Benefits and Help with Health Care Costs
Living with a long term health condition can impact on all aspects of your life, including your financial wellbeing. There are a range of benefits and help with health care costs that you may be entitled to.
We understand that the benefits system can be confusing and this simple guide has been put together to try and help you to navigate the benefit system.
There are different benefits that you can claim depending if you are under or over state pension age.
You can access advice from your local Citizens Advice service, or your local council will have a welfare rights service.
If your hospital has a social worker they can support you to claim any benefits you may be entitled to, and also help you to access any additional support you might need.
You can complete a simple benefit check online with turn2us.org.uk.
If you are employed:
If you work for an employer and need to take time off work you may be able to claim Statutory Sick Pay (SSP).
If you are self employed you will not be able to claim this but there may be other benefits that you can claim.
If you are under the state pension age and self employed, unemployed or unable to work because of your health issue:
Employment and Support Allowance (ESA) is paid to people under state pension age if your ability to work is affected by your illness. It is paid at different rates, and is means tested so it is a good idea to speak to a welfare rights/benefits advisor for more information. You can make a claim online at www.gov.uk.
Universal Credit (UC) is paid to people who are unable to work or are on a low income. It has replaced means tested benefits and covers housing benefit, income support, child tax credit, working tax credit, and income based ESA/JSA. You can make a claim online at www.gov.uk
If you do not have access to the internet please visit your local Job Centre where the staff will be able to help you to make a claim.
If you are over State Pension age:
You will be entitled to your state pension, and if you have a low income you may be entitled to pension credit.
Find out if your eligible to recieve pension credit and how much you will get using the pension credit calculator.
Personal Independence Payment (PIP)
If you are under 65 you may be entitled to Personal Independence Payment (PIP)
This is a non-means tested benefit that is designed to help you with additional costs associated with your long term health condition or disability.
In order to claim PIP you must meet the following criteria.
- You must be aged between 16 and 65 to apply.
- You must have had daily living and/or mobility needs for at least 3 months and expect these needs to continue for at least 9 months to apply.
- You need to have lived in England, Scotland or Wales for 2 of the last 3 years to apply.
PIP is paid at standard or enhanced rate and covers your care and mobility needs. If you claim PIP at the enhanced rate then a friend or relative may be able to claim Carers Allowance.
If you receive the mobility component at the enhanced rate then you will automatically be entitled to a BLUE BADGE which allows you to park in disabled bays. Alternatively you can apply for one from your local authority.
To claim PIP call the DWP on 0800 9172222. You will need your NI number, bank details and details of professionals involved in your care to hand when you make this call which should take approximately 15 minutes.
A claim form will be sent to you shortly after that you will need to complete and return.
Attendance Allowance (AA)
If you are over 65 you may be entitled to Attendance Allowance (AA)
This is a non-means tested benefit that covers your care needs during the day and at night. It is paid at low and high rates.
To make a claim– visit the gov.uk website to make a claim online. You can also print a paper copy and post this if you prefer.
When claiming any of these benefits it is important to remember that when you complete the forms you need to describe how your condition affects you on your worst day.
It is also important to remember to keep copies of the forms for your future reference.
The forms can feel very daunting. If you are finding them difficult to complete you can contact Citizens Advice or your local welfare rights service for help and support.
Claiming Under Special Rules:
If you are terminally ill you can ask your hospital consultant/specialist nurse or GP to complete a SR1 and send it to the DWP.
This will mean that disability benefits are looked at quickly and you will receive the highest rate.
The rules for claiming PIP/AA differ in Northern Ireland – you can visit the www.gov.uk website for further information.
Help with healthcare costs:
Certain benefits mean you are entitled to help with health care costs including free prescriptions and travel to and from hospital.
The qualifying benefits are:
- Income-based Income Support
- Income-based Employment and Support Allowance
- Income Support
- Pension Credit Guarantee Credit
- Pension Credit Guarantee Credit with savings credit
- Universal Credit (if assessable income is below £425 or £935 if it includes a child element or limited capability for work or work related activity) *amount correct Nov 2021.
- NHS Tax Credit Exemption – where family income is £1526.70 or less and receive Child Tax Credit, or Child Tax Credit and Working Tax Credit together or Working Tax Credit including disability or severe disability premium. *amount correct November 2021.
If you receive Contribution Based Job Seekers Allowance or Contribution Based Employment and Support Allowance you will not automatically be entitled, but may still be able to claim help with health care costs using the NHS Low income Scheme.
NHS Low Income Scheme
To apply for the NHS Low Income Scheme you will need to complete an HC1 form.
If you live in England:
If you live in Scotland:
You can download and print an HC1 form (PDF: 124KB), or you can get an HC1 form from Jobcentres, GP practices, pharmacies and Citizens Advice.
If you live in Wales:
You can download an HC1 form from the Welsh Government website.
You can also call 0345 603 1108 and select the option for health publications to get a copy sent to you.
You may also be able to get an HC1 form from Jobcentres, NHS hospitals, dentists and opticians.
If you are claiming back costs of travelling to and from hospital appointments you must bring proof of benefit entitlement with you every time you attend clinic, along with valid public transport tickets.
You can claim for private vehicle mileage but you can not normally claim for taxi costs.
If you attend clinic with a relative or carer you can not normally claim their travelling costs.
In England you must pay for your medication unless you have an exemption certificate.
Please note that immune-suppression drugs taken after a transplant do not entitle you to free prescriptions.
Further information about exemptions can be found at www.nhsba.nhs.uk/exemption-certificates
If you are not entitled to an exemption certificate you can still apply for a Prescription Pre-Payment Certificate (PPC) to help manage the costs of your medication.
- A 3 month PPC costs: £31.25 *correct August 2023
- A 12 month PPC costs: £111.60 *correct August 2023
The easiest way to buy a certificate is online and they can be purchased from www.services.nhsba.nhs.uk
Citizens Advice. https://www.citizensadvice.org.uk/
Turn to us. https://www.turn2us.org.uk/
Step change (debt management.) https://www.stepchange.org/
For all benefits and carers information. https://www.gov.uk/
Contact your local council for welfare rights services.
All information including costs and qualifying amounts correct as of August 2023