Should I buy private medical insurance?

With NHS waiting lists at a record high, is now a good time to look into private medical insurance? Our answers to the most common questions about private medical cover might help you decide whether it’s for you.

You’ve probably seen the headlines about ballooning NHS waiting lists and staff shortages.

And they may have made you wonder whether buying private medical insurance is the answer. For a monthly premium, you might be able to sidestep the long wait and see a specialist more quickly.

But how does private medical insurance work, which treatments does it cover and how much does it cost?

How does private medical insurance work?

Private medical insurance is generally designed to cover the cost of private treatment for conditions that start after your policy begins – so that excludes many pre-existing conditions.

Like most insurance, there are various policies available offering different levels of cover. You can also decide what contribution you’d be willing to make towards the treatment costs (the “excess”).

Policies usually cover eventualities such as seeing a consultant, staying in a private hospital, undergoing tests and surgery.

What are the benefits of private medical cover?

Across the UK, NHS waiting lists have hit a record high, with almost 8 million people waiting for routine hospital treatment.

This could be worrying if your GP wants to refer you to a consultant for a suspected serious health condition, illness or surgery. Having private cover might mean you could see a specialist consultant sooner than you would on the NHS, although this depends on various factors, such as where you live. You could even have a wider selection of specialists to choose from, and you will likely have some flexibility in choosing the date of the appointment.

If you’re already on a waiting list, buying private medical insurance likely won’t help, as the cover is usually only for conditions you may have in the future, but you should read the policy before committing to be sure.

The alternative is paying for your own private care, known as 'self-pay' or 'self-fund'. This can be useful if you’re facing a long wait with the NHS and don’t have insurance, or perhaps the treatment you want is urgently needed or only available privately. But this comes at a price.

How much does private medical insurance cost?

Quotes for private medical insurance can vary widely. By plotting in different patient profiles on price comparison sites, it becomes apparent that younger people normally pay less. A healthy, non-smoking 34-year-old might be able to pick up a policy for less than £30 a month, while a 70-year-old may have to pay more than twice that amount.

The location of services can also dictate the price. For example, a consultant appointment starts at £200 on average in London, compared to £175 in Wales.

Keep in mind that the complexity of surgical procedures and length of treatments will reflect how much you may have to pay out of pocket if you do not have full coverage. For example, cataract surgery could cost almost £2,500, while hearing implants could cost £6,000.

You could consider paying less each month for insurance if you are willing to contribute a higher excess. But that could be risky if you do not have an emergency fund to cover the cost.

If my employer offers private health insurance, do I still have to pay?

You may be able to get private medical cover through work. Some companies offer a reduced rate (so you still pay the premiums), while others pay the premiums for you as part of an employee benefits package.

The latter option can feel more generous. But bear in mind it’s unlikely to be completely free: you’ll probably have to pay tax on the premiums through your payslip, as it's considered a benefit.

What is often excluded with private health insurance?

Pre-existing conditions and ongoing conditions, such as asthma and diabetes, are not normally covered by private medical insurance. Pregnancy, birth and aftercare are rarely covered on family medical plans, but some may offer access to private healthcare during pregnancy, especially if there are complications. Cosmetic surgery and weight-loss treatments are usually excluded, too.

How can I lower my private medical premiums

To try to get the right cover for the best price, shop around using online comparison sites. To lower your premiums, try the following:

• increasing the excess
• limiting your hospital choices
• cutting out optional extras that you are unlikely to use

If you or members of your family have a complicated medical history, an insurance broker could guide you to providers that best suit your needs and budget.

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