What Is Private Medical Insurance and Should I Get Covered?

Ian Lewis[1]

Ian Lewis

Money Savings Advice What Is Private Medical Insurance and Should I Get Covered?

If you live in the UK, you’re lucky enough to have the NHS to rely on. The National Health Service provides essential healthcare that’s delivered. With the care of the NHS, you can get diagnosed and get the treatment you need for nothing more than the cost of an occasional prescription.

Though it’s great to have the NHS looking after your health, you might want more or want something the NHS can’t offer. If that’s the case, you can join roughly 15% of the population in choosing private medical insurance.

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What Is Private Medical Insurance?

Private medical insurance is a paid-for product available from many providers. You pay an insurance premium, much like you’d pay for car insurance or life insurance, and if you become ill, you can claim a pay-out that covers the cost of private treatment.

Private treatment could be quicker than the same treatment through the NHS. You may be treated in more comfortable facilities, like the best private hospitals. You may be entitled to some treatments that aren’t available through the NHS. From diagnosis to treatment, private medical insurance can cover some or all of your costs.

Private Medical Insurance Meaning

Private medical insurance is designed to complement the NHS, giving you choices that those without insurance might not get. Paying for private medical insurance doesn’t mean that you can’t use the NHS. Many people try the NHS first, avoiding making claims on their insurance, but can turn to their insurance if they’re unhappy with waiting lists or NHS facilities.

Private medical insurance means extra protection, extra options, and extra security.

Is Private Medical Insurance Worth It?

Private medical insurance is a cost that many people choose not to pay. It’s seen as a luxury rather than an essential, thanks to the National Health Service. We all know that we can get help with our health needs without making any extra payments. So, you must look at the pros and cons to decide if private medical insurance is worthwhile:

What Are the Pro’s of Private Medical Insurance?

There are some great benefits to paying for private medical insurance, even with NHS cover that you might use more often:

Private Medical Insurance Provides Fast Access

Private medical insurance can give you faster access to a diagnosis or treatment. NHS waiting lists can be long, and the NHS is under pressure. With private cover, you can skip the queues if you feel like you’ll be on them for too long.

Private Medical Insurance Provides Private Facilities

Just like private schools have better facilities than most state schools in the UK, thanks to the money they receive from fee-paying parents, private hospitals are often more luxurious than their NHS counterparts. If you’re expecting a long hospital stay, you might want it in more comfortable surroundings. You may be able to pay for an en-suite private room instead of being kept in a ward.

Private Medical Insurance Provides Treatment Time Options

With private medical insurance, you’ll have more control over when your treatment takes place. You might be given a better choice of appointment times and dates.

Private Medical Insurance Provides a Choice of Treatments

You might have access to treatments that aren’t available on the NHS. Often, private healthcare covers complementary therapies and a wider range of cancer treatments. Instead of having the NHS dictating what treatments you’ll receive, you may be able to have more of a say and contribute to your treatment plan. You may be able to choose where you are treated and even which surgeon will operate on you if any surgery is needed.

Private Medical Insurance Provides Specialist Referrals

If you’re unhappy with someone’s medical opinion, you’ll be within your rights to request a referral to an additional specialist. You can get a second opinion, covered by your medical insurance.

What Are the Con’s of Private Medical Insurance?

There are some drawbacks to private medical insurance, which you’ll want to consider:

Private Medical Insurance Comes at an Additional Cost

Everyone pays for the NHS through their taxes and National Insurance, but private medical insurance is an optional extra and comes at an additional cost. Average premiums for private healthcare are around £1,500 per year. Not everyone has that money spare, and many would say that there are more important things to spend money on than luxury healthcare. In the UK, we’re lucky to all have access to excellent NHS healthcare, so it may not be easy to make the decision to spend your hard-earned money on health cover.

Private Medical Insurance Doesn’t Cover Pre-Existing or Chronic Conditions

Typically, private healthcare will not cover any pre-existing conditions. If you already have a health condition, it’s likely that these will be excluded from any insurance you can get. Chronic conditions might also be excluded from your health insurance cover.

Private Medical Insurance Premiums Rise With Age

Once you’ve started paying for private medical insurance, you might not want to give it up. Yet, as you age, you’re at higher risk of ending up with an illness or an injury. Premiums will rise in line with the risk, so committing to medical cover long-term means accepting those ever-rising prices.

Private Medical Insurance Can Be Less Local

You might be lucky enough to have the perfect private hospital nearby, but often accessing private treatment means you’ll need to travel further afield. You may also be required to travel a lot more for the specialist treatments you need. If you want the option to choose exactly which hospital you’d like to be placed in, there’s usually an option to add this to your policy for an additional price.

What Are the Benefits of Private Medical Insurance?

Private medical insurance has many benefits for those that choose to pay for it. You can benefit from choices and facilities that NHS patients can’t access.

Benefits of Private Medical Insurance

With private medical insurance, you’ll be able to choose where you’re treated and who you’re treated by. You may have access to a wider range of treatments and quicker access than you’d otherwise get.

Private healthcare cover might give you better access to specialists. You could also spend your time in private hospitals or in private en-suite rooms in any NHS facilities. Some insurance providers even offer a 24/7 advice line, so help is only ever a phone call away.

Even if you have private medical insurance, you can still use the NHS. You’re not forced to claim on your medical insurance, and some providers might even give you a cash payment if you choose to use NHS services.

Benefits of Using the NHS

Whilst private medical insurance has many benefits; the NHS also has its plus points. Aside from prescription costs, NHS treatment is free at the point of delivery. If you find a lump, you can get the scans you need to diagnose cancer. Then, you can get all the treatment you need as well as any ongoing check-ups. NHS services are available to everyone, paid for by taxes and NI. Sometimes, NHS treatment can be just as good as – or better than – the care you’d get if you went private.

What Does Private Medical Insurance Cover?

There’s no ‘one size fits all’ for private medical insurance, and every policy is different. Before choosing private healthcare, find out exactly what’s covered and how much you’re covered for.

Roughly speaking, the more you pay, the more comprehensive your cover, but sometimes the cheaper premiums turn out to be for the most suitable policies.

Look out for private medical insurance policies with some of the following features. Most providers offer quick comparison tables, but you’ll need to look into the terms and conditions to see exactly what cover you’ll be getting:

Does Private Medical Insurance Cover Surgery?

Private medical insurance can cover many different types of surgery. You might use your cover for cancer surgery, cataract surgery, and even emergency dentistry. Your insurance might cover your hospital stay, including private hospital costs, both before your surgery and whilst you’re recovering from it. Some providers may cover cosmetic surgeries, or subsidize the costs, though these are less common additions to health insurance policies.

Does Private Medical Insurance Cover Dental Work?

Private medical insurance won’t usually cover the costs of check-ups and treatments. For these, you can buy private dental insurance instead. Your medical cover might, however, fund certain types of oral surgery. Your insurance may cover the costs of removing wisdom teeth, removing cysts, or providing dental surgery after an accident.

Does Private Medical Insurance Cover Scans and Tests?

If you need or want any scans or tests, then your medical insurance might cover them. These could include any x-rays or medical exams. Sometimes, NHS staff won’t approve scans that they don’t feel will be helpful. If you believe that a test should be run, but the NHS won’t approve it, you’ll have the option to use your medical insurance for diagnostic tests and scans of your choice.

Does Private Medical Insurance Cover Therapy?

Your medical insurance might cover therapies and a range of mental health treatments. Usually, policies cover a specific number of appointments per year. Things like counseling and CBT might be covered as standard, whilst paying higher premiums could give you access to things like acupuncture, homeopathy, and consultations with psychiatrists and psychologists. Some cover will even help with addictions like alcohol and drug addictions. For the physical side, treatments like physiotherapy are often covered.

Does Private Medical Insurance Cover Cancer?

Whilst existing cancer might not be covered and may be excluded from your policy if you develop cancer whilst you’re paying for cover, you should get diagnosis and treatment. Cancer cover might include a wide range of potential cancer treatments, including those that might not be available on the NHS. If you’ve lost your hair as a result of cancer treatment, your private insurance could fund a wig. You may also get cover for cancer screenings and end-of-life nursing home care if the worst should happen.

Does Private Medical Insurance Cover GP Appointments?

Many people choose to use the NHS for GP appointments they require. Often, this is a quick and easy first step that won’t require any private funds. If you’d prefer, your private cover might include GP consultations. You may be able to access video appointments available at very short notice.

Does Private Medical Insurance Cover Rehabilitation?

Your insurance might cover rehabilitation after a stroke or brain injury or if you’ve suffered a long-term illness and need help getting back on your feet. Usually, you’ll be funded for a limited number of days.

Does Private Medical Insurance Cover Pregnancy?

Not all private medical policies cover pregnancy costs, but if yours does, then you may get funds for outpatient and inpatient treatments. You might also receive a one-off cash payment after the birth of your child, which could give you a nice little boost to buy something nice for the baby.

Does Private Medical Insurance Cover Parent Accommodation?

If you have a family policy and your child needs treatment, your policy might cover accommodation for the child’s parents or guardians. Accommodation cover could pay what you need to stay very close to the hospital.

Does Private Medical Insurance Cover Weight Loss?

Some private medical insurance policies will cover gastric bypass surgery and other weight loss treatments to help you reach a healthier weight.

Private Medical Insurance and NHS Cash Benefits

If you pay for your insurance but choose NHS treatment, your insurer is going to save money. Some will share these savings with you, so you’ll get a cash payment if you decide that you’re happy just to use the NHS.

When Does Private Medical Insurance Payout?

You’ll need to be prepared to pay up-front for private medical costs. Often, instead of paying up-front in full, you may need to pay an ‘excess.’ Once you’ve paid the excess, the insurer should pay the rest of the money to the clinic or hospital directly. Any excess will be mentioned in the terms and conditions of your insurance policy.

Insurance pay-outs might be delayed if you’ve opted for moratorium underwriting. Here, instead of providing your medical history up-front, you only need to provide your history if you want to claim on the insurance.

What Is the Process for a Private Medical Insurance Pay-Out?

If you want to claim on private medical insurance, the process is roughly the same no matter who you’re insured with.

Once you’ve made the decision to opt for private treatment, your next step is to contact your insurer. Your insurer will take details of your situation and will guide you through your next steps. You may be required to pay an excess or up-front payment. Your insurer will tell you what excess is due and who exactly you should be paying. Once your treatment is complete, your insurer will pay the rest of the money directly.

Before you’re treated, the person that’s treating you will want to know how costs are being covered. There may be a delay whilst you wait for an insurance pay-out to be fully approved.

If you’ve chosen a policy with full underwriting, you’ll have provided your medical history up-front, and this will streamline the pay-out process. You’ll know which conditions are covered and which are excluded. This option is usually more difficult and time-consuming in the first instance, but a lot less effort once the cover’s in place and much easier if you need to claim.

If you’ve chosen a policy with moratorium underwriting, your insurance provider won’t have details of your medical history. It’s quick and easy to set up this type of policy, but when you need to claim, there’s more paperwork that needs to be dealt with. You might find that your insurer decides that they cannot pay out for a condition, and they might need additional proof before they can payout for your treatment.

What Are the Private Medical Insurance Pay-Out Values?

Insurance pay-outs will depend on your provider and your chosen policy. All the details will be available when you sign up for insurance. You may be able to lower your premiums by choosing to have lower cover, but this could leave you with additional costs if your treatment ends up being expensive.

You might choose to be covered for a specific amount of diagnosis or treatment costs per year or to choose full coverage, which is unlimited but much more expensive.

With a basic policy, you might receive £500-£1,000 of annual cover for certain types of treatment. If you don’t want limits, look for full cover instead.

How Long Does It Take for Private Medical Insurance to Payout?

Typically, private medical insurance claims will be finalized and paid out very quickly. Usually, minor things like GP visits will payout in less than seven days. For hospital stays and surgeries, insurers might take up to 14 days to payout.

Sometimes, further information may be needed before payments can be approved. This is especially likely if you chose moratorium underwriting. If further details are needed, there might be a delay whilst the insurer gets the details they need.

Private Medical Insurance Severe and Minor Pay-Outs

If you have full cover, your pay-out will cover all the costs that you’ll be accruing. If you’ve chosen a policy with pay-out limits, the amount you receive might be restricted. You may need to skip the private treatment or cover the extra costs yourself.

Private Medical Insurance Severe Pay-Outs

If you need surgery or you’re diagnosed with cancer, you’ll want to know that your policy will cover your ongoing costs and expenses. More severe situations aren’t usually covered by the cheapest and most basic of policies, or they’ll be covered, but with financial limits, that could mean you’ll have a big bill of your own.

Before you choose a private health insurance policy, check what limits are in place. Some limits are financial (like cover of £1,000 per year for outpatient appointments), whilst other limits might be time-restricted (like cover for up to 14 days in a private hospital).

Private Medical Insurance Minor Pay-Outs

Most private medical insurance will offer coverage for minor costs like GP appointments, scans, check-ups, and basic therapies. There might still be financial limits, or time restrictions, in place. Your policy terms and conditions will explain how much insurance coverage you’re getting and will mention any exclusions that might stop you from making a claim.

How Much Does Private Medical Insurance Cost?

The average cost of private medical insurance is around £1,500 in annual premiums. Joint policies might be £500 to £1,000 more expensive per year.

You’ll want to get a personalized quote for private medical insurance. Pre-existing conditions, including obesity, will raise the cost of most policies. Private medical insurance costs more as you age, as you’re at increased risk of injury and illness, and you might also pay more if your job makes you more of a risk.

Your private medical insurance could cost as little as £35 per month if you’re young and healthy. However, for a policy with premiums this low, you’ll need to expect some restrictions. Check your policy documents carefully to see what you’re getting for your money.

Can You Get Private Medical Insurance if You Have Pre-Existing Conditions?

You can still get private medical insurance if you have a pre-existing condition, but your insurer will usually exclude it from your policy. If your illness or injury is found to be linked to any existing condition, your insurer might not pay out for the treatment you need. You might still want cover for any future health conditions you might develop.

Can You Get Private Medical Insurance for the Family?

There are different ways to get private medical insurance. You’ll likely choose between an Individual, Joint, or Family private medical insurance policy.

It’s often cheaper to get Joint medical insurance than to pay separately for two individuals. Children can usually be added to policies without raising the premiums too much.

If you’re choosing a Family health insurance policy, check any restrictions very carefully. In most cases, you’ll need to be a parent of a child that’s under the age of 18 (or perhaps, at a push, 21). It’s very unlikely that a Family policy will cover a mum, a dad, and their two adult children.

Do you need individual Private Medical Insurance for each family member?

It’s usually better to choose a Joint or Family policy than to pay individually for each different member of your family.

Policies specifically for children are unusual, and even when available, they have a lot of restrictions, so it’s usually best to choose the Family cover and get everyone included in one policy.

For a couple without children, a Joint insurance policy could save some money when compared to Individual insurance.

If several people are included in one policy, you’ll need to make sure that you’ve provided the details of everyone that’s going to be covered. Insurers need to know about every customer and may need medical records from each different person.

Do You Pay Tax on Private Medical Insurance?

Whilst medical insurance provided by your employer is subject to tax as a ‘benefit in kind,’ the same doesn’t apply to private policies. You won’t pay tax on your private medical insurance.

Can You Get Private Medical Insurance if You’ve Survived Cancer Previously?

If you’re a cancer survivor, you’ll still be able to get private medical insurance. Your cancer will typically be classed as a pre-existing condition, even if you’re in remission, so you’re unlikely to be covered for the same condition in the future. Being a cancer survivor is likely to raise your insurance quotes and premiums, so be prepared to pay more than another healthy individual your age.

Is There an Age Limit for Private Medical Insurance Cover?

There’s no specific age limit for private medical insurance, though each provider will have their own policies and rules. Typically, they’ll stop customers from taking out new policies somewhere between the ages of 65 and 80. If you’re over 80, it’s extremely unlikely that you’ll be offered private medical insurance.

Private Medical Insurance Benefits for the Over 30s

As a relatively young adult, you can get private medical insurance at a fairly low price. Your premiums might total less than £1,000 per year, including full coverage. Though you’d hope at your age that you’ll stay in good health, it can be reassuring to have private health cover in place in case it’s ever needed.

Private Medical Insurance Benefits for the Over 40s

If you're over 40, private medical insurance could still be an affordable option. At this point, any general policy should still suit your needs. Some providers offer Over 50s policies, which are something to look into as you age, but premiums shouldn't be too high even if you choose a standard provider.

When you're over the age of 40, you may start to visit your GP a bit more. You might be very happy with NHS services, but many people decide at this point that they'd like to pay for private insurance. People in this age bracket often have a little extra money available, choosing to spend it on ensuring their good health instead of on more frivolous purchases.

Private Medical Insurance Benefits for the Over 60s

When you're over the age of 60, you'll be considered to be in the older age bracket. Private medical insurance might be much more expensive, but you're also more likely to want it. At this point in your life, you're likely to be noticing more reasons to visit your GP. Having private insurance can help you to get quick access to diagnosis and treatment, as well as comfortable rooms in private hospitals if you ever need to visit them.

Private Medical Insurance Benefits for the Over 70s

Those in the Over 70s age bracket will pay the most for private medical insurance. Some insurers might not be happy to take you on as a new customer, though others will still over medical coverage at an inflated price. Though the premiums are high, having private health cover can be very reassuring at this age.

You'll know that you can get a diagnosis and treatment without NHS waiting lists, and you may get cover for additional conditions like cataracts and other eye problems. Even over the age of 70, there are ways to decrease your insurance costs. You might set a minimum wait before you can ask for private treatment or could increase your excess if you've got spare money available.

Does My Private Medical Insurance Cover International Travel?

Most standard private medical insurance will not cover overseas travel. If you're planning to travel as a one-off event, you'll want to get travel insurance with medical coverage.

You can pay a premium for medical insurance that includes international travel, and you might want to choose this if you frequently travel for leisure or for business purposes.

Typically, international travel is something to add to your cover. It usually isn't something a provider will offer as standard with your policy. Even still, you may be limited to international cover for a certain number of days. If you pay extra for international cover, there's usually quite a high financial limit to cover emergency expenses.

If you want international cover, look out for terms like 'Global,' 'International' and 'Worldwide' in the names of private medical products.

Can You Buy an Extension or Bolt-On To Cover International Travel?

Most insurance providers will offer a bolt-on to cover international travel. Though overseas medical treatment's not included as standard, you can choose to pay a bit more if you'd like to be covered abroad.

International cover can be added for a full policy year, so you’ll need to think about adding this cover at the start or on your renewal date. You’re unlikely to be able to temporarily add cover for one or two holidays per year, so be prepared for your insurance premiums to increase for the full 12 months.

What Happens if I Get Sick Abroad? Am I Covered by My Private Medical Insurance?

If you’re covered for international medical emergencies, and you become sick when you’re abroad, your insurance provider should cover your expenses in the same way that they would in the UK.

Just like in the UK, you’ll be covered to access the best available medical facilities in the country that you’re visiting. You (or your representative) can contact your insurer to connect them with the hospital you’re in. Your insurer should then take care of everything, paying your bills on your behalf, so you don’t need to worry.

As in the UK, you’ll be able to choose where you’re treated and who you’re treated by, and your insurance provider is likely to have a 24/7 phone helpline.

How Can Money Savings Advice Help You With Private Medical Insurance?

Here at Money Savings Advice, we have partnered with some of the UK’s leading Private Medical Insurance companies. They have already helped thousands of people get the best private medical insurance cover, and, they can do the same for you.

Choosing an independent adviser means they won’t recommend a policy unless they are sure it is in your best interests. Their advice is also regulated by the FCA, which gives you an additional layer of protection.

If you would like to speak to one of these brokers, then click on the below and answer the very simple questions.

Money Savings Advice Author Ian Lewis

Ian Lewis

Ian Lewis is one of our specialist financial writers. Ian has over 15 years of financial writing experience, having worked for some of the largest financial publications in the UK covering topics from mortgages, equity release, loans and financial claims, to name a few.

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