnosis

If you have a cancer diagnosis, you can get a Form FP50 completed by your GP practise and send that off to the address shown. You will then get a medical exemption certificate back that will exempt you from any prescription charges for the next five years.  This is regardless of your income or savings.

If you need to pay for prescriptions while awaiting that certificate, you would be able to get a refund as long as you keep the receipts and these are for payments made after the earliest date on the certificate.

If you normally live in one of the other three home nations but are anticipating spending a while in England, then your GP may be able to issue you with . You can find more details about these certificates on the  NHS Business Services Authority website..

Free prescriptions - in England - for others:

So you are covered if you have a cancer diagnosis, but that won't help if anyone else in your household needs prescriptions. They can get free prescriptions in their own right if they: 

  • are aged under 16 (or under 19 if in relevant education) ; or
  • are aged over 60; or.
  • receive one of the qualifying benefits or qualify separately under the NHS Low income scheme (see below in this blog

Help with dental costs

If you are registered with an NHS charges there will be standard charges for check-ups and treatments. But you may get help with these charges.

Dental check ups

These are free:

  • in Scotland – for everyone
  • in Wales for all under 25
  • in England for all under 18 (or under 19 if still in education)

Dental treatments

These are free (including check ups in N.Ireland) if:

  • you receive one of the qualifying benefits - see below ; or
  • you qualify under the NHS Low Income Scheme ; or
  • you are pregnant or have given birth in the last 12 months; or
  • you are resident in a care home with local authority funding; or
  • your treatment is via hospital dental services or specialist community dental service (e.g. for disability access

Help with eye care

You can sometimes get help with the costs of sight tests, glasses and contact lenses:

Sight tests

In Scotland, you can get free eye tests.

If you live in England, Wales or Northern Ireland you can get free sight tests if, you:

  • receive one of the qualifying benefits or qualify separately under the NHS Low income scheme (see below in this blog)
  • are aged 60 or over or under 16 (or under 19, if still in education); or
  • are registered blind or partially-sighted, or
  • have been prescribed complex or powerful lenses or
  • have been diagnosed with diabetes or glaucoma (or are at risk of getting it / have close relatives with it);  or
  • are a patient of the Hospital Eye Service 

Vouchers for glasses and contact lenses 

Following a sight test, vouchers can help with the costs of prescribed glasses or contact lenses. You will qualify for one (the value of which will depend on the prescription) if you:

  • receive one of the qualifying benefits or qualify separately under the NHS Low income scheme (see below in this blog)
  • are under 16 (or under 19 if in relevant education)
  • are a Hospital Eye Service patient needing frequent changes
  • have been prescribed powerful or complex lenses.

Wigs and fabric supports

These can be important for cancer patients undergoing chemo or coping with lymphoedema. Wigs especially can be very personal – the one that works for you may very well be within the NHS range, but your local hospital may well also be able to advise about private providers.

In Scotland, Wales and N. Ireland you can get free wigs and fabric supports from the hospital.

In England, there will be a charge for these unless you:

  • receive one of the qualifying benefits or qualify separately under the NHS Low income scheme (see below in this blog)
  • are aged under 16 (or 19,  if in relevant education); or
  • are a hospital inpatient or a resident in a residential care home (with local authority funding)

Find out more on the NHS website

Qualifying benefits and the NHS Low income scheme

In each area of health costs mentioned above, sometimes help is available regardless of your income in certain circumstances. But often I have used the phrase “if you receive one of the qualifying benefits or qualify separately under the NHS Low income scheme (see below in this blog)”

So, now I finally explain what I mean by this. The NHS Low Income Scheme is available for anyone to apply to and will do its own financial assessment to decide if you qualify for help and by how much. However, there is no need to make this separate application if you are already receiving one of a number of qualifying benefits who have already assessed your finances

Qualifying benefits

If you receive one of the following benefits, you will automatically qualify for maximum help with health costs  if you get one of these qualifying benefits:

  • Income Support*, Income-based Jobseeker’s Allowance*, Income-related Employment and Support Allowance* or Pension Credit (Guarantee Credit)
  • Tax credits* if you are not earning.
  • Tax credits* if you are earning but less than £15,276 in the last tax year. (Note: earners must either have  Child Tax Credit included in the claim or their Working Tax Credit includes one of the two disability elements)
  • Universal Credit if you are not earning.
  • UC if you are earning,  as long as earnings are below  £935 in the last month (if you have a “work allowance” in your UC sums) or £435  if you do not.  

(note: those marked with an asterisk * are eventually due to merge into Universal Credit)

That’s why a Maggie’s Advisor would be very interested to see if you might be missing out on one of these benefits before reaching for the HC1 Low Income Scheme form. If you get one of these qualifying benefits you simply tick the box for the benefit you receive on the back of your prescription or on a form from your optician or dentist.

You may be asked for evidence that you get the relevant benefit. That might be a letter confirming entitlement. For UC this would be your latest UC statement (available via your online account). For tax credits, HMRC will send you a certificate of qualification.

A problem has arisen with old forms in circulation that do not have the boxes for Universal Credit on them.  The NHS Business Services policy – acting on out of date advice from DWP was for people to tick the Income-based JSA box instead. However as UC opened up to all comers it may have seemed much more appropriate and “correct to tick another one eg Income-related ESA if unwell or Income Support if a carer

It would be entirely wrong if there were any repercussions for not knowing of an outdated and ill advised policy. Ticking a box to the same effect as receiving UC is the only way to proceed if the ageny is not practically able to ensure only new forms are in place. No repayment of costs nor penalty is lawful or appropriate in these circumstances . If you are = or have been - affected by this issue, get advice.

Applying under the NHS Low Income Scheme:

This is open for all to apply under whether you get any benefits or none. There is no need if you have one of the qualifying benefits above. The process involves you filling in an HC1 Help with Health Costs form. These vary slightly between each of the “home nations”. See the links below

After the assessment of your income you will be either told either:

  • that unfortunately you don’t qualify for any help; or
  • you do qualify, but that you will still need to pay some additional contribution ; ie you get an HC3 “partial help” certificate
  • you qualify for the full range of help in the same way as someone receiving a qualifying benefit; you get an HC2” full help with health costs” certificat

Getting further help and advice

If you have any general queries, comments or concerns about help with health costs, please join the linked Conversation.

But don’t forget that there may be considerably more help available than just help with those worrying extra costs of travel to hospital. Do take a look at some of the other Benefit blogs in the links below

Please also feel free to drop in and speak to a Benefits Advisor at your nearest Maggie's Centre. Or to message me (if you are registered with the Maggie’s Community) for individual one to one support.

Further reading and useful links:

Official explanations and forms:

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Other benefits blogs:

A full list of benefits blogs currently available. Of particular relevance may be mini-series starting on the links below:

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