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With well over seven million people waiting for NHS treatment in England alone, private health insurance might be an option you’re considering. But if you’ve never had health insurance before, it’s not always clear what you get for your money. Here, we look at health insurance premiums, what they cover and how they work so that you can decide if private medical insurance (PMI) might be right for you.
Chris is our resident private health insurance and healthcare expert. He has over a decade of experience writing about private medical insurance and treatment. He's Chartered Insurance Institute qualified and is regularly quoted by the national press.
An insurance premium is a fixed amount of money you pay to keep your policy active. Premiums apply to all insurance products, including your car and home cover.
If you take out private health insurance, you’ll pay a monthly or annual premium for the length of the policy term (usually one year).
You can renew your policy with your current provider at the end of the term or look for a new plan elsewhere. Either way, you’ll need to keep paying premiums if you want to continue with private health insurance.
Our own research revealed the average premium for a new comprehensive policy was £86.07 per month (£1,032.84 per year).
While that figure is the average across a range of age groups, the premium you pay could look very different depending on your own circumstances. With that in mind, if you’re considering PMI and are concerned about cost, don’t assume that a policy is out of reach simply based on the average.
The average prices from our research are for new policies, typically with a significant no-claims discount applied (as most providers start you off high up their discount levels). If you claim on your policy and get older (we all do), your renewal premiums will likely be higher than our research averages.
Most premiums are paid monthly, but you should be able to pay for your policy annually – just speak to your provider if this is something you’d like to do.
Insurance is fundamentally about risk and how likely it is that you’ll make a claim. The probability of you making a claim is then reflected in your premium (the higher the chances, the higher your premium is likely to be).
To calculate the risk, insurers will consider multiple factors, including:
As a rule, health insurance premiums increase as we age because we become more vulnerable to illness and injury.
When we looked at quotes from eight leading insurers, we found that premiums significantly increased from the age of 50 and continued to rise thereafter:
*The health insurance prices above are the averages of hundreds of quotes for new policies; if you claim on your policy, your renewal premiums will likely be higher than those listed above. See the next section for more.
If you’ve made a number of claims in recent years, you can expect to pay more compared to someone who hasn’t. When you claim, assuming you don’t have a protected no-claims discount, you’ll drop down your insurer’s no-claims discount levels, reducing the discount you receive on your policy.
You can read more about how claims affect no-claims discounts here.
If you’ve suffered from various illnesses in the past or are prone to injury, it could affect your premium, and you could pay more.
It may even be excluded from your policy depending on how recent your illness was or how severe your condition is. In other words, your insurer won’t cover you for that specific ailment.
Smoking or using nicotine replacement products such as vapes can increase your premium, and most insurers will ask you if you use any sort of nicotine-based product before you take out a policy.
While vaping and other nicotine replacement products are largely seen as less harmful than smoking, the long-term effects are still relatively unknown, so insurers treat them the same as cigarettes at the moment.
Health insurance plans vary depending on the provider but in most cases, you’ll be able to choose from different levels of cover, for example, from a basic, mid-tier or comprehensive policy. These varying plans typically determine the type of treatment you can access.
Some insurers will also let you add extra features for a fee (such as alternative or complementary treatments).
As you’d expect, the more treatments and features your policy includes, the more you can expect to pay. But as well as this, your policy is shaped by logistical elements, such as where you’re treated and by who. The way your policy is written is also hugely important in calculating your health insurance premium. Considerations include:
Health insurers work with a network of hospitals. If you need treatment, you’ll be able to choose which of these hospitals you go to. Generally, the wider the network, the more you can expect to pay (as it means greater choice).
However, hospital location also needs to be considered. If your chosen hospital network is in an area with running costs, your policy will likely be more expensive.
Most health insurance providers will give you some sort of choice over who to see about your condition.
If you choose a policy with an unrestricted list of consultants, it means you can decide who to see. Each insurer will have a maximum they are willing to pay for each type of treatment and consultation, so while you have unrestricted access, bear in mind if you choose a world-renowned surgeon who charges a lot more than their peers, your insurer may not cover the whole cost.
Unrestricted consultant lists typically mean higher costs, usually around 20% more, so choice comes at a cost.
The alternative is a restricted or guided consultant list. This means you can choose from a list of consultants your health insurer provides. If you opt for a guided list, your provider will ensure that the consultants included are specialists in the area you need treatment, but you won’t have as much freedom over who is treating you.
An aspect of guided vs. unrestricted consultant access often overlooked is waiting times. As the private sector gets busier, consultants on the guided lists of insurers are likely to get booked up faster than those not. So, there’s a possibility that by opting for a guided list, your treatment may be slower compared to someone with unrestricted access.
Underwriting describes the way insurers calculate the probability of you making a claim. Your policy can be underwritten in one of two ways:
When you take out a policy, you’ll only need to answer basic questions and your insurer won’t ask about any health conditions.
Moratorium policies work on the basis that any pre-existing condition is excluded (this is any illness you’ve had symptoms of, or treatment for within the last five years). After you’ve been symptom-free for a certain period of time (usually two years), your insurer will usually reinstate cover for that particular condition or illness.
However, every time you claim, your insurer will look at your medical history and determine whether or not your claim is valid. In some instances, your insurer will ask to speak to your GP or other health professional for clarification.
Moratorium underwriting can mean your claim takes longer to process.
Instead of waiting until you make a claim, insurers will ask you to fill in a comprehensive health questionnaire before they issue a policy. Insurers may also ask your permission to speak to your GP or other health professional. You’ll also be asked about any pre-existing conditions when you apply.
This information means insurers can tailor a specific policy based on your medical history. Your policy documents will then clearly set out what illnesses aren’t covered.
Because your insurer already has all your medical details and a greater understanding of your health, claims are usually quicker to process than moratorium policies. Policies with medical underwriting can be slightly less expensive too.
Your premiums help pay for private medical treatment (alongside what other policyholders pay). Of course, thanks to the NHS, most of us don’t actually realise just how expensive even common medical procedures really are.
To put this into perspective, here are some common surgical procedures and how much they cost to carry out in a private hospital:
Also, bear in mind that premiums will be affected by costs outside of insurers’ control, such as rising energy prices.
But on top of everyday price rises, healthcare is also affected by medical inflation. This is the price of healthcare treatments themselves, including new drugs and investing in newer technology.
Health insurance premiums are more likely to rise rather than fall, and most people will experience premium increases at renewal.
That said, the amount by which they increase will depend. They won’t necessarily always increase by the same amount each year. Premiums will be affected by your circumstances (such as your age, health and claims) and by external factors (for example, general and medical inflation).
Private health insurance covers acute conditions. These are illnesses and conditions that get better or can be cured with treatment, for example, cataracts.
While policies will vary according to your level of cover, you can expect most plans to provide:
Some policies also include added benefits such as an NHS cash benefit, which means you’ll get money back if you choose to have NHS treatment instead of private.
Private health insurance doesn’t cover chronic conditions. These are illnesses and conditions that cannot currently be cured, for example, diabetes. Policies also won’t cover pre-existing conditions (unless you’ve been symptom-free for at least two years).
In the UK, we’re lucky enough not to need private health insurance. Nevertheless, in practice, NHS waiting lists can be a barrier to accessing timely treatment, which is a genuine concern for many of us.
Private health insurance can be a way to avoid waiting lists, as well as providing you with other benefits that can help you maintain your health, both physically and emotionally.
Policies also don’t need to be expensive. In addition to GP access, basic private health insurance typically includes any hospital treatment you need as well as any post-surgery follow-ups.
If you’re weighing up the pros and cons and need more clarity on what’s covered, these in-depth guides may help:
You can keep health insurance premiums as low as possible by:
Private health insurance is an investment in your wellbeing. Any plan you choose, should give you peace of mind, knowing that you can get the help and treatment you need when you need it most.
To explore your options, contact us and we’ll put you in touch with a regulated broker who can take you through what’s available.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
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*Based on 461 quotes between 01/22-01/23
