The NHS provides healthcare free at the point of use. So why do around 10% of UK residents pay for private medical insurance (PMI)? The short answer: speed and choice. The longer answer is below.
What Is Private Medical Insurance?
PMI is insurance that covers the cost of private medical treatment in the UK. Instead of waiting for an NHS appointment, you can see a specialist, get diagnosed, and receive treatment — often within days.
What it gives you:
- Skip NHS waiting lists — treatment in days or weeks, not months
- Choose your hospital and consultant — you pick where and who
- Private room — more comfortable, more privacy
- Faster diagnosis — tests and results come back quickly
- NHS backup — you still use the NHS for emergencies and GP visits
What PMI Typically Covers
| Covered | Not Covered |
|---|---|
| Consultant and specialist appointments | Pre-existing conditions (usually excluded for first 2 years) |
| Diagnostic tests (MRI, CT, blood tests) | Chronic conditions (diabetes, arthritis — managed, not cured) |
| Surgery and hospital stays | A&E and emergency treatment (use NHS) |
| Cancer treatment (diagnosis through to treatment) | Maternity and childbirth |
| Physiotherapy (varies by policy) | Cosmetic surgery |
| Mental health treatment (increasingly included, limits apply) | Experimental or unproven treatments |
| Follow-up care | Dental and optical (usually separate add-ons) |
Coverage varies by provider and policy tier. Always read the policy documents, not just the marketing material.
Average Costs
PMI premiums depend on your age, health, where you live, and the level of cover you choose.
| Profile | Monthly Cost | Annual Cost |
|---|---|---|
| Individual, basic cover | £50–£80 | £600–£960 |
| Individual, comprehensive | £80–£150 | £960–£1,800 |
| Family (2 adults, 2 children), basic | £150–£250 | £1,800–£3,000 |
| Family, comprehensive | £250–£400 | £3,000–£4,800 |
Costs rise with age. A 50-year-old can expect to pay 2–3x what a 30-year-old pays for the same cover.
Types of Cover
| Level | What You Get | Best For |
|---|---|---|
| Comprehensive | Full cover — consultations, diagnostics, surgery, cancer, mental health, therapies | People who want complete private cover |
| Outpatient | Consultations, diagnostics, tests — but no hospital or surgery cover | Those who want fast diagnosis without full cover |
| Core hospital | Surgery and hospital stays only — no outpatient consultations | Budget-conscious buyers who want protection against big bills |
| Budget / access | Limited hospital list, higher excess, some treatments excluded | Young, healthy people who want low-cost catastrophic cover |
Adding optional extras (dental, optical, therapies) increases the premium but fills gaps the NHS doesn’t cover well.
NHS vs Private Insurance
| Factor | NHS | Private (PMI) |
|---|---|---|
| Cost to you | Free (funded by taxes) | £50–£400/month |
| Wait times | 6–18 weeks for routine procedures | Days or weeks |
| Choice of hospital | Assigned by NHS trust | You choose |
| Choice of consultant | Limited | Full choice |
| Private room | Shared wards typically | Private room standard |
| Cancer treatment | Excellent but can involve waits | Fast-track, often within 2 weeks |
| A&E and emergencies | Full NHS cover | Use NHS for emergencies |
| GP visits | Free via NHS | Use NHS GP (or private GP add-on) |
PMI is not a replacement for the NHS — it complements it. You still use the NHS for emergencies, GP visits, and many routine services. PMI fills the gaps where the NHS has long waits or limited choice.
Employer Schemes
Many UK employers offer PMI as a workplace benefit. If you’re not sure, check with HR — you might already have cover and not know it.
Key points about employer PMI:
- Usually covers your spouse and children too
- Often cheaper than buying individually (group rates)
- Premiums may be paid through salary sacrifice (tax-efficient)
- If you leave the job, the cover usually stops — check if you can continue it privately
- Pre-existing conditions may be covered immediately (unlike individual policies)
If your employer offers PMI, take it — even if you rarely use it. The tax savings alone make it worthwhile.
Tips for Choosing a Policy
- Check if your employer provides PMI. You might already be covered.
- Compare quotes from at least 3 providers. Bupa, AXA Health, Vitality, Aviva, and WPA all offer different strengths.
- Increase your excess to reduce the premium. A £250 excess can cut costs by 15–20%.
- Read the exclusions. Pre-existing conditions, mental health limits, and waiting periods vary widely.
- Consider a moratorium underwriting policy — no medical history needed upfront, but pre-existing conditions excluded for first 2 years.
- Think about waiting periods. Most policies have 2–4 week waits for outpatient claims and no wait for inpatient/surgery.
- Don’t duplicate cover. If your employer has PMI, you probably don’t need a personal policy too.
Worked Example
Profile: 40-year-old in London, family of 4 (2 adults, 2 children). Comprehensive PMI with £250 excess.
| Item | Detail |
|---|---|
| Monthly premium | £200 |
| Annual cost | £2,400 |
| Excess per claim | £250 |
| What’s covered | Cancer, surgery, consultations, diagnostics, mental health |
| What’s not covered | Dental, optical, pre-existing conditions (first 2 years), maternity |
Scenario: Cancer diagnosis
- NHS route: Specialist referral → diagnosis → treatment plan. Typical wait: 2+ months from GP referral to first treatment.
- PMI route: Self-refer to consultant → scans within days → treatment plan within 2 weeks. Total time: under 1 month.
In a serious scenario like cancer, the difference between waiting 2 months and 2 weeks matters. That’s the value PMI provides.
Scenario: No claims
- You’ve paid £2,400 for peace of mind. The same way you pay for home insurance without your house burning down. Some policies offer a “no claims” benefit or wellness rewards (Vitality, for example, rewards gym visits and healthy eating with discounts).
Is PMI Worth It?
It depends on your circumstances:
| Situation | PMI Probably Worth It | PMI Probably Not Worth It |
|---|---|---|
| You want fast access to specialists | Yes | |
| You have a chronic condition the NHS manages | Yes — NHS handles it | |
| You’re self-employed and can’t afford time off | Yes | |
| You’re healthy and happy with NHS | Yes | |
| Your employer offers it for free or subsidised | Yes — always | |
| You’re on a tight budget | Yes — put the money elsewhere |