Help with NHS Healthcare Costs

Why might it be of interest?

Not all disabled young people will be entitled to free prescriptions and it is important to know when they are or are not entitled.  When young people turn 19, even with a disability and / or still in full time education they are not automatically entitled to free prescriptions and dental care.

Free healthcare costs or help with healthcare costs are all based on means tested benefits.  Being in receipt of PIP is not enough as it is not a means tested benefit.

Many of our young people will be eligible for free healthcare costs – and help towards costs where it is not entirely free for anyone.  They should not require an HC2 certificate as this is for people with an earned income but which is a low income.  The NHS website itself says that presenting your award letter should be enough.

The above link will take you to the main page on the NHS website about free healthcare.

Disabled young people are not automatically exempt from NHS prescription charges and other healthcare costs once they turn 19 and are not in full time education.  There are a number of instances where you can get free NHS prescriptions and help with other healthcare costs, such as dental care, which you can read in full on the above links.  The most likely instances for our young people to be eligible for free healthcare costs are:

• They are in receipt of income related ESA
• They are in receipt of UC and in the LCW or LCWRA group and earn less than £935 in any given assessment period (2023-2024 figures)
• They have an exempt medical condition
• They have a continuing physical disability which means they are unable to go out without help from another person and hold a valid medical exemption certificate

Income related ESA is a legacy benefit which means you cannot apply for it any more although some of our young people will still be in receipt of it.  To get the same financial benefit our young people need to apply for UC (Universal Credit) and if they are assessed as having a limited capability for work (LCW) or limited capability for work and work related activities (LCWRA) they would likely qualify for free prescriptions.

It should be noted that our young people in either LCW or LCWRA groups are able to do some work earning an income before their benefit is affected.  If they earn enough in any UC assessment period they may find that they are not, for that period, entitled to free prescriptions.

What free healthcare costs are you entitled to?

• Prescriptions
• Dental care
• Sight test

You will also be entitled to help with the cost of:

• Travel to receive necessary NHS treatment
• Glasses or contact lenses
• NHS wigs
• Abdominal and spinal supports
• Surgical brassieres

There are links on the NHS website to more information about all of the above.

Links to the NHS website re free prescriptions and dental care:

https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs

https://www.nhsbsa.nhs.uk/help-nhs-dental-costs

https://www.nhsbsa.nhs.uk/help-nhs-dental-costs/free-nhs-dental-treatment

https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/free-nhs-prescriptions

Click on the benefits button – a few sentences down:  Use your award notice as proof that you’re entitled.

Medical Exemption Certificate:  you will be eligible for free healthcare costs if you are have a medical exemption certificate for one of the conditions listed below:

• a permanent fistula (for example, caecostomy, colostomy, laryngostomy or ileostomy) which needs continuous surgical dressing or an appliance
• a form of hypoadrenalism (for example, Addison’s Disease) for which specific substitution therapy is essential
• diabetes insipidus and other forms of hypopituitarism
• diabetes mellitus, except where treatment is by diet alone
• hypoparathyroidism
• myasthenia gravis
• myxoedema (that is, hypothyroidism which needs thyroid hormone replacement)
• epilepsy which needs continuous anticonvulsive therapy
• a continuing physical disability which means you cannot go out without the help of another person
• cancer and are undergoing treatment for either:
  • cancer
  • the effects of cancer
  • the effects of cancer treatment

For people who are not eligible for free prescriptions but who need regular medication the cost can be reduced with a Prescription Prepayment Certificate.

Help towards healthcare costs for people on a low income

The NHS has a Low Income Scheme to help people on a low income with healthcare costs, including prescriptions, dental care.  You apply by completing an HC1 form.

You can order an HC1 form online, or download an HC1 form from the NHS Business Services Authority website and print it yourself.

The NHS website doesn’t give a figure for what a low income is.  It does say that a person, or a couple together, must have less than £16,000 in savings, investments or property (not including the home where you live) or if you are in permanent residential care you must have less than £23,250 in savings, investments or property.

The Low Income Scheme can help pay for:

• NHS prescription charges
• NHS dental treatment charges
• the cost of sight tests, glasses and contact lenses
• the cost of travelling to receive NHS treatment
• NHS wigs and fabric supports (check with your hospital for their arrangements for supplying NHS wigs)

If you are eligible, ie your income is low enough, you can be offered full help with healthcare costs or some help with healthcare costs.

HC2 certificate – entitles you to the following:

• free NHS prescriptions
• free NHS dental treatment
• free NHS sight tests
• help with the cost of glasses or contact lenses
• help with the cost of travelling to receive NHS treatment
• free NHS wigs and fabric supports

HC3 certificate – will tell you how much help you can get towards the cost of:

• NHS dental treatment
• NHS sight tests
• travelling to receive NHS treatment
• NHS wigs and fabric supports

You may also be entitled to help with the cost of glasses or contact lenses.  The amount will depend on the strength of your prescription.

Prescription Prepayment Certificate (PPC)

If you are not eligible for free or help towards healthcare costs but need regular prescriptions you may be able to save money with a Prescription Prepayment Certificate.

You are likely to save money with a PPC if you need more than 3 items in 3 months, or 11 items in 12 months.

https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-prescription-prepayment-certificate-ppc