Is Private Medical Insurance Worth It in the UK?

It’s no secret today that the NHS is under significant pressure. With long waiting times hitting the headlines and patients increasingly facing longer delays for routine appointments, people are starting to look beyond the NHS and ask what is Private Medical Insurance and how does it work in practice?

For those who are worried about taking time off work due to medical concerns, managing ongoing discomfort, or are anxious about available treatment times, then private medical insurance could be the solution you’re looking for.

But is private healthcare worth it?

In this article, we take a comprehensive look at exactly what private health insurance offers, how private care can work alongside the NHS, and who could best benefit from private medical insurance. Let’s begin.

What Is Private Medical Insurance and How Does It Work in the UK?

Private medical insurance (PMI) is a specialist type of health insurance that can cover the cost of private medical treatment for short-term illnesses, injuries, and certain medical conditions. In the UK, PMI is often used alongside the NHS and can help provide patients with faster access to consultations, tests, and procedures that might take longer on public healthcare.

So, how does PMI work?

When you have a Private Medical Insurance policy in place, then all you have to do is contact your insurance provider whenever a medical concern arises. Your insurer will confirm what is covered and approve the appointment, helping you schedule scans, tests, or procedures much sooner than waiting through NHS queues.

Once the appointment is booked, the insurer usually handles the billing directly with the hospital or clinic for covered treatment, meaning you typically don’t need to pay upfront. Some policies may require payment first for certain services, so it’s important to check the details of your plan.

Let’s look at an example in practice:

Imagine you have persistent knee pain. With the NHS, you might start with a visit to your local GP, then be submitted for a referral, potentially then waiting weeks or months for a specialist appointment and imaging.

With a PMI policy, you could simply contact your insurer as soon as the problem arises, book a private consultation directly, and schedule an MRI within days. Your chosen consultant can guide you through treatment, and the insurer takes care of the costs, reducing delays and giving you more certainty about your care.

In short: Private medical insurance can provide faster access to appointments and greater control over your healthcare, while keeping the NHS as a safety net for emergencies and ongoing treatment.

What is crucial to note is how a private medical insurance policy can be tailored to suit your needs. Some policies may focus solely on inpatient care, while others include outpatient appointments, diagnostic tests, or mental health support. You can often adjust the level of cover, choose preferred hospitals, and select optional extras, making the policy flexible to your lifestyle, medical history, and budget.

What Are the Pros and Cons of Private Medical Insurance in the UK?

There are a host of benefits that having a private medical insurance policy can offer, including quicker access to appointments and more control with the freedom to choose your consultant or hospital. However, it’s important to understand that not all PMI coverage is equal, with some policies being limited depending on the level of cover you choose.

To help provide you with a key understanding, let’s review some of the main pros and cons of private medical insurance:

Pros of Private Medical Insurance

• Fast Access to Healthcare When You Need

Your health is everything and when you’re unwell and need medical care, being able to get care without long waits can make a huge difference.

Securing private medical insurance can help provide you access to arrange appointments, scans, and treatments much sooner than NHS waiting times. This can help reduce stress, which can affect your condition and recovery, and help ensure that you get the care you need without long delays.

• Flexibility

With private medical cover, policies will often give you the freedom to choose your consultant, hospital, and even appointment times. This feature brings your health into a practical life as you can schedule treatment around work, family commitments, or other responsibilities, helping you manage both your personal finances and your time.

Being able to have control over when and where you are seen can help reduce stress and make it easier to balance healthcare with your daily life.

• Tailored Policies for Bespoke Services

Private medical insurance can also be customised to your specific needs, allowing you to choose the level of cover, add optional extras, or focus on particular areas of care.

Ultimately, PMI can go beyond simple inpatient care, covering outpatient appointments, mental health support, and diagnostic tests that might take longer on the NHS.

• Complete Peace of Mind

Finally, private medical insurance provides the comfort of knowing that, should a health problem arise, you’ll have quick access to medical care when you need it. Whether it’s a sudden illness or an elective treatment, having PMI can provide you with the cover and confidence that you’ll receive quality care that you can rely on.

Cons of Private Medical Insurance

• Cost

The total price of private medical insurance will depend on a variety of factors, including age, current health, and of course the level of cover you require.

• Exclusions and Limitations

Private medical insurance policies will often come with exclusions or limits, and it’s important to know exactly what is covered in your chosen policy. For example, many plans have restrictions around pre-existing conditions, which means some chronic illnesses or ongoing health problems may only be partially covered or subject to waiting periods.

However, as we’ve mentioned before, policies can often be customised to suit your needs, allowing you to select levels of cover or add optional extras for certain treatments. Understanding your chosen PMI’s limitations will help you ensure the policy matches your health requirements and lifestyle.

• Not a Replacement for the NHS

Most importantly, private medical insurance is best used in conjunction with the NHS, and is not a replacement. For example, most policies will focus on areas of healthcare or non-emergency treatments, meaning routine care, emergency care, and certain complex procedures may still rely on NHS services.

Ultimately, no PMI policy will be able to cover everything, and so it’s important to understand their limitations and consider how private and NHS care can work together to meet your health needs.

How Much Does Private Medical Insurance Cost in the UK?

There is no one size fits all or single price for private medical insurance in the UK. This is because each PMI policy will be tailored to the individual to match the cover they require. As such, private medical insurance costs will depend on factors like your age, current health, and the level of cover you choose.

It is common practice for insurers to take any pre-existing conditions and lifestyle activities into account, before offering cover. This means that two people of the same age could end up paying very different premiums for similar coverage.

In short: Policy costs are personalised, and so it’s difficult to provide exact figures. However, taking the time to explore your options – such as the treatments and services you want most – can help you find the right balance between coverage and price.

At Boon Brokers, our dedicated mortgage and insurance advisers can help you find the PMI cover that matches your needs. As a fee-free, whole-of-market broker, we can help you compare policies from multiple providers, finding the cover that suits your health needs and lifestyle.

What Treatments and Services Does Private Medical Insurance Cover in the UK?

Private medical insurance can cover a wide range of treatments and healthcare services, providing access to specialist consultations, diagnostic tests, and planned procedures. As coverage is often customised to match your needs, the exact cover included will vary from one policy to another.

That said, most PMI policies will focus on protecting against common health conditions, as well as outpatient care, mental health support, and follow-up appointments.

Example Coverage for Common Conditions

Private medical insurance will usually cover planned treatment for most common illnesses, including:

• Cancer Care: Diagnostic tests, consultations, and planned treatments such as chemotherapy, radiotherapy, or surgery (coverage may vary; some policies may limit certain therapies)
• Heart Conditions: Elective procedures such as angioplasty or bypass surgery, plus specialist consultations
• Orthopaedic Conditions: Knee, hip, or joint replacements, and physiotherapy
• Digestive or Abdominal Conditions: Planned surgeries such as hernia repair or gallbladder removal
• Respiratory Conditions: Planned treatments for chronic conditions such as asthma or COPD flare-ups
• Diagnostic Tests: X-rays, MRI and CT scans, blood tests, and other pathology investigations
• Mental Health Support: Counselling, psychotherapy, or specialist psychiatric consultations

Coverage for pre-existing conditions may be limited and certain procedures, such as some dental treatments, may not be included. It’s important to review your policy carefully in order to ensure you secure a policy that includes the cover you need.

What Treatments Are Not Covered by Private Medical Insurance?

Not all medical care is covered by private medical insurance. Policies typically focus on planned or elective treatments, meaning chronic or incurable conditions, emergency care, and certain procedures may be excluded.

Each policy will have its own list of exclusions and limits, depending on your chosen insurer and policy, and so it’s important to check exactly what is and isn’t included before committing to your chosen cover.

For example, PMI will generally not include cover for:

• Emergency Care: Life-threatening events like heart attacks, strokes, or severe injuries will generally be treated by the NHS and not covered by many PMI policies.
• Pre-Existing or Chronic Conditions: Some PMI policies will exclude pre-existing conditions or offer only limited coverage.
• Routine Dental, Maternity, and Fertility Treatments: These types of medical procedures can often be added as optional extras, but are generally not included in standard PMI plans.
• Therapy or Medications: More niche and specialist treatments, therapies, or prescribed medications may be excluded, depending on the chosen PMI policy.

Ultimately, the best PMI will be customised to match your needs and will come down to personal preference, however, even with bespoke or highly customised policies, limitations may still apply. Ensuring you understand your policy’s scope and any exclusions, will help you choose the cover that meets your needs and avoid unexpected surprises.

At Boon Brokers, our mortgage and insurance advisers can help you review different PMI policies, explain exclusions clearly, and ensure the cover you choose reflects your personal needs and priorities.

Who Should Consider Getting Private Medical Insurance in the UK?

Private medical insurance is not for everyone, but it can suit those who want quicker access to medical care, more choice over how they are treated, and less reliance on the NHS for planned treatment. In addition, PMI can also provide access to drugs, consultations, and elective procedures that may not be readily available through the NHS, depending on your policy and level of cover.

As such, who should consider PMI really comes down to those who are searching for a more comprehensive healthcare plan with added flexibility alongside NHS services.

As an insurance policy, PMI can be particularly helpful for those who are worried about taking time away from work, those who need appointments that fit around a busy schedule, or if you want more control over where and how you receive treatment.

Ultimately, whether private medical insurance is right for you will depend on your personal circumstances, health priorities, and expectations around access to care. It is a personal decision, and the value will differ from one person to the next.

How Can I Get Private Medical Insurance in the UK?

Getting the best private medical insurance starts with understanding your own healthcare needs and priorities. By working with a trusted whole-of-market insurance adviser, you can compare a vast range of policies from insurers, looking at different levels of cover, optional extras, exclusions, and costs.

At Boon Brokers, our mortgage and insurance advisers take the time to understand your priorities and needs. We will explain all of your private medical insurance without the jargon, helping show you exactly how your PMI cover will work in practice.

As a fee-free, whole-of-market broker, we can compare policies from across the UK market, helping you understand your options, exclusions, and levels of cover before you decide.

Whether you are exploring private medical insurance for the first time or reviewing existing cover, our team is here to help you find a policy that works for you.

Want to find the PMI cover that matches your needs?

Contact Boon Brokers today and our dedicated advisers will walk you through everything you need to know.