As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr provides expert insight into the UK's private medical insurance market. Understanding what drives your premium is the first step towards finding the right cover. This guide breaks down the two biggest factors: your age and your address.
Experts state every year and postcode can affect what you pay. Londoners and older adults often pay much more for the same policy. — MoneyPeopleOnlineWeCovr
Private Medical Insurance (PMI) offers a valuable alternative to relying solely on the NHS, providing faster access to specialists and treatments for acute medical conditions. However, the price you pay isn't a one-size-fits-all figure. Insurers use sophisticated calculations to determine your premium, and at the heart of this pricing model are two undeniable factors: your age and your postcode.
Understanding why these elements have such a profound impact is key to navigating the market and finding a policy that offers genuine value. Let's delve into the mechanics of PMI pricing and what it means for you.
Why Your Age is a Primary Factor in PMI Premiums
It’s a simple truth in the insurance world: risk determines price. With private health cover, your age is the single most significant indicator of your potential health risk. As we get older, the statistical likelihood of needing medical treatment increases, and insurers adjust premiums accordingly.
This isn't a penalty for ageing; it's a reflection of actuarial data. The Office for National Statistics (ONS) data consistently shows that the prevalence of long-term health conditions rises sharply with age. While PMI doesn't cover chronic conditions, this data highlights the increased probability of developing new, acute conditions that would be eligible for a claim.
The Year-on-Year Impact of Ageing
Insurers typically review premiums annually. This renewal price is influenced by several things, but one constant is your age "ticking over." Each birthday can lead to a premium increase, even if you haven't made a claim. This is often referred to as "age-banding."
Here’s a breakdown of why older individuals typically face higher premiums:
- Increased Health Risks: The probability of developing conditions like cancer, heart disease (requiring surgery), or joint problems (requiring replacements) grows with age.
- More Complex Treatments: Medical care for older patients can be more complicated, potentially involving longer hospital stays or more intensive diagnostic tests.
- Longer Recovery Times: Recovery from surgery or serious illness can take longer as we age, increasing the overall cost of a claim (e.g., more physiotherapy sessions or follow-up consultations).
Illustrative Premiums by Age
To demonstrate the impact of age, let's look at a typical, illustrative example for a non-smoker seeking a comprehensive policy in a mid-cost area like Manchester. These are not real quotes but serve to show the trend.
| Age Bracket | Illustrative Monthly Premium | Common Health Concerns Covered by PMI |
|---|
| 30-39 | £50 - £80 | Sports injuries, minor surgeries, diagnostic tests. |
| 40-49 | £80 - £120 | Hernia repairs, gallbladder removal, early-stage joint issues. |
| 50-59 | £120 - £200 | Cataract surgery, joint replacements (hip/knee), cardiac procedures. |
| 60-69 | £200 - £350+ | Cancer treatment, major heart surgery, extensive diagnostics. |
| 70+ | £350 - £600+ | Complex multi-stage treatments, ongoing specialist consultations for new conditions. |
Disclaimer: These figures are for illustrative purposes only. Your actual quote will depend on the insurer, your specific details, and your chosen cover options.
As you can see, the premium doesn't just rise—it accelerates, particularly after the age of 50. This is why securing a policy when you are younger and healthier can be a wise long-term financial strategy.
The Postcode Lottery: How Your UK Location Shapes Your Premium
The second major pillar of PMI pricing is your home address. Insurers don't look at your street to judge your lifestyle; they use your postcode to determine the cost of private medical treatment in your local area. This is known as "geographical rating" or "postcode rating."
The cost of delivering private healthcare varies enormously across the United Kingdom. A procedure in a Central London private hospital can cost significantly more than the exact same procedure in a hospital in Newcastle or Belfast.
What Drives Regional Price Differences?
Several elements contribute to this geographical price disparity:
- Hospital and Clinic Costs: The primary driver is the fee charged by private hospitals. These costs are influenced by property prices, staff wages, and the level of investment in technology. Central London hospitals, with their high overheads, are the most expensive in the country.
- Specialist Fees: The fees charged by consultant surgeons, anaesthetists, and other specialists can also vary by region. Top consultants in high-demand areas often command higher fees.
- Availability of Facilities: In areas with a high density of state-of-the-art private hospitals, prices are often higher due to the premium nature of the facilities.
- Local Demographics: While less direct, some insurers may factor in regional health statistics when modelling their risk.
Illustrative Premiums by UK Location
Let's take our example of a 45-year-old individual and see how their premium for the same comprehensive policy might change based on their location.
| Location | Illustrative Monthly Premium | Reason for Price Level |
|---|
| Central London | £160 - £220 | Highest hospital and consultant fees in the UK. |
| Manchester | £95 - £130 | Major city with competitive but still high-cost private facilities. |
| Edinburgh | £90 - £125 | Established private healthcare market, slightly less costly than Manchester. |
| Cardiff | £85 - £115 | Growing market with more moderate hospital costs. |
| Rural Cornwall | £75 - £100 | Fewer private options, leading to lower base costs. |
| Northern Ireland | £70 - £95 | A separate healthcare system with historically lower private costs. |
Disclaimer: These figures are for illustrative purposes only and do not constitute a quote.
The takeaway is clear: a Londoner could pay double what someone in a more rural area pays for identical health insurance benefits. This is why it's crucial to be precise about your address when getting a quote. If you move house, you must inform your insurer, as it will likely trigger a re-evaluation of your premium.
Before going further, it's vital to understand the fundamental purpose of private medical insurance in the UK. It is designed to cover acute conditions that arise after you take out your policy.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, joint pain requiring replacement, or cancer.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, is incurable, has no known cure, or is likely to recur. Examples include diabetes, asthma, high blood pressure, and arthritis.
Standard private medical insurance UK policies explicitly exclude treatment for chronic and pre-existing conditions.
A pre-existing condition is any ailment for which you have experienced symptoms, received medication, or sought advice from a medical professional before your policy's start date. Insurers use two main methods to handle this:
- Moratorium Underwriting: A popular and simple option. Any condition you've had in the five years before your policy starts is automatically excluded for an initial period (usually two years). If you remain symptom-free and need no treatment or advice for that condition during this two-year period, it may become eligible for cover thereafter.
- Full Medical Underwriting (FMU): You provide a detailed medical history upfront. The insurer then assesses it and explicitly states what will and will not be covered from day one. It provides certainty but can be more complex.
An expert broker like WeCovr can help you understand which type of underwriting is best for your circumstances.
Beyond Age and Location: Other Key Factors That Influence Your Premium
While age and postcode are the heavyweights, several other choices you make when designing your policy will significantly affect the final price.
1. Level of Cover
Insurers typically offer tiered plans:
- Basic/Core Cover: Usually covers inpatient and day-patient treatment (where you need a hospital bed). Diagnostics and consultations related to that hospital stay are often included.
- Mid-Range Cover: Adds a level of outpatient cover, such as a set number of specialist consultations or a financial limit for diagnostics (£500 - £1,500 per year).
- Comprehensive Cover: Offers extensive inpatient cover plus generous or unlimited outpatient benefits, often including therapies like physiotherapy and sometimes mental health support.
2. Hospital List
Insurers create lists of eligible hospitals, often grouped into tiers:
- Local/Regional List: Restricts you to a network of hospitals in your area. This is a cost-effective option if you're happy with local treatment.
- National List: Gives you access to a wide range of private hospitals across the UK, but usually excludes the most expensive Central London facilities.
- London/Premium List: The most comprehensive option, giving you access to all hospitals in the network, including the prestigious and costly ones in Central London. Choosing this significantly increases your premium.
3. Policy Excess
An excess is the amount you agree to pay towards the cost of a claim. It's a one-off payment per policy year or per claim, depending on the insurer.
- Typical Excess Levels: £0, £100, £250, £500, £1,000.
- The Rule: A higher excess leads to a lower monthly premium. Choosing a £500 excess instead of £0 can reduce your premium by 15-25%.
4. The 6-Week Option
This is a popular way to reduce costs. If you add a 6-week option, you agree to use the NHS for inpatient treatment if the NHS waiting list for that procedure is less than six weeks. If the wait is longer, your private cover kicks in immediately. Given that NHS waiting times for many elective procedures are currently far longer than six weeks (the median wait was 14.5 weeks in August 2024 according to NHS England data), this option can offer significant savings with relatively low risk.
5. No-Claims Discount (NCD)
Similar to car insurance, most PMI providers operate an NCD scale. For every year you don't claim, you move up a level on the scale, earning a larger discount on your base premium (up to a maximum of 60-75%). When you make a claim, your NCD level is typically reduced.
You can further tailor your policy with add-ons, each impacting the cost:
- Dental and Optical Cover: For routine check-ups, treatments, and eyewear.
- Mental Health Cover: Provides access to psychiatrists and therapists.
- Therapies Cover: Extends cover for physiotherapy, osteopathy, and chiropractic treatment.
Actionable Steps to Manage and Reduce Your PMI Costs
Knowing what drives your premium puts you in control. Here are practical ways to ensure you’re not overpaying for your private health cover.
- Review Your Policy Annually: Never let your policy auto-renew without checking the market. Renewal prices often include increases due to your age, medical inflation, and any claims made. An independent broker can compare your renewal offer against the entire market in minutes.
- Increase Your Excess: Are you comfortable paying the first £250 or £500 of a claim? If so, this is one of the quickest ways to lower your monthly payments.
- Refine Your Hospital List: Do you really need access to Central London hospitals if you live in Glasgow? Opting for a regional or national list can deliver substantial savings.
- Consider the 6-Week Option: As discussed, this is a powerful cost-saving feature that still provides a crucial safety net against long NHS waits.
- Embrace a Healthy Lifestyle: While it won't give you an immediate discount, long-term health is your best defence against rising premiums. Insurers reward low-claiming customers. A balanced diet, regular exercise, and sufficient sleep contribute to better health outcomes. To help with this, WeCovr provides all its health and life insurance customers with complimentary access to CalorieHero, our AI-powered diet and calorie tracking app.
- Talk to an Expert Broker: This is the most effective step. A specialist PMI broker like WeCovr has a deep understanding of the market. We can:
- Instantly compare policies from all leading UK insurers.
- Explain the subtle differences in policy wording.
- Advise on the right level of cover for your needs and budget.
- Help you switch insurers smoothly if a better deal is available.
- Provide our expert service at no cost to you.
Furthermore, when you purchase a PMI or life insurance policy through WeCovr, you may be eligible for discounts on other types of cover, such as home or travel insurance, adding even more value.
Finding the Right Policy with WeCovr
Navigating the complexities of age-bands, postcode ratings, and policy options can be daunting. The private medical insurance UK market is competitive, but finding the best value requires specialist knowledge.
At WeCovr, we demystify the process. Our team of FCA-authorised experts uses their market knowledge and technology to find the policy that fits you perfectly. We take the time to understand your priorities—whether it's budget, comprehensive cover, or a specific hospital network—and present you with clear, unbiased options. With high customer satisfaction ratings, our focus is entirely on getting the best outcome for you.
Don't let rising premiums put you off securing peace of mind. Let us help you find affordable, high-quality private health cover today.
Will my PMI premium increase every year?
It is highly likely, yes. Premiums typically increase each year for two main reasons: firstly, you will be a year older, moving you into a higher age-band associated with greater health risk. Secondly, insurers apply an increase to cover medical inflation—the rising cost of treatments, drugs, and hospital services. Making a claim will also usually reduce your no-claims discount, further increasing your renewal price.
Can I get private health insurance if I have a pre-existing condition?
Yes, you can still get private health insurance, but it's important to understand that the policy will not cover your pre-existing conditions, at least not initially. Most policies exclude any condition for which you've had symptoms or treatment in the 5 years prior to joining. With 'moratorium' underwriting, these exclusions may be lifted after a 2-year claim-free and symptom-free period. Chronic conditions like diabetes or asthma are always excluded from cover.
Is it cheaper to get PMI through a broker like WeCovr?
Using a broker like WeCovr does not cost you anything, as we are paid a commission by the insurer you choose. In many cases, it can be cheaper because a broker has access to the whole market and can find deals and policy combinations that aren't always obvious when going direct. We can quickly compare dozens of options to find the most competitive price for the level of cover you need, saving you both time and money.
Does moving house affect my private medical insurance premium?
Yes, moving house will almost certainly affect your premium. Insurers base their prices on your postcode because the cost of private healthcare varies significantly by region. Moving from a lower-cost area (like rural Scotland) to a high-cost area (like London or Surrey) will increase your premium. Conversely, moving from a city to a more rural location could lead to a reduction in your payments at your next renewal. You must always inform your insurer of a change of address.
Ready to see how your age and location impact your quote? Get a free, no-obligation quote from WeCovr today and let our experts find the best private health cover for you.