TL;DR
Private medical insurance (PMI) offers invaluable peace of mind, providing fast access to high-quality healthcare when you need it most. Here at WeCovr, our experienced advisers have helped arrange cover for thousands of UK families and individuals. We understand that while the benefits are clear, the cost can be a concern.
Key takeaways
- Increasing your policy excess.
- Tailoring your level of outpatient cover.
- Selecting a more focused hospital list.
- Choosing the right underwriting method.
- Outpatient: Consultations, tests, or procedures where you are not admitted to a hospital bed (e.g., seeing a specialist, MRI scans, blood tests).
Private medical insurance (PMI) offers invaluable peace of mind, providing fast access to high-quality healthcare when you need it most. Here at WeCovr, our experienced advisers have helped arrange cover for thousands of UK families and individuals. We understand that while the benefits are clear, the cost can be a concern. The good news is that you have significant control over your premium.
This guide will walk you through the four main levers you can pull to make private health cover more affordable, without compromising on the quality of care you receive.
How to make private healthcare more affordable by adjusting excess, outpatient cover, hospital lists and underwriting
The price of your private medical insurance policy isn't fixed. It's a dynamic figure based on several key choices you make when you set up your plan. By understanding and adjusting these components, you can tailor a policy that fits both your health needs and your budget.
The four most effective ways to reduce the cost of your premium are:
- Increasing your policy excess.
- Tailoring your level of outpatient cover.
- Selecting a more focused hospital list.
- Choosing the right underwriting method.
Let's explore each of these in detail, providing practical examples and expert tips to help you make the best decision.
Lever 1: Adjusting Your Policy Excess
One of the quickest and most direct ways to lower your monthly or annual premium is by adjusting your policy excess.
What is an excess?
An excess is a fixed amount of money you agree to pay towards the cost of your treatment each policy year. The insurer pays the rest. Once you have paid your chosen excess amount for the year, you typically won't have to pay it again for any subsequent claims within that same year.
For example, if you have a £250 excess and your first claim for a consultation and scan costs £800, you would pay the first £250, and your insurer would cover the remaining £550. For any further eligible treatment in that policy year, the insurer would cover 100% of the cost.
How Excess Impacts Your Premium
Insurers reward you for sharing a small part of the risk. The higher the excess you choose, the lower your premium will be. This is because a higher excess deters small, frequent claims and reduces the insurer's overall payout.
Here’s a typical illustration of how your premium might change based on the excess level you select:
| Excess Amount | Estimated Annual Premium Reduction | Who It's Good For |
|---|---|---|
| £0 | None (Base Premium) | Those who want complete peace of mind with no upfront costs. |
| £250 | Approx. 10-15% reduction | A balanced option offering good savings and a manageable excess. |
| £500 | Approx. 20-25% reduction | Individuals happy to cover a larger initial cost for big savings. |
| £1,000 | Approx. 30-40% reduction | Best for those primarily insuring against major, high-cost events. |
Adviser's Tip: When choosing an excess, select an amount you would be comfortable paying at short notice without causing financial difficulty. For many, a £250 or £500 excess strikes the perfect balance between premium savings and affordability if a claim is needed.
Lever 2: Tailoring Your Outpatient Cover
Your private medical insurance policy is primarily designed to cover inpatient treatment—care that requires a hospital bed overnight. However, much of the diagnostic journey happens before you are ever admitted. This is where outpatient cover comes in.
- Outpatient: Consultations, tests, or procedures where you are not admitted to a hospital bed (e.g., seeing a specialist, MRI scans, blood tests).
- Inpatient/Day-patient: Treatment that requires admission to a hospital bed, either overnight (inpatient) or just for the day (day-patient).
Because diagnostic tests and specialist consultations are common, outpatient cover can significantly influence your premium. You generally have three options:
- Full Outpatient Cover: Covers all eligible consultations, scans, and tests in full. This offers the most comprehensive cover but is also the most expensive option.
- Capped Outpatient Cover: You set a financial limit per policy year (e.g., £500, £1,000, or £1,500) for outpatient services. This provides a safety net for initial diagnostics while substantially reducing your premium compared to a full cover option.
- No Outpatient Cover: You choose to pay for any outpatient consultations and tests yourself. Your PMI policy would only kick in if you need to be admitted for inpatient or day-patient treatment. This is the cheapest option.
| Outpatient Cover Level | Impact on Premium | Ideal Scenario |
|---|---|---|
| Full Cover | Highest Cost | You want complete cover from the very first specialist visit to the final treatment, with no worries about diagnostic costs. |
| Capped Cover | Medium Cost (Significant Savings) | You want to lower your premium but still have cover for the initial, often expensive, stages of diagnosis like MRI scans. A £1,000 cap is a popular choice. |
| No Cover | Lowest Cost (Maximum Savings) | You are comfortable paying for consultations and tests yourself and want the policy mainly as a safeguard against the high costs of surgery. |
Adviser's Tip: A capped outpatient limit of £1,000 is often a sweet spot. It's typically enough to cover the initial consultations and a major scan (like an MRI or CT scan), which are often the costliest parts of a diagnosis. This can reduce your premium by 25-40% compared to full outpatient cover.
Lever 3: Choosing the Right Hospital List
UK health insurers don't just partner with every private hospital. They create curated lists or "networks" of approved facilities. The hospital list you choose has a direct and significant impact on your premium.
Generally, these lists are tiered based on cost, with hospitals in major city centres (especially London) being the most expensive.
The typical tiers you'll encounter are:
- Local or Regional Lists: These lists include a selection of private hospitals within your local area or a specific region. They are the most affordable option but limit your choice of facility.
- National Lists: These are the standard option for most insurers. They provide access to a broad range of several hundred private hospitals across the UK, excluding the most expensive ones in Central London.
- London / Premium Lists: These comprehensive lists include everything in the national network plus the premier private hospitals in Central London (e.g., The London Clinic, Cromwell Hospital). This is the most expensive option.
| Hospital List Tier | Impact on Premium | Who It's For |
|---|---|---|
| Local/Regional | Lowest Premium | People who live outside major cities and are happy to use their local private facilities. |
| National (Standard) | Mid-range Premium | The majority of UK residents. It offers an excellent choice of high-quality hospitals across the country. |
| London/Premium | Highest Premium | Those who live or work in Central London and want access to the facilities there, or who want the absolute widest choice. |
Insider Tip: Before opting for a reduced hospital list to save money, ask your adviser to check which specific hospitals near you are included. It’s a false economy to save 15% on your premium if the nearest approved hospital is a two-hour drive away. A good PMI broker, like WeCovr, can instantly provide you with the lists for your postcode.
Lever 4: Selecting the Right Underwriting Method
Underwriting is the process an insurer uses to assess your medical history and decide what they will and won't cover. This is perhaps the most complex area of private medical insurance UK, but understanding it is key to managing your policy effectively.
A Critical Point: Standard UK private medical insurance is designed to cover new, acute conditions that arise after you take out your policy. It does not cover pre-existing conditions (illnesses or injuries you already have or have had symptoms of) or chronic conditions (long-term illnesses that cannot be cured, like diabetes or asthma).
There are two main types of underwriting for new policies:
- Moratorium (Mori) Underwriting: This is the most common method. You don't need to provide a full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the past five years. However, if you then go two full, continuous years on the policy without any symptoms, treatment, or advice for that condition, it may become eligible for cover.
- Full Medical Underwriting (FMU): With this method, you complete a detailed health questionnaire when you apply. The insurer reviews your medical history and then explicitly states in your policy documents what conditions, if any, are excluded from cover. These exclusions are typically permanent.
| Feature | Moratorium (Mori) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Upfront Process | Quick and simple. No medical forms to fill out. | Longer application process. Requires a full health declaration. |
| Initial Premium | Often slightly cheaper. | Can sometimes be slightly more expensive, depending on your health history. |
| Clarity on Cover | Ambiguous. You don't know for sure what's covered until you make a claim and the insurer investigates your history. | Crystal clear. Your policy documents list any specific exclusions from day one. |
| Claims Process | Can be slower and more complex, as the insurer needs to check your medical history at the point of claim. | Generally faster and simpler, as the decision on what's covered has already been made. |
| Pre-existing rule | Conditions from the last 5 years are excluded. They may become eligible for cover after a 2-year clear period on the policy. | The insurer assesses your history and applies specific, usually permanent, exclusions. There's no pathway for them to be covered. |
| Best For | Younger people with a clean bill of health who want a quick start. | Anyone who wants certainty about what is and isn't covered, especially if you have a complex medical history. |
WeCovr Broker Insight: While Moratorium underwriting can seem appealing due to its speed, we often recommend Full Medical Underwriting for clients who value certainty. Knowing exactly what is excluded from day one prevents nasty surprises during the claims process, which is often a stressful time. An FMU application may take a little longer, but the peace of mind it provides is invaluable.
More Ways to Secure Affordable Private Healthcare
Beyond the 'big four', there are other smart strategies you can use to reduce your costs.
The '6-Week Option'
This is a hugely popular and effective cost-saving feature. If you add the 6-week option to your policy, your private cover will only be used if the NHS waiting list for the inpatient treatment you need is longer than six weeks. If the NHS can treat you within six weeks, you would use the NHS.
This works as a brilliant compromise:
- You still get to use your PMI for initial diagnostics and consultations (if you have outpatient cover).
- Your premium is significantly reduced (often by 20-30%).
- You have a safety net, ensuring you will never wait more than six weeks for eligible treatment.
Given current NHS waiting times, this option provides substantial savings while still delivering the core benefit of PMI: timely treatment.
Pay Annually
Most insurers offer a discount (typically around 5%) if you pay your premium for the full year upfront rather than in monthly instalments. If you can afford the lump sum, it's an easy way to save.
Constantly Review Your 'Add-Ons'
Many policies allow you to add extra benefits like dental, optical, or comprehensive mental health cover. While valuable, these increase your premium. Regularly review them and ask yourself: "Do I truly need this?" For instance, if you have a good workplace dental plan, you may not need to pay extra for it on your PMI.
Use a Specialist PMI Broker
It costs you nothing to use an expert broker like WeCovr. We are regulated by the Financial Conduct Authority (FCA) and have access to policies and rates from across the market.
Instead of getting a single quote from one insurer, we compare all the leading providers on your behalf. We do the hard work of matching your budget and needs to the right policy, explaining the differences in hospital lists, and clarifying the fine print. Our expertise can save you both time and money.
As a WeCovr client, you also get complimentary access to our AI-powered nutrition app, CalorieHero, and can benefit from discounts on other insurance products like life or income protection cover.
Understanding What Private Health Insurance Covers
To make an informed decision, it's vital to be clear on the purpose of PMI in the UK.
| Typically Covered (Acute Conditions) | Typically Not Covered |
|---|---|
| Inpatient & Day-patient Treatment (e.g., surgery, hospital stays) | Chronic Conditions (e.g., diabetes, asthma, high blood pressure) |
| Cancer Care (chemotherapy, radiotherapy, surgery) - often a core, comprehensive benefit | Pre-existing Conditions (illnesses you had before taking out the policy) |
| Outpatient Diagnostics (MRI, CT, PET scans, consultations - depending on your cover level) | Accident & Emergency (A&E) services |
| Mental Health Support (level of cover varies significantly by policy) | Normal Pregnancy & Childbirth |
| Therapies (physiotherapy, osteopathy - often as an add-on) | Cosmetic Surgery (unless for reconstruction after an accident or eligible surgery) |
| Specialist Consultations | Organ Transplants |
The fundamental rule is that private medical insurance is for treating new, curable (acute) medical conditions that occur after your policy begins.
Take Control of Your Health and Your Finances
Private medical insurance doesn't have to be out of reach. By being strategic with your excess, outpatient cover, hospital list, and underwriting, you can design a policy that gives you fast access to the best care at a price you can afford.
The key is to not go it alone. The UK PMI market is complex, and the best policy for your neighbour might not be the best for you.
Ready to find an affordable private health cover plan that’s tailored to you? The expert, friendly team at WeCovr is here to help. We'll compare the market for you, explain your options in plain English, and provide a free, no-obligation quote.
