As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr know that understanding the cost of private medical insurance in the UK can feel complex. This guide breaks down exactly how insurers calculate your premiums, giving you the expert knowledge to make an informed choice.
In-depth look at premium pricing factors age, postcode, underwriting type, benefit limits, excess, and market trends affecting prices in 2025
Private health insurance is a personal contract between you and an insurer. The price you pay, known as the premium, reflects the insurer's assessment of the likelihood you will need to claim for private medical treatment. This isn't a random figure; it's a carefully calculated sum based on a combination of personal details, policy choices, and wider market forces.
Let's demystify these factors one by one.
The 6 Core Factors That Determine Your PMI Premium
Your final premium is a blend of several key ingredients. While some you can't change (like your age), others you can adjust to find a price that fits your budget.
1. Your Age: The Most Significant Factor
It's a simple fact of life: as we get older, we are more likely to require medical care. Insurers view age as the primary indicator of risk.
- Why does age matter so much? From a statistical standpoint, the incidence of many health conditions, from joint problems to heart disease and cancer, increases with age. Data from the Office for National Statistics (ONS) consistently shows a higher prevalence of long-term health conditions in older age groups.
- How it impacts your premium: Premiums rise in line with age. The increases are typically modest in your 20s and 30s but can become more significant from your 50s onwards. Insurers have detailed actuarial tables that map out the statistical risk for every year of age.
Example: Illustrative Monthly Premium by Age
This table shows how a premium for the same level of cover can change purely based on age. These are illustrative figures for a non-smoker in a mid-cost UK region.
| Age Bracket | Illustrative Monthly Premium | Why the Change? |
|---|
| 30-39 | £45 | Lower statistical risk of needing major medical treatment. |
| 40-49 | £65 | Risk begins to increase for various conditions. |
| 50-59 | £90 | Significant increase in risk for age-related illnesses. |
| 60-69 | £140 | Higher likelihood of claims for joint replacements, cardiac care, etc. |
2. Your Postcode: Location, Location, Location
Where you live in the UK has a direct and surprisingly large impact on your private health insurance costs. This is because the cost of private medical treatment varies dramatically across the country.
- The "London Effect": Central London hospitals, with their world-renowned specialists and high operating costs, are the most expensive in the UK. A policy that includes access to these facilities will carry a much higher premium.
- Hospital Lists: Insurers manage this by creating "hospital lists." A basic policy might give you access to a national network of good-quality private hospitals but exclude the premium-priced ones in Central London. A comprehensive policy will offer a wider choice, including those top-tier London hospitals, but at a higher cost.
Example: Illustrative Monthly Premium by Postcode
Here's how the same policy for a 45-year-old might vary by location.
| Location | Illustrative Monthly Premium | Reason for Difference |
|---|
| Rural Scotland | £55 | Lower private hospital and consultant fees. |
| Manchester | £70 | Major city with higher costs than rural areas. |
| Central London | £110 | Access to the most expensive private hospitals in the country. |
An expert broker like WeCovr can help you understand the hospital list options and select one that provides excellent care in your area without you paying for access to hospitals you're unlikely to use.
3. Your Underwriting Type: How Your Medical History is Assessed
Underwriting is the process an insurer uses to assess your medical history and decide what they will and won't cover. This is a crucial choice that affects both your price and your cover.
Crucial Point: Standard UK private medical insurance is designed to cover acute conditions – illnesses or injuries that are likely to respond quickly to treatment. It does not cover chronic conditions (like diabetes or asthma) or pre-existing conditions you had before taking out the policy.
There are two main types of underwriting for new policies:
- Moratorium (MORI) Underwriting: This is the most common and straightforward option. You don't have to declare your full medical history upfront. Instead, the insurer applies a blanket exclusion for any condition you've had symptoms, advice, or treatment for in the last five years.
- The "2-5-2 Rule": A pre-existing condition might become eligible for cover after you've held the policy for two continuous years, provided you have had no symptoms, treatment, medication, or advice for that condition (or a related one) during that two-year period.
- Full Medical Underwriting (FMU): With FMU, you complete a detailed health questionnaire, disclosing your entire medical history. The insurer's underwriting team then assesses this information and tells you from day one exactly what will be excluded from your policy.
Which Underwriting Type is Right for You?
| Feature | Moratorium (MORI) | Full Medical Underwriting (FMU) |
|---|
| Upfront Process | Quick and simple. No medical questionnaire. | Longer process. Requires a detailed health questionnaire. |
| Clarity on Cover | Some initial uncertainty. Claims can be delayed while history is checked. | Complete certainty from day one. You know exactly what is excluded. |
| Cover for Pre-existing | Conditions may become eligible for cover after a 2-year symptom-free period. | Exclusions are usually permanent and written into the policy for life. |
| Best For | People with a clean bill of health or those who prefer a faster application. | People with a complex medical history who want absolute clarity upfront. |
For those switching providers, there is also Continued Personal Medical Exclusions (CPME) underwriting, which allows you to carry your existing exclusions over to a new insurer, ensuring continuous cover without new moratorium periods.
4. Your Level of Cover: Tailoring Your Benefits
This is where you have the most control. A "bare-bones" policy is much cheaper than an all-inclusive one. You can mix and match options to build a plan that suits your priorities and budget.
Key choices include:
- Inpatient vs. Outpatient Cover:
- Inpatient: Covers treatment when you are admitted to a hospital bed overnight. This is the core of any PMI policy.
- Outpatient: Covers consultations, diagnostic tests (like MRI scans), and procedures that don't require a hospital stay. Limiting or removing outpatient cover is a popular way to reduce premiums.
- Cancer Cover: All standard PMI policies offer a good level of cancer care. However, "comprehensive" cancer cover provides access to a wider range of specialist drugs and therapies that may not be available on the NHS.
- Mental Health Cover: Basic policies may offer limited cover, while more comprehensive plans provide extensive support for both inpatient and outpatient psychiatric treatment.
- Therapies: Cover for physiotherapy, osteopathy, and chiropractic treatment can often be added or have its limits adjusted.
- Add-ons: Options like dental, optical, and travel cover can be added for an extra cost.
Example: Basic vs. Comprehensive Cover
| Benefit | Basic Plan Example (£50/month) | Comprehensive Plan Example (£95/month) |
|---|
| Inpatient/Day-patient | Full Cover | Full Cover |
| Outpatient Cover | £500 limit per year | Full Cover |
| Cancer Cover | Standard NHS-approved drugs | Comprehensive, including experimental drugs |
| Mental Health | Limited to outpatient | Full inpatient and outpatient cover |
| Therapies | Not included | Included up to £1,000 per year |
5. Your Excess: Sharing a Small Part of the Cost
An excess is a fixed amount you agree to pay towards a claim. It works just like the excess on your car or home insurance. For example, if you have a £250 excess and make a claim for a £3,000 procedure, you would pay the first £250 and the insurer would pay the remaining £2,750.
- How it affects your premium: The higher the excess you choose, the lower your monthly or annual premium will be.
- Common options: Excesses typically range from £0 to £1,000. Choosing a £250 or £500 excess can offer a good balance between premium savings and out-of-pocket cost if you do need to claim.
6. The "6-Week Option": A Smart Way to Save
This is a popular feature that can significantly lower your premium. If you choose the 6-week option, your private treatment will only be covered if the waiting time for that same treatment on the NHS is longer than six weeks. If the NHS can treat you within six weeks, you would use the NHS.
This is a fantastic compromise for many, ensuring you're never left waiting long for treatment while keeping your policy affordable. It’s private cover that works in partnership with the NHS.
Market Trends Influencing PMI Prices in 2025
Beyond your personal circumstances, wider economic and social trends are pushing private health cover prices up. Understanding these helps explain why your renewal premium might increase.
- Soaring NHS Waiting Lists: The single biggest driver of demand for PMI. As of mid-2025, NHS England's waiting list for routine consultant-led treatment remains stubbornly high, with millions of people waiting. This long wait for diagnostics and surgery pushes more people towards the private sector, increasing demand and therefore claim costs for insurers.
- Medical Inflation: The cost of healthcare consistently rises faster than general inflation (the Consumer Price Index). In 2025, medical inflation is running at an estimated 8-10%. This is driven by:
- The cost of new, more effective drugs and treatments.
- Advances in complex diagnostic and surgical technology.
- Increased wages for highly skilled medical staff.
- Insurance Premium Tax (IPT): This is a government tax on all general insurance policies, including PMI. It currently stands at 12% and is automatically added to your premium. Any future rise in IPT would directly increase your cost.
- Increased Use of Mental Health Services: The post-pandemic era has seen a necessary and welcome increase in people seeking support for mental health. This increases the volume of claims for psychiatric and therapy services, which insurers must factor into their pricing.
How WeCovr Helps You Find the Best Value
Navigating these variables can be daunting. As an independent and FCA-authorised PMI broker, WeCovr does the hard work for you.
- We Compare the Whole Market: We have access to policies from all the leading UK providers, including Bupa, AXA Health, Vitality, and Aviva. We compare their prices, benefits, and hospital lists side-by-side.
- Expert, Personalised Advice: Our experts take the time to understand your needs, budget, and health priorities. We can explain the pros and cons of a moratorium vs. full medical underwriting, or help you decide if a £1,000 outpatient limit is right for you. Our advice comes at no cost to you.
- Exclusive Benefits: When you arrange a policy through us, you get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support your health goals. We also offer discounts on other insurance products, like life or income protection, if you hold a PMI policy with us. Our high customer satisfaction ratings reflect our commitment to finding you the right cover.
A Note on Wellness: Taking Control of Your Health
While healthy habits don't directly give you a discount on a new PMI policy, they are the best long-term investment you can make. Many insurers, like Vitality, now actively reward healthy behaviour with perks and even premium reductions at renewal.
- Diet: A balanced diet rich in fruit, vegetables, and whole grains can reduce the risk of many chronic diseases.
- Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. Even a brisk 30-minute walk five days a week makes a huge difference.
- Sleep: Aim for 7-9 hours of quality sleep per night. It's vital for mental resilience, immune function, and physical recovery.
By taking proactive steps to manage your health, you not only improve your quality of life but also reduce your long-term reliance on medical services, whether public or private.
Frequently Asked Questions (FAQ)
Are my pre-existing medical conditions covered by private health insurance?
Generally, no. Standard UK private medical insurance is designed to cover new, acute conditions that arise after your policy begins. Pre-existing conditions and chronic conditions (long-term illnesses like diabetes or asthma) are typically excluded. However, if you choose 'Moratorium' underwriting, a pre-existing condition may become eligible for cover after you have been on the policy for two years, provided you have been completely free of symptoms, treatment, and advice for it during that time.
Can I lower my PMI premium once my policy has started?
Yes, you absolutely can. The best time to review your cover is at your annual renewal. You can speak to your broker to explore options like increasing your excess, adding the 6-week option, reducing your outpatient cover limit, or changing your hospital list to a more local network. These adjustments can make a significant difference to your renewal price without compromising on core inpatient cover.
Why does a policy that includes London hospitals cost so much more?
The cost is higher simply because the cost of providing private medical treatment in Central London is significantly more expensive than anywhere else in the UK. This is due to higher property costs, staff wages, and the concentration of highly specialised consultants and cutting-edge facilities. Insurers pass this cost on through higher premiums for policies that grant access to these top-tier hospitals.
Does being a smoker or vaper affect my private health insurance premium?
Yes, it often does. Many insurers will ask about your smoking or vaping status in their application. As smoking is a major risk factor for a wide range of health issues, including cancer and heart disease, insurers may charge a higher premium for smokers. The exact increase varies by insurer, but it reflects the higher statistical likelihood of future claims.
Ready to Find the Right Cover at the Right Price?
Understanding how premiums are calculated puts you in control. The next step is to see what this means for you.
Contact WeCovr today for a free, no-obligation quote. Our expert team will compare the market and help you build a private medical insurance policy that protects your health and your budget.