
Navigating the world of private medical insurance in the UK can be complex, but with an expert guide, it becomes clear. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we're here to separate fact from fiction, ensuring you make informed decisions about your health.
Private Medical Insurance (PMI) is a powerful tool for taking control of your health, but it's surrounded by a surprising number of myths. These misconceptions can prevent people from getting the right cover—or from getting cover at all. Let's bust these common myths with hard facts, helping you understand what PMI truly offers.
This is perhaps the most pervasive myth of all. Many people assume a health insurance policy is an all-access pass to any medical service, but this isn't the case.
The Fact: PMI is specifically designed to work alongside the NHS, not replace it. Its primary purpose is to cover the diagnosis and treatment of acute conditions that arise after you take out your policy.
Let's break this down:
However, the line is becoming more flexible. Many modern policies now include valuable add-ons, such as:
Here’s a simple table to clarify what’s typically handled by PMI versus the NHS:
| Service | Typically Handled by NHS | Typically Handled by PMI |
|---|---|---|
| Emergency Care (A&E) | ✅ Yes (Exclusively) | ❌ No |
| Routine GP Appointments | ✅ Yes | ❌ No (Except for virtual GP add-ons) |
| Chronic Condition Management | ✅ Yes (Exclusively) | ❌ No |
| Elective Surgery (e.g., hip replacement) | ✅ Yes (with waiting list) | ✅ Yes (quickly) |
| Diagnostic Tests (MRI, CT scans) | ✅ Yes (with waiting list) | ✅ Yes (quickly) |
| Specialist Consultations | ✅ Yes (with waiting list) | ✅ Yes (quickly) |
| Cancer Treatment | ✅ Yes | ✅ Yes (often with more drug choices) |
Understanding this distinction is the first step to appreciating PMI's true value: providing speed, choice, and comfort for non-emergency, eligible treatment.
This is a critical misunderstanding that can lead to disappointment and rejected claims. It is the single most important concept to grasp before you buy a policy.
The Fact: Standard private medical insurance in the UK is designed for unforeseen future health problems. It does not cover pre-existing conditions. It also does not cover chronic conditions.
Insurers use a process called "underwriting" to assess your health history and determine what they will and won't cover. There are two main types:
Moratorium Underwriting: This is the most common and straightforward method. The insurer doesn't ask for your full medical history upfront. Instead, they apply a blanket exclusion for any condition you've had in the 5 years before your policy began. However, if you then go for a continuous 2-year period after your policy starts without having any symptoms, treatment, medication, or advice for that specific condition, the insurer may automatically start covering it.
Full Medical Underwriting (FMU): With this method, you complete a detailed health questionnaire as part of your application. The insurer assesses your medical history and explicitly lists any conditions that will be excluded from your cover from day one. These exclusions are usually permanent. While it involves more paperwork, FMU provides absolute clarity on what's covered from the outset.
An expert broker like WeCovr can help you understand which underwriting option is best for you and can even approach insurers who may be more lenient with certain minor past conditions.
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple, no health forms. | Detailed health questionnaire required. |
| Clarity on Cover | Less clarity at the start; cover is decided at the point of a claim. | Full clarity from day one; exclusions are written on your policy documents. |
| Covering Old Conditions | Pre-existing conditions from the last 5 years can become eligible for cover after a 2-year trouble-free period. | Exclusions are typically permanent. |
| Best For | People with few or no recent health issues who want a quick start. | People with a more complex medical history who want certainty about what is covered. |
While PMI is accessible to many, it's not an automatic "yes" for everyone. Insurers are businesses that manage risk, and the application process is their way of assessing that risk.
The Fact: Your acceptance and the price you pay are based on several personal factors. Insurers don't just accept everyone for any policy without conditions.
Key factors that influence your application and premium include:
While an outright decline is rare, an insurer might:
This is where using a specialist PMI broker is invaluable. We can match your specific health profile and budget to the provider most likely to give you the most favourable terms.
It's a lovely thought, but unfortunately, it's a complete myth. Your PMI premium is not fixed for life.
The Fact: You should expect your premiums to increase every year at renewal. Understanding why helps manage expectations.
There are three primary drivers of premium increases:
Illustrative Annual Premium Increases by Age (For a Mid-Range Policy)
| Age Bracket | Illustrative Annual Premium | Reason for Typical Increase |
|---|---|---|
| 30-39 | £600 - £900 | Small, age-related increases. |
| 40-49 | £900 - £1,400 | Age-related increases become more noticeable. |
| 50-59 | £1,400 - £2,200 | Significant age-related jumps as health risks increase. |
| 60-69 | £2,200 - £3,500+ | Premiums rise steeply with age and higher claims probability. |
Note: These figures are purely illustrative for 2025 and will vary significantly based on insurer, location, and level of cover.
This belief stems from a misunderstanding of the UK's unique healthcare landscape. Unlike some other countries, private healthcare here complements the public system.
The Fact: PMI is a partner to the NHS, not a replacement. You will still rely on and use the NHS.
Think of it as having two tools in your healthcare toolkit.
A Real-World Example:
Sarah, 45, develops severe hip pain. Her NHS GP suspects she needs a hip replacement. The NHS waiting list for an initial consultation with an orthopaedic surgeon is 18 weeks, and the wait for the surgery itself could be over a year.
With her PMI policy, Sarah gets a private referral. She sees a top-rated surgeon of her choice the following week. An MRI scan is done two days later. The surgery is scheduled and performed in a private hospital within a month of her initial GP visit. She recovers in a private room.
If Sarah were to be in a serious car accident, she would be taken to an NHS A&E. Her PMI would not be involved. Her ongoing high blood pressure is also managed entirely by her NHS GP.
PMI fills the gaps where the NHS is under the most pressure—elective care waiting times—which, according to the latest NHS England statistics, remain stubbornly high, affecting millions of people.
This is like saying all cars are the same. While they might all have four wheels and an engine, the difference between a basic city runabout and a luxury SUV is enormous. The same is true for the private medical insurance UK market.
The Fact: Policies differ hugely in price and scope. Customising your policy is key to getting the right cover at a price you can afford.
The main variables you can control are:
Level of Cover:
The Excess: This is the amount you agree to pay towards the cost of a claim. For example, if you have a £250 excess and your treatment costs £4,000, you pay the first £250 and the insurer pays the rest. A higher excess (£500 or £1,000) will significantly lower your monthly premium.
Hospital List: Insurers have tiered hospital lists. A policy that gives you access to every private hospital in the country, including the prestigious ones in Central London, will be the most expensive. Choosing a list that includes quality local hospitals but excludes the most expensive London facilities can be a great way to save money.
The Six-Week Wait Option: This is a clever cost-saving feature. If you add this to your policy, it means that for any eligible treatment, if the NHS can provide it within six weeks, you will use the NHS. If the waiting list is longer than six weeks, your private cover kicks in. Given that many NHS waits are much longer than this, it offers a great balance between saving money and ensuring timely care.
| Policy Level | In-Patient/Day-Patient | Out-Patient Cover | Therapies (e.g., physio) |
|---|---|---|---|
| Basic | ✅ Fully Covered | ❌ Not Included | ❌ Not Included |
| Mid-Range | ✅ Fully Covered | ✅ Covered (up to a limit, e.g., £1,000) | 🟨 Optional Add-on |
| Comprehensive | ✅ Fully Covered | ✅ Fully Covered | ✅ Included |
It's easy to think of insurance as something for 'later in life', but this overlooks the immediate benefits and long-term wisdom of starting early.
The Fact: Getting cover while you're young and healthy is the smartest time to do it. Acute illness and injury, especially musculoskeletal issues, can affect anyone at any age.
Here's why PMI is valuable for younger people:
Trying to compare the dozens of policies from providers like Bupa, AXA Health, Aviva, and Vitality can be overwhelming. This is where a dedicated, independent PMI broker becomes your greatest asset.
At WeCovr, we provide a human touch backed by deep industry knowledge. Our service is provided at no cost to you; we are paid a commission by the insurer you choose.
Here’s how we help:
While having a great insurance policy is a fantastic safety net, the best strategy is always to proactively manage your health. Many PMI providers actively encourage this with wellness programmes and discounts.
Here are some tips to stay healthy:
Ready to find the right health cover, free from myths and confusion?
The world of PMI is easier to navigate with an expert by your side. Contact WeCovr today for a free, no-obligation quote. Our friendly, professional team will help you compare the UK's leading insurers and build a policy that gives you peace of mind.






