Private health insurance

Why private health insurance is on more UK minds

Private health insurance pays for private diagnosis and treatment for acute, short-term conditions. It sits alongside the NHS, not instead of it. Many people use it to access faster consultations, scans, and procedures, especially when waiting times are long. In Great Britain, NHS waiting lists reached about 7.42 million in March 2025, which is over 3 million higher than before the pandemic. That pressure has reshaped how people think about care.

Today, around 14% of UK adults hold Private Medical Insurance. Uptake is not evenly spread. London has higher coverage, with roughly a fifth of adults insured, while some regions such as Northern Ireland have far lower levels. One in seven Britons used private healthcare in the past year, with speed the main reason and a median spend of about £500 among users. Employers are also a key driver, with many policies offered through workplace schemes that open access to a wider range of households.

The market has grown strongly in 2024 and 2025, with more people choosing cover for quicker access, predictable costs, and more personalised appointments. Insured admissions to private hospitals have edged up while self-pay has eased slightly, suggesting a shift towards insurance as the funding route. Healthcare cash plans, which reimburse everyday costs like dental or optical, have also grown.

You should expect private insurance to help with speed and choice, not blanket coverage for everything. Pre-existing conditions, chronic illnesses, and routine pregnancy are often excluded. This guide walks through benefits, limits, costs, and how claims work so you can decide calmly and confidently.

Insurance can help with access and certainty - not guarantee outcomes.

What is covered and how it works

Most policies cover consultations, diagnostics such as MRI or CT scans, and treatment for acute conditions - those that respond to active treatment and aim to return you to your previous health. In-patient and day-patient procedures are usually included. Out-patient care may be included in full, capped, or excluded depending on your plan. Cancer cover varies - some policies include comprehensive drugs and therapies, others limit to those approved for NHS use, and some require an upgrade.

Exclusions are important. Long-term or chronic conditions often fall outside standard policies, as do routine pregnancy, cosmetic procedures, and treatments considered experimental or unproven. Pre-existing conditions might be excluded depending on underwriting. Many policies use either moratorium underwriting - where recent conditions are temporarily excluded - or full medical underwriting, where you disclose history and receive firm decisions upfront.

Claims are straightforward. You typically contact your insurer before booking, provide your GP referral if required, and obtain authorisation. The insurer confirms which specialists and hospitals are covered, and what excess you must pay. The provider then bills the insurer directly, and you settle any excess. Example: you feel persistent knee pain, your GP refers you, you get authorisation, see a consultant, have an MRI, receive a day-case arthroscopy, and return to normal activity - with claim costs settled by the insurer according to your policy limits.

Who might benefit

Private health insurance can be helpful if you want faster access to diagnosis and treatment, choice of hospital or consultant, and more flexible appointment times. It can be particularly valued by working-age adults who need to minimise time away from work, and by families balancing childcare and employment. Many employers include cover to support wellbeing and reduce absence.

If you live in areas with longer NHS waits or limited local specialist capacity, insurance can provide a practical alternative path. It may be less necessary if you are comfortable with NHS waiting times, have straightforward needs, or if exclusions mean little of your likely care would be covered. Always weigh the premium against your budget and health priorities.

Types of cover and add-ons

1. Basic - Core in-patient and day-patient care

   • Covers hospital treatment and surgery after diagnosis.
   • Often excludes or caps out-patient tests and consultations.
   • Lower premiums, higher reliance on the NHS for diagnostics.

2. Standard - Balanced out-patient and in-patient benefits

   • Includes consultations and diagnostics, usually with an annual out-patient cap.
   • Access to a defined hospital list and network specialists.
   • Good balance for many budgets and needs.

3. Comprehensive - Extensive out-patient and in-patient cover

   • Higher or unlimited out-patient limits and broader hospital choices.
   • Often includes therapies such as physiotherapy after surgery.
   • Higher premiums and wider clinical flexibility.

4. Cancer care options

   • Ranges from NHS-aligned drugs only to comprehensive drugs and therapies.
   • Some include home chemo or specialist nurse support.
   • Check limits on experimental or unlicensed treatments.

5. Mental health add-ons

   • Out-patient counselling, psychiatry, and in some cases in-patient care.
   • Limits, pre-authorisation, and specialist networks commonly apply.

6. Therapies and diagnostics upgrades

   • Additional physiotherapy, osteopathy, or chiropractic sessions.
   • Enhanced imaging and specialist consultations with higher caps.

7. Hospital list and excess choices

   • Tiers for hospital networks influence price and location options.
   • Choosing a higher excess can reduce the premium.

What it costs and what shapes your premium

Typical private health insurance costs vary. The table shows broad patterns only - not quotes.

Costs vary with market conditions. Recently, insured admissions have risen slightly while self-pay has eased, and premiums may reflect changing demand and hospital fees. Always compare multiple quotes and check what is included before focusing on price.

Can you apply - eligibility in plain English

Most UK residents can apply, subject to age limits and underwriting. Insurers usually require your address, identity, and medical history. Underwriting may be moratorium - where recent conditions are temporarily excluded and can be reconsidered after a symptom-free period - or full medical underwriting, where you disclose your history and receive decisions on what is covered from day one.

Common reasons for decline or exclusions include ongoing investigations, recent serious diagnoses, or conditions requiring frequent treatment. Policies typically exclude routine pregnancy and long-term management of chronic conditions. If you have employer cover, eligibility follows your scheme rules. Students and dependants may be added, often with different pricing. Always read eligibility notes carefully before applying.

From quote to claim - simple steps

1. Gather medical history and agree your budget range.
2. Choose cover level, hospital list, and preferred excess.
3. Request quotes from multiple insurers for fair comparisons.
4. Check inclusions, exclusions, and out-patient limits carefully.
5. Complete underwriting - moratorium or full medical disclosure.
6. Activate your policy and receive membership and authorisation details.
7. For treatment, obtain GP referral and pre-authorisation before booking.
8. Pay any excess and keep records for renewal and claims.

Weighing it up

Aim for the right level of cover - not simply the most or least.

Before you buy - key checks

Take time to read the policy schedule and key facts. Confirm your excess, out-patient limits, and hospital list. Look for any waiting periods before certain benefits start. Check how cancer drugs and therapies are handled, plus any caps on diagnostics and physiotherapy. Understand authorisation steps, referral requirements, and whether a GP referral is needed for each claim. At renewal, prices can change due to age, claims, and medical inflation, so budget for potential increases. Keep your medical declarations accurate and up to date - non-disclosure can invalidate cover.

Alternatives you might consider

1. Healthcare cash plans - Reimburse routine dental, optical, and therapy costs. Useful for predictable expenses and lower budgets.
2. Self-pay packages - Fixed-price private procedures without insurance. Suitable for one-off treatments when you know the likely cost.
3. Critical illness cover - A lump sum on diagnosis of specified serious conditions. Supports finances rather than paying medical bills.
4. Income protection - Replaces a portion of income if illness stops you working. Complements NHS and private treatment by covering living costs.
5. NHS services and private GP pay-as-you-go - For those prioritising occasional speed without ongoing premiums.

FAQs

Q: Does private insurance cover pre-existing conditions? A: Often not as standard. With moratorium underwriting, recent conditions can be excluded initially. With full medical underwriting, the insurer confirms which conditions are covered or excluded from the start.

Q: Can I use the NHS and private healthcare together? A: Yes. Many people use the NHS for emergencies and chronic care, and private insurance for faster diagnostics and elective procedures. Your GP can refer you into either route as appropriate.

Q: Is cancer treatment fully covered? A: It depends on your policy. Some include comprehensive cancer drugs and therapies, others limit to approved treatments or apply caps. Always examine the cancer care section closely before buying.

Q: Are premiums cheaper through work? A: Employer schemes can be more affordable due to group pricing and company contributions. Benefits and excesses vary by employer, and cover usually ends when employment ends.

Q: What if I live outside major cities? A: Access and pricing can vary by region. Hospital networks may be narrower in some areas, which can lower cost but reduce choice. Confirm your nearest covered hospitals before you apply.

What to do next

If private health insurance feels suitable, compare a few providers on the same cover level, hospital list, and excess. Read the key facts, check exclusions, and only proceed when you understand the limits and authorisation steps. Take your time - the right policy is the one that fits your budget, health needs, and expectations.

Important

This guide is general information, not personal advice. Policy terms vary by insurer. Always read the policy documents, key facts, and exclusions, and consider speaking to a regulated adviser if you need personalised guidance.