TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. Yet, we find the same misconceptions crop up time and again, preventing people from accessing the benefits of private healthcare. This article will expose those myths.
Key takeaways
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery (e.g., a cataract, joint replacement, hernia).
- Chronic Condition: A condition that continues for a long time, has no known cure, and needs ongoing management (e.g., diabetes, asthma, high blood pressure).
- Pre-existing Condition: Any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy start date.
- Your Excess: This is the amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will significantly reduce your monthly premium compared to a £0 or £100 excess.
- Hospital List: Insurers have tiered hospital lists. Choosing a list that excludes the most expensive central London hospitals can dramatically lower your costs.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. Yet, we find the same misconceptions crop up time and again, preventing people from accessing the benefits of private healthcare. This article will expose those myths.
Dispelling the top misconceptions—eligibility, costs, and claims myths for 2025
Private Medical Insurance (PMI) can feel like a complex world filled with jargon and confusing clauses. It’s no wonder that myths and misunderstandings are common. Many people believe it's too expensive, too exclusive, or too difficult to use.
The reality for 2025 is quite different. The UK private health insurance landscape has evolved, offering more flexibility, a wider range of price points, and valuable wellness benefits that extend far beyond hospital treatment.
Let's cut through the confusion and tackle the most persistent myths head-on.
Myth 1: Eligibility & Access—"I'm Not a Candidate for PMI"
Many people mistakenly rule themselves out before even exploring their options. Let's break down the common myths surrounding who can and cannot get private health cover.
"I'm too old to get private medical insurance."
The Myth: Insurers won't cover you once you reach retirement age.
The Reality: This is simply not true. While it's a fact that premiums increase with age, there is no upper age limit for taking out a new PMI policy with most major UK insurers. Many providers offer specialised policies designed for over-60s, over-70s, and beyond.
Age is one of the most significant factors in pricing because, statistically, the likelihood of needing medical treatment increases as we get older. However, insurers are keen to provide cover for all age groups.
Key Takeaway: You are never "too old" to get a policy, but it is more cost-effective to get cover when you are younger and healthier. Your premiums will be lower, and you will have fewer pre-existing conditions to be excluded.
"I can't get cover because I have a health condition."
The Myth: Any existing health problem means you will be automatically rejected.
The Reality: This is one of the biggest and most important misunderstandings. You can almost certainly still get a policy, but it will not cover pre-existing conditions.
Crucial Point: Standard UK private medical insurance is designed to cover acute conditions that arise after your policy begins. It is not designed to cover chronic conditions or conditions you already have.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery (e.g., a cataract, joint replacement, hernia).
- Chronic Condition: A condition that continues for a long time, has no known cure, and needs ongoing management (e.g., diabetes, asthma, high blood pressure).
- Pre-existing Condition: Any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy start date.
Insurers handle pre-existing conditions in two main ways:
| Underwriting Type | How It Works | Best For |
|---|---|---|
| Moratorium (Most Common) | You don't declare your full medical history upfront. Instead, the insurer applies a blanket exclusion for any condition you've had in the last 5 years. This exclusion can be lifted if you go for a set period (usually 2 years) without any symptoms, treatment, or advice for that condition after your policy starts. | People who want a quick and simple application process and haven't had recent medical issues. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire. The insurer assesses your medical history and may write to your GP. They will then explicitly list any conditions that are excluded from your policy from day one. These exclusions are usually permanent. | People who want absolute clarity on what is and isn't covered from the start, or those with a more complex medical history. |
Even with a history of cancer, heart disease, or other serious illnesses, you can get a new policy. It will simply exclude that condition and any related issues.
"I don't need a medical exam to apply."
The Myth: Everyone has to undergo a full medical examination to get private health insurance.
The Reality: This is very rare. For the vast majority of applicants, a medical exam is not required. With Moratorium underwriting, you answer no medical questions at all. With Full Medical Underwriting, you simply fill out a form. Only in very specific, complex cases might an insurer ask for more information, but a physical exam is not standard procedure.
Myth 2: Cost & Value—"PMI is Unaffordable"
The price tag is often the biggest barrier for people considering PMI. While it is an ongoing financial commitment, the idea that it's exclusively for the ultra-wealthy is outdated.
"Private health insurance costs a fortune."
The Myth: A comprehensive policy will cost hundreds of pounds every month, no matter what.
The Reality: The cost of private medical insurance in the UK is highly flexible and depends entirely on the choices you make. You can tailor a policy to fit your budget by adjusting several key levers:
- Your Excess: This is the amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will significantly reduce your monthly premium compared to a £0 or £100 excess.
- Hospital List: Insurers have tiered hospital lists. Choosing a list that excludes the most expensive central London hospitals can dramatically lower your costs.
- Outpatient Cover: This covers diagnostic tests and consultations that don't require a hospital bed. You can choose a full cover limit, a capped limit (e.g., £1,000 per year), or remove it entirely to reduce the premium.
- The "6-Week Wait" Option: This is a clever way to save money. If you add this option, your PMI will only kick in if the NHS waiting list for the inpatient treatment you need is longer than six weeks. If the NHS can treat you within that timeframe, you use the NHS. This can reduce premiums by 20-30%.
Illustrative Monthly Premiums for a Healthy Non-Smoker:
| Age | Basic Policy (High Excess, Local Hospitals) | Comprehensive Policy (Low Excess, Full UK Access) |
|---|---|---|
| 30 | £30 - £45 | £70 - £95 |
| 45 | £45 - £65 | £95 - £130 |
| 60 | £80 - £120 | £180 - £250 |
Disclaimer: These are illustrative estimates for 2025. Your actual quote will depend on your specific circumstances, location, and chosen cover level.
An expert broker like WeCovr can be invaluable here. We can instantly compare plans from all the leading insurers and help you adjust these levers to design a policy that meets both your health needs and your budget, all at no extra cost to you.
"The price you're quoted is not the price you'll pay later."
The Myth: Insurers lure you in with a cheap price and then double it at renewal.
The Reality: Your premium will almost certainly increase at renewal each year. However, this is not an arbitrary "bait-and-switch." There are three clear reasons for this:
- Age: You are one year older, which moves you into a slightly higher risk bracket.
- Medical Inflation: The cost of new drugs, advanced scanning technology, and specialist fees rises faster than general inflation. This is typically between 5-8% per year.
- Your Claims History: If you make a claim, you may lose some or all of your No Claims Discount (NCD), similar to car insurance.
While frustrating, these increases are predictable. A good broker can help you manage renewal costs by reviewing the market for you each year to ensure you're still on the best possible plan.
"PMI is just for treatment; it offers no other value."
The Myth: You're just paying for a hospital bed if you get sick.
The Reality: Modern PMI policies are shifting to become holistic health and wellness partners. The value extends far beyond a claim. Most leading plans now include a wealth of added benefits at no extra cost, such as:
- Digital/Virtual GP: 24/7 access to a GP via phone or video call, often with the ability to get prescriptions or referrals. This alone can be worth the premium for busy families.
- Mental Health Support: Most policies now include a set number of therapy or counselling sessions (e.g., CBT) without affecting your main policy limits or NCD.
- Wellness Programmes: Discounts on gym memberships, fitness trackers, and healthy food.
- Health and Wellbeing Helplines: Access to nurses, pharmacists, and counsellors for everyday health queries.
As a WeCovr customer, you also get complimentary access to our AI-powered nutrition app, CalorieHero, to help you stay on top of your health goals. Furthermore, customers who purchase PMI or Life Insurance with us are eligible for discounts on other types of insurance we offer.
Myth 3: Coverage—"PMI Covers Everything the NHS Doesn't"
This is perhaps the most dangerous myth of all. Understanding what PMI is for—and what it isn't for—is vital to avoid disappointment at the point of a claim.
"PMI is a total replacement for the NHS."
The Myth: Once you have private cover, you can bypass the NHS for everything.
The Reality: This is completely false. PMI is designed to work alongside the NHS, not replace it. You will always need the NHS for:
- Accidents and Emergencies (A&E): If you have a car crash, a suspected heart attack, or a broken leg, you go to your local A&E. PMI does not have its own emergency departments.
- Chronic Condition Management: As mentioned, long-term conditions like diabetes, COPD, or epilepsy are managed by your NHS GP and specialists.
- Organ Transplants: These are typically handled by specialised NHS centres.
- Pregnancy and Childbirth (Standard): Routine maternity care is not covered by standard PMI, though some complications of pregnancy might be.
Think of PMI as your key to the fast-track lane for planned, non-emergency treatments for new, acute conditions.
"Private insurance will pay for any treatment I want."
The Myth: If a treatment exists, your policy will cover it, including experimental or cosmetic procedures.
The Reality: All treatments must be medically necessary and proven to be effective. Insurers have guidelines to determine what they will and will not fund.
| Typically Covered by PMI | Typically Excluded from PMI |
|---|---|
| Consultations with a specialist after a GP referral. | Pre-existing conditions you had before the policy started. |
| Diagnostic tests like MRI, CT, and PET scans. | Chronic conditions like asthma, diabetes, and high blood pressure. |
| Inpatient and day-patient surgery (e.g., hip replacement, hernia repair). | Accident & Emergency services. |
| Cancer treatment (chemotherapy, radiotherapy, surgery). Often a core benefit. | Routine pregnancy and childbirth. |
| Mental health support (therapy and counselling sessions). | Cosmetic surgery unless medically necessary after an accident. |
| Physiotherapy and other therapies (e.g., osteopathy). | Treatment for drug or alcohol abuse. |
| Experimental or unproven treatments. |
The golden rule is: PMI covers eligible treatment for acute conditions that arise after you join.
"My cancer cover is guaranteed to be unlimited."
The Myth: All policies that say they cover cancer will cover everything, forever.
The Reality: Cancer cover is a cornerstone of modern PMI, but its depth and limitations vary significantly between policies. Some providers offer "full" cancer cover as standard, which includes ongoing treatment, monitoring, and even palliative care.
However, other, more budget-friendly policies might have:
- Financial Caps: A limit on the total value of cancer treatment, such as £50,000.
- Time Limits: Cover that expires one or two years after diagnosis.
- Treatment Type Limits: Covering surgery and radiotherapy but not the latest expensive biological therapies.
When comparing the best PMI providers, it's crucial to examine the cancer cover details closely. This is an area where a specialist PMI broker can add immense value by explaining the subtle but critical differences.
Myth 4: Claims & Renewals—"The Process is Designed to Trip You Up"
The fear of a rejected claim or a punitive renewal price stops many from using the insurance they pay for. Let's separate fact from fiction.
"Insurers will do anything to avoid paying a claim."
The Myth: Insurance companies are looking for loopholes to reject your claim.
The Reality: This is a perception issue more than a reality. The vast majority of claims are paid. The Association of British Insurers (ABI) reports that in 2022, a staggering 97.3% of individual private medical insurance claims were paid out.
When claims are rejected, it's almost always for one of these clear-cut reasons:
- It's for a pre-existing condition.
- It's for a chronic condition.
- It's for a general exclusion on the policy (e.g., cosmetic surgery).
- The member did not get pre-authorisation.
The key to a successful claim is to follow the process:
- See your GP: You get a referral to see a specialist.
- Call your Insurer: Before booking anything, you contact your insurer's claims team with the referral details.
- Get Authorisation: They confirm the specialist and treatment are covered and give you an authorisation number.
- Book Your Treatment: You can now proceed, knowing the bills will be handled directly by the insurer.
"My premium will double if I make a single claim."
The Myth: One claim will make your insurance unaffordable forever.
The Reality: Making a claim will likely increase your renewal premium, but it's unlikely to double it. The increase is primarily due to the impact on your No Claims Discount (NCD).
Most insurers have an NCD scale, often ranging from 0% to 75%. Each year you don't claim, you move up a level. When you claim, you typically move down two or three levels.
Example NCD Impact:
- You are on Level 5 (50% discount).
- You make a claim.
- At renewal, you move down to Level 2 (20% discount).
Your premium will increase because your discount is smaller, on top of the standard increases for age and medical inflation. However, you can often "protect" your NCD for an additional fee, allowing you to make one or two claims without your discount level being affected.
Take Control of Your Health and Wellbeing
Understanding the realities of private medical insurance empowers you to make an informed decision. It's not a magic wand, but it is a powerful tool for gaining speed, choice, and control over your health when you need it most.
By dispelling these common myths, you can see PMI for what it is in 2025: a flexible, accessible, and valuable partner to the NHS, designed to get you diagnosed and treated faster for acute conditions. Working with an independent, FCA-authorised broker like WeCovr ensures you get impartial advice tailored to your needs, helping you navigate the market and find the right cover at the right price. Our high customer satisfaction ratings reflect our commitment to clear, honest guidance.
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Ready to see how affordable peace of mind can be? Get a free, no-obligation quote from WeCovr today and let our experts build the perfect health insurance plan for you.
