More and more patients in the UK are turning to the private sector because they do not want to wait for NHS treatment. If you’re thinking about taking out private medical insurance, here are a few things to consider.
Do I need private medical insurance?
If you plan to use private healthcare in the UK, either to avoid waiting for NHS treatment or simply to choose a private consultant or hospital, then private medical insurance can help spread costs compared to paying out-of-pocket (known as ‘self-pay’).
You should always check with your insurer before booking any medical treatment to ensure that it's covered.
Age matters when considering private medical insurance
It’s a fact of life that as our age goes up, so do our chances of needing medical treatment – whether that’s for a chronic illness, or an elective procedure like a hip replacement.
If you’re considering private medical insurance, it’s best to take it out early on – if you can – so that you can take advantage of lower premiums and get a policy with fewer conditions excluded.
Rates tend to be lower when you're younger but will rise with age.
Once you get past the age of 50, you may find getting insured is more difficult and expensive. Some insurers do offer special insurance packages for those over 55, so if you’re that age (or older) then it will be worth looking into.
Can I get health insurance if there’s something already wrong with me?
It is essential that you declare every illness you've ever had when buying your health insurance. Otherwise, you could find the policy is ruled invalid just when you need it the most.
Normally insurers won’t cover pre-existing illnesses, but you can still take out insurance to cover the risk of other issues you want private healthcare cover for. They will sometimes include pre-existing conditions if your medical history shows that your condition has been well-controlled for two years or more (e.g. high blood pressure or diabetes).
Some insurers may agree to cover a pre-existing chronic condition after you’ve paid your premiums for a while and if it then worsens. This is because if the condition appears well-managed for the first couple of years, any worsening is classed as a ‘new’ development and therefore can still be covered.
What else might my insurance policy not cover?
It’s very important to find out exactly what your private medical insurance policy does not include.
For example, some policies limit the number of scans or blood tests that are covered in the space of a year to reduce your premiums. This is an important issue if you need repeat tests. They may also not cover other diagnostic checks that are not deemed medically necessary.
Ambulance transport, home nursing, and physical aids or devices may be limited or excluded.
Is cancer care included?
Although cancer is a common illness, there are things to consider when investigating a private medical insurance policy.
For instance, most policies will cover standard cancer treatments such as surgery, radiotherapy and chemotherapy, but it’s worth double-checking how long your insurer will continue to pay for your treatment and recovery. For example, some insurers only cover the first 12 months of chemotherapy. However, many insurers will have policies that offer an NHS benefit built in that means you’ll receive cash if you choose to take treatment in an NHS hospital rather than using your private medical insurance for cancer treatments.
Some people will choose to exclude cancer care from their policy altogether, which can help save significant amounts (sometimes up to £300 or £400 a year).
Always check the small print. If you're diagnosed with cancer within the first three to six months of taking out a policy, your insurer may not cover treatment beyond an emergency admission. Insurers will often specify that if you knew or suspected you had cancer, or a related condition, when you took out the policy or were added to it, it will be counted as a pre-existing condition.
If you have had cancer in the past, some insurers might exclude paying for treatment if that cancer returns. Other insurers might say that after five years they will cover you again, but only for new (primary) cancers.
What are my other options for paying for treatment?
Sometimes, your best choice may be to pay for treatments or scans yourself, even if you have private medical insurance. A typical outpatient consultation will cost £125 - £200 which may be cheaper than your excess and give you peace of mind.
This can particularly be the case for people over 70. Any policy you have at that age usually excludes any medical need that’s developed within the past five years. We tend to see more people in their 70s onwards using self-pay.
That’s because even if you are only claiming on your insurance for a test or scan (and even if that gives you the ‘all clear’) you are still likely to face higher premiums.
For any one-off procedures, including cataract surgery (£2,000 - £3,000) or an endoscopy (£1,000 - £2,500), which don’t require ongoing care, it may be cheaper to pay out of pocket rather than go through insurance.
However, not all claims affect your premiums. If your condition needs treatment, contact your insurer as soon as possible to find out what support is available.
Can I switch my private medical insurer?
Yes. You should also compare your premiums with other insurers at your renewal for the best coverage. You may be able to move mid-policy if your new insurer agrees to ‘continuation of underwriting’ terms.
Want to know more?
We have guides on the different funding methods:
