Do you need private medical insurance?

Private medical insurance (also known as health insurance) can supplement what’s available on the NHS. If you don’t already have it as part of your employee benefits package and you can afford to pay the premiums, you might decide it’s worth paying extra to have more choice over your care.

Private medical insurance - What is it?

Most UK residents are entitled to free healthcare from the NHS.

Health insurance pays all – or some – of your medical bills if you are treated privately. It gives you a choice in the level of care you get and how and when it is provided.

You don't have to take out private medical insurance – but if you don’t want to use the NHS, you might find it hard to pay for private treatment without insurance, especially for serious conditions.

Private medical insurance - What does it cover?

Like all insurance, the cover you get from private medical insurance depends on the policy you buy.

Basic private medical insurance usually picks up the costs of most in-patient treatments (tests and surgery) and day-care surgery.

Some policies extend to out-patient treatments (such as specialists and consultants) and may pay you a small fixed amount for each night you spend in an NHS hospital.

Private medical insurance - What isn't covered?

Your healthcare insurance usually won’t cover private treatment for:

  • pre-existing medical conditions
  • chronic illnesses such as HIV/AIDs-related illnesses, diabetes, epilepsy, hypertension and related illnesses
  • normal pregnancy and childbirth costs
  • organ transplants
  • injuries relating to dangerous sports or arising from war or war-like hostilities
  • cosmetic surgery to improve your appearance

You may be able to choose a policy which covers mental health, depression and sports injuries but these aren't always covered.

Do you need private medical insurance?

Did you know?

NHS patients who need treatment in hospital wait an average of 8.1 weeks. Only 1 in 10 waits longer than 18 weeks.

Source: Department of Health data from January 2012

It’s very much a personal choice. You get free treatment on the NHS, so you only really need private medical insurance if:

  • you want to be covered for drugs and treatment you can’t get on the NHS, like specialist surgery for sports-related injuries (check that the treatment is included in your policy before you buy)
  • you just don’t want to use the NHS and would prefer to stick to private hospitals where possible
  • you would prefer not to wait for NHS treatment

Who doesn’t need private medical insurance cover?

You don't need private medical insurance if:

  • you’re happy to rely on the NHS for your care
  • you already have medical insurance through your employee benefits package
  • you only have spare cash for basic insurance, like car and home insurance (and life insurance if you have dependants)
  • you have debts to repay and no savings – you should put your money towards those, rather than private medical insurance
  • you can pay for individual treatments – if you have sufficient savings it might be more cost effective to pay for any treatment you may need privately than to pay regular insurance premiums
  • you’re worried about your child becoming sick – children get immediate priority treatment on the NHS

Private medical insurance - Pros and cons

Note: all of this depends on the type of policy you buy.

Pros

  • Specialist referrals. You can ask your GP to refer you to an expert or specialist working privately to get a second opinion or specialist treatment.
  • Get the scans you want. If the NHS delays a scan, or won’t let you have one, you can use your cover to pay for it.
  • Reduce the waiting time. You can use your insurance to reduce the time you spend waiting for NHS treatment, if your wait time is more than six weeks.
  • Choose your surgeon and hospital. You can (in theory) choose a surgeon and hospital to suit your time and place – which isn’t possible on the NHS.
  • Get a private room. You can use it to get a private room, rather than staying in an open ward which might be mixed-sex.
  • Specialist drugs and treatments may be available. Some specialist drugs and treatments aren’t available on the NHS because they’re too expensive or not approved by the National Institute for Health and Clinical Excellence in England and Wales (NICE) or the Scottish Medicines Consortium (SMC).
  • Physiotherapy. You get quicker access to physiotherapy sessions if you have insurance than you would through NHS treatment.

Cons

  • You might get better care on the NHS. If you have a serious illness such as cancer, heart disease or stroke, you’ll get priority NHS treatment. NHS hospitals can be as good as or better than private hospitals.
  • It’s expensive – and the price will go up. A typical family premium (two adults in their 40s and two children under 10) can vary from £700 to £1,650 per year. Premiums will rise every year, and with age – so by the time you’re older, and more likely to need hospital treatment, you may not be able to afford it.
  • Chronic illnesses aren’t usually covered. Most policies don’t cover chronic illnesses which are incurable, such as diabetes and some cancers.
  • There may not be any local treatment options. If you choose a policy with an approved list of consultants and hospitals this may not include the expert consultant you want to see or a convenient location for treatment.

Is private medical insurance good value for money?

Waiting times in the NHS are currently pretty good and fairly stable, so there’s less need to pay privately in order to reduce the time it takes you to get back to work or to good health.

It can be good value if you might need specialist, expensive treatment. If you’re a sporting enthusiast, for example, you might want access to specialist private treatment that isn’t available in the NHS – like surgeons and experts who only do private work. You’d need to have a policy that covers the type of treatment you might need.

If you needed to make more than one claim, it’s quite likely that private medical insurance would save you money.

Even if you get private medical insurance, you will keep your right to use the NHS. It remains a safety net that will pick up the tab for anything that isn’t covered by your insurance policy.

Alternative options if you want to go private

  • Use savings for all or part of your medical costs – around one in five private patients do this. Hip and knee replacements cost an average of £10,000 each, while MRI scans cost from £600. You can shop around for scan prices – your GP can help you do this.
  • Just pay for a private consultation if you want an expert or second opinion. Then, if necessary, your consultant will refer you back into the NHS for treatment.

Other types of insurance to consider

If you fall ill or have an accident and can’t work, you might find it hard to keep up mortgage payments or handle the bills – especially if you don’t have enough savings or sick pay from your employer. Your priority should be insurance that keeps you out of financial difficulty such as income protection.

To find out more, take a look at our guide:

Choosing the right policy and cover

To help you decide which policy might be right for you, read the Which? guide to choosing private medical insurance