What is private health insurance and is it worth getting?
A guide covering the costs of private health insurance in the UK, and what conditions it will and won't cover.
Private health insurance can cover many of the costs incurred by a loved ill getting ill or injured.
But with some insurance schemes coming at a premium, are they cost-effective and should you get covered?
As if anyone needed reminding, the NHS offers excellent care for people across the UK. But private healthcare providers are also available, and some people choose to use these in certain circumstances.
However, the cost of these services can be very high. Private health insurance is a way of spreading these expenses over time, so that if you do choose to ‘go private’, it doesn’t break the bank.
Here’s how private medical cover works, how much it typically costs, and what it does and does not cover.
Summary
- Private health insurance typically covers a range of acute conditions, but not chronic conditions
- The average yearly premium on private health insurance is around £1,500
- There are ways to bring the cost of private medical insurance down
- You don’t need private medical insurance to lead a healthy life but it does carry several benefits
What is private health insurance and how does it work?
Private health insurance typically covers a range of acute conditions (i.e. conditions that come on suddenly and have a limited term of treatment), but not chronic conditions (i.e. conditions like diabetes that you may live with all or much of your life).
If you need treatment for a new health problem, your insurance can cover the cost of getting private treatment, which can sometimes be thousands of pounds.
Private health insurance also doesn’t cover you for a pre-existing condition.
Broadly, medical insurance works in much the same way as other insurance policies.
You pay a monthly premium (sometimes annually or quarterly) and claim on your insurance if you need treatment.
Each time you claim, you’ll pay a small excess while your insurer covers most of your medical bill. The excess can be anything from £0 to £500.
You can get private health insurance to cover just you or other members of your family.
How much does private health insurance cost on average?
The average yearly premium on private health insurance is around £1,500.
This works out at about £125 a month, but lots of people pay much less.
The amount you pay depends on your insurer, what’s covered on your policy and your own circumstances and current state of health.
Insurers may offer you cheaper premiums if you’re less likely to become unwell and need to claim for treatment.
Here are some of the factors that affect the cost of private health insurance:
- Who’s covered – There are policies to cover individuals, families or couples, and this will affect the price. Depending on the circumstances of each person, it may work out cheaper to have one policy or to keep several distinct policies.
- Your age – The older you are, the more likely you are to claim on your insurance, making the premiums more expensive. The same happens with life insurance premiums.
- Your medical history – Private health insurance doesn’t usually cover pre-existing conditions, but any conditions you have may suggest you’re at risk of developing further problems. This could make your premiums increase.
- Your family history – If family members have suffered from serious conditions, this could indicate that you are likely to as well, which can make insurance more expensive for you.
- Your lifestyle – Factors like smoking, drinking and your weight can all affect the price you pay.
- Where you live – It seems unfair, but some areas of the country are linked to certain medical conditions and others carry a higher price tag for private treatment. Something as apparently trivial as your postcode might mean private medical insurance is more expensive.
How can I reduce the cost of private health insurance?
There are ways to bring the cost of private medical insurance down, no matter your circumstances.
These include:
- Adding a waiting period – Opting for the waiting period means that if you can be treated through the NHS within six weeks, you won’t be covered for private treatment. As soon as the NHS waiting list goes over the six-week period, you can go private and claim on your insurance.
- Limit the hospitals – You may be able to bring down the cost of your insurance by limiting the number of hospitals and surgeries available to you.
- Choose a higher excess – You have to pay an excess when you need to claim, unless you’ve selected the £0 option. Agreeing to pay a higher excess can bring down the cost of your premiums. However, facing a higher excess may put you off claiming on your insurance, which can make your policy unsuitable for your needs.
- Having a no-claims discount – If you haven’t had to claim on your insurance for a certain length of time, you could get a discount – much like you do for car insurance.
- Living in a ‘healthy’ postcode – As mentioned above, health insurance can be cheaper in some places than others, so you could bear this in mind when buying a home.
Does the cost of private medical insurance go up?
Generally the cost of your healthcare premiums will go up as you age, and will also increase with inflation.
They may also rise if you’ve had to claim recently. But if you’ve made lifestyle changes, such as you’re now in a healthy weight and stopped smoking, you may be able to get a cheaper quote.
Some people find simply switching provider brings down their premium.
What does UK private medical insurance cover?
Insurers will offer different plans, which can fall into basic, mid-range and comprehensive categories, though they may have different names for them.
The table shows what’s generally covered on each type of policy.
| Type of cover | What’s usually covered | There may be limits on: |
|---|---|---|
| Basic | In-patient treatment (when you stay in hospital) | Ambulance transport Home nursing Types of treatment and the hospitals you can choose The number of treatments you can have in one year Diagnostic tests – you will normally be diagnosed by the NHS |
| Mid-range | Inpatient treatment Outpatient treatment (where you don’t need to stay overnight) Consultation appointments, diagnostic tests, and services like physiotherapy and sometimes psychiatry | The number of treatments you can have in a year, though usually more than basic policies Ambulance transport Home nursing Hospitals you can use |
| Comprehensive | Inpatient and outpatient treatment Home nursing Private ambulance A parent staying in hospital with a child (depending on the policy) Dental treatment Alternative medicine May cover whole family, rather than an individual |
As you would with other insurance policies, you can often choose various add-ons, though each addition will usually add a few pounds to your monthly premium.
Here are the common add-ons people opt for:
- Dental
- Optical
- Psychiatric
- Physiotherapy
- Medical treatment and care at home
- A private room when you stay in hospital
- Specific illnesses – but do check with your insurer. Cancer treatment, for example, is now covered by most standard policies, but some may still exclude it (or some types of it).
What is not covered by private medical insurance in the UK?
Some conditions and treatments are rarely covered by private health insurance, including most pre-existing medical conditions.
These include:
- Chronic conditions – Ongoing treatment for incurable illnesses like HIV, diabetes and some cancers aren’t included.
- Emergency treatment – These services are mostly provided by the NHS.
- Elective treatment – These are treatments you don’t necessarily need but want, such as cosmetic surgery.
- Treatments required by some lifestyle factors – Such as drug and alcohol rehabilitation services.
- Treatment abroad – If it’s an emergency, this should be covered by your travel insurance. You may be able to get specialist insurance if you want to have treatment overseas.
- Pregnancy care – You will normally need to pay extra for care during pregnancy, though some unexpected complications may be covered.
What is the typical cost of the most popular private medical procedures?
Private medical care is certainly not cheap – hence the need for insurance if you’re not using the NHS.
To give you an idea on costs, here are some ballpark figures for common treatments carried out privately.
| Type of treatment | Approx cost |
|---|---|
| Knee or hip replacement surgery | £10,000 to £15,000 |
| Hernia repair | £2,500 |
| Having a pacemaker fitted | £5,000 |
| Wisdom tooth removal | £2,000 |
| Cataract surgery (one eye) | £2,500 |
| Gall bladder removal | £6,000 |
| Cancer treatment – chemotherapy | £30,000 |
What are the top providers of health insurance in the UK?
1. Aviva
Currently the most popular insurance provider in the UK, Aviva has won plenty of awards over the years for the quality of its insurance policies.
Amongst Aviva’s most popular insurance policies, the company offers full health coverage across a range of hospitals in the UK, speedy diagnosis, child health solutions as well as a cash plan policy that covers some of the day-to-day healthcare costs over a year.
Trustpilot rating: 4.7
2. AXA
Another one of the leading private health insurance companies, AXA PPP Healthcare offers healthcare coverage from flexible personal health cover with a range of add-ons to suit your requirements, CashBack plans that cover some of your daily healthcare expenses and health and wellbeing solutions.
Trustpilot rating: 3.8
3. Bupa
Bupa is a not-for-profit provider of health insurance. Thanks to this business model, the company always looks to reinvest its profits back into healthcare coverage. With no shareholders, Bupa focuses its service on its customers.
You can find insurance policies such as Bupa By You, which allows individuals to build the perfect health plan to suit their own needs.
Users who choose Bupa Comprehensive have their medical and diagnosis costs covered, while Treatment and Care allows individuals to get diagnosed on the NHS, and receive treatment privately. Bupa also has a cancer promise and is always evolving its insurance schemes to make the best possible prices.
Trustpilot rating: 4.4
4. Vitality
Vitality is an innovative healthcare provider that uses behavioural economics to encourage individuals to practice healthier lifestyles, and rewards them for doing so.
Amongst its policies, Vitality offers core coverage that can be tailored to your needs, full cancer cover and a wide range of optional extras, such as physiotherapy cover, psychiatric cover and worldwide travel cover.
Trustpilot rating: 4.2
5. General and Medical healthcare
General and Medical offer individuals different tiers of coverage, with plenty of flexibility and add-ons as you see fit.
Scaling up from the essentials level of coverage to the elite level, individuals can make the most of the right amount of coverage that they need. General and Medical also includes cancer coverage as part of the everyday package.
Trustpilot rating: 4.2
Do I need private medical insurance and should I get it?
Having private treatment is considered a luxury by many.
Because the NHS offers fantastic levels of care and treatment, you don’t need private medical insurance to lead a healthy life with access to medical support.
However, some people prefer to go through private healthcare services to jump ahead of NHS waiting lists, and perhaps to have more flexibiliy over their treatment, such as receiving care at home.
When you consider the costs of paying for each private treatment, you might prefer to have insurance in place to help pay your bills.
:quality(20))