TL;DR
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. Fact-checking widespread PMI myths including A&E coverage, GP visit costs, automatic acceptance beliefs, and lifetime coverage assumptions Private Medical Insurance (PMI) is a powerful tool for taking control of your health, but it's surrounded by a surprising number of myths.
Key takeaways
- Acute Conditions: These are diseases, illnesses, or injuries that are likely to respond quickly to treatment and lead to a full recovery. Think of conditions like cataracts, joint problems requiring replacement, or hernias.
- Emergencies (A&E): Private hospitals in the UK are not equipped to handle life-threatening emergencies. They do not have Accident & Emergency departments. For incidents like a heart attack, stroke, or major trauma from an accident, your first and only port of call is an NHS A&E department. The NHS is unparalleled in its ability to provide immediate, critical care.
- Routine GP Visits: Standard PMI policies do not cover the cost of your regular appointments with your NHS General Practitioner. The NHS GP remains your primary point of contact for day-to-day health concerns.
- Virtual GP Services: These 24/7 digital services allow you to have a video or phone consultation with a private GP, often within hours. This is a fantastic benefit for getting quick advice, prescriptions, or a referral, but it's an enhancement, not a replacement for your local NHS surgery.
- Pre-existing Condition: Any ailment for which you have experienced symptoms, sought advice, or received treatment in the years leading up to your policy's start date (typically the last 5 years).
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.
Fact-checking widespread PMI myths including A&E coverage, GP visit costs, automatic acceptance beliefs, and lifetime coverage assumptions
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.
Myth 1: "Private Health Insurance Covers All Medical Needs, Including A&E and GP Visits"
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:
- Acute Conditions: These are diseases, illnesses, or injuries that are likely to respond quickly to treatment and lead to a full recovery. Think of conditions like cataracts, joint problems requiring replacement, or hernias.
- Emergencies (A&E): Private hospitals in the UK are not equipped to handle life-threatening emergencies. They do not have Accident & Emergency departments. For incidents like a heart attack, stroke, or major trauma from an accident, your first and only port of call is an NHS A&E department. The NHS is unparalleled in its ability to provide immediate, critical care.
- Routine GP Visits: Standard PMI policies do not cover the cost of your regular appointments with your NHS General Practitioner. The NHS GP remains your primary point of contact for day-to-day health concerns.
However, the line is becoming more flexible. Many modern policies now include valuable add-ons, such as:
- Virtual GP Services: These 24/7 digital services allow you to have a video or phone consultation with a private GP, often within hours. This is a fantastic benefit for getting quick advice, prescriptions, or a referral, but it's an enhancement, not a replacement for your local NHS surgery.
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.
Myth 2: "My Pre-Existing Conditions Will Be Covered Immediately"
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.
- Pre-existing Condition: Any ailment for which you have experienced symptoms, sought advice, or received treatment in the years leading up to your policy's start date (typically the last 5 years).
- Chronic Condition: A long-term health issue that requires ongoing management and has no known cure. Examples include diabetes, asthma, hypertension, and Crohn's disease. Management of these conditions remains with the NHS.
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. |
Myth 3: "Getting PMI is Automatic – Everyone is Accepted"
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:
- Age: This is the most significant factor. As we get older, the statistical likelihood of needing medical treatment increases, so premiums rise accordingly.
- Medical History: As discussed under Myth 2, your past health plays a huge role.
- Lifestyle: Smokers or vapers will always pay a higher premium than non-smokers, sometimes by as much as 30-50%.
- Location: The cost of private medical care varies across the UK, with costs in Central London being the highest. Your postcode can affect your premium.
- Level of Cover: A comprehensive plan with a central London hospital list will cost far more than a basic plan with a local hospital list.
While an outright decline is rare, an insurer might:
- Apply specific exclusions: "We will cover you, but not for anything related to your past back problems."
- Charge a "loading": This means they increase your premium to reflect a higher perceived risk.
- Offer a policy that is prohibitively expensive.
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.
Myth 4: "My Premiums Will Stay the Same for Life"
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:
- Ageing: As you move into a new age bracket, your premium will increase. This is the biggest and most predictable factor. The increases are often steeper once you are over 50.
- Medical Inflation: The cost of private healthcare—including new drugs, advanced scanning technology, and specialists' fees—rises much faster than general inflation. This rate, often cited as being between 7% and 10% per year, is passed on to consumers through their premiums.
- Claims History: If you make a claim on your policy, your premium is likely to increase at the next renewal. The size of the increase can depend on the value and frequency of your claims. Most insurers offer a No Claims Discount, which you build up over years and which a claim will reduce or remove.
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.
Myth 5: "PMI is a Complete Replacement for the NHS"
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.
- The NHS is your foundation: It's there for everything from your GP and A&E to the management of long-term chronic conditions and maternity care. It's comprehensive and available to everyone. Its major drawback is waiting times for non-urgent care.
- PMI is your fast-track pass: It's for bypassing the NHS waiting lists for eligible acute conditions. It gives you choice over your specialist and hospital and provides a more comfortable, private setting for your treatment.
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.
Myth 6: "All Health Insurance Policies Are Basically the Same"
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:
- Basic: Covers you for treatment when you are admitted to hospital as an in-patient or day-patient.
- Mid-Range: Includes the above, plus a set limit for out-patient services like specialist consultations and diagnostic scans (e.g., £1,000 per year).
- Comprehensive: Offers extensive (often unlimited) out-patient cover and usually includes therapies like physiotherapy.
-
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 |
Myth 7: "I'm Young and Healthy, So PMI is a Waste of Money"
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:
- Lowest Premiums: You will never get a cheaper policy than when you are young and have a clean bill of health. Locking in cover before any health issues develop means you avoid future exclusions.
- Mental Health Support: The pressure on NHS mental health services is immense. Most modern PMI policies offer excellent, fast-tracked mental health support, from counselling sessions to psychiatric care, which is a vital resource for many younger adults.
- Sports Injuries & Musculoskeletal Issues: If you're active, injuries can happen. Whether it's a torn ligament from football or back pain from sitting at a desk, PMI provides rapid access to diagnostics (MRI scans) and therapies (physiotherapy, osteopathy) to get you back on your feet quickly.
- Beat the Queues: NHS waiting lists are not just for the elderly. A surprise diagnosis for something like a hernia or gallstones could leave you in discomfort and unable to work for months while you wait for treatment. PMI resolves this in weeks. As of late 2024, the NHS referral-to-treatment waiting list in England stood at over 7.5 million cases.
How a Specialist Broker Like WeCovr Demystifies PMI
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:
- Market Comparison: We compare policies from across the market to find the one that best fits your needs and budget.
- Tailored Advice: We listen to your priorities—be it mental health cover, a specific hospital list, or budget constraints—and recommend the most suitable options.
- Application Support: We guide you through the application process, ensuring you understand the underwriting and the terms of your cover.
- Annual Reviews: We don't just disappear after you buy. At renewal, we can re-broke the market for you to ensure you're still on the best possible deal.
- Added Value: As a WeCovr client, you get more than just insurance advice. You'll receive complimentary access to our AI-powered diet and calorie tracking app, CalorieHero, to support your health goals. Plus, clients who take out PMI or life insurance with us are eligible for discounts on other types of cover, like home or travel insurance. Our clients consistently give us high satisfaction ratings on independent review websites.
Proactive Health: A Companion to Your Insurance
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:
- Balanced Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains. A Mediterranean-style diet has been consistently linked to better heart health and longevity.
- Consistent Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to a host of issues, from a weakened immune system to poor mental health. Create a relaxing bedtime routine and minimise screen time before bed.
- Regular Activity: The NHS recommends at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or tennis) a week.
- Mind Your Mind: Don't neglect your mental wellbeing. Practices like mindfulness, spending time in nature, and maintaining strong social connections are powerful buffers against stress and anxiety.
Do I need to declare every single cough and cold I've ever had on my PMI application?
Can I add my family to my private medical insurance policy?
What happens if I want to switch my private medical insurance provider for a better price?
Is mental health treatment covered by private health insurance?
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.











