Inpatient vs Outpatient Cover What Do You Really Need
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr knows that navigating the world of private medical insurance (PMI) in the UK can feel complex. The key to unlocking the right policy lies in understanding its core components: inpatient and outpatient cover.
WeCovr's guide to understanding the different tiers of private healthcare cover
Choosing a private health insurance policy is one of the most significant decisions you can make for your health and wellbeing. It's a commitment to gaining faster access to high-quality medical care when you need it most. But with so many options, terms, and levels of cover, it's easy to feel overwhelmed.
The fundamental choice you'll face is the level of cover you need, which primarily boils down to the distinction between 'inpatient' and 'outpatient' care. Getting this right is crucial. It dictates not only what treatments you're covered for but also how much your policy will cost.
This comprehensive guide will demystify these terms, break down the different tiers of cover, and empower you to make an informed decision that perfectly balances your healthcare needs with your budget.
What is Inpatient Cover? The Foundation of Your Health Insurance
In simple terms, inpatient care is any treatment that requires you to be admitted to a hospital and occupy a bed, even if it's just for one night. Think of it as the core protection that nearly every private medical insurance policy is built upon.
If you have an inpatient-only policy, you are covered for the major medical events that necessitate a hospital stay.
What Inpatient Cover Typically Includes:
- Hospital Accommodation: A private room with an en-suite bathroom, providing comfort and privacy during your recovery.
- Nursing Care: Round-the-clock care from the hospital's nursing team.
- Surgery Costs: This includes the fees for the surgeon who performs the procedure and the anaesthetist.
- Specialist Consultations: Any consultations with your specialist that take place while you are admitted to the hospital.
- Diagnostics and Tests: Any scans (MRI, CT), X-rays, or blood tests conducted during your hospital stay.
- Medication: All prescribed drugs administered while you are an inpatient.
- Prostheses and Implants: The cost of items like an artificial hip or knee joint.
- Limited Post-operative Care: Some policies include a set number of follow-up consultations or a limited course of physiotherapy after your discharge to aid recovery.
Real-Life Example: A Knee Replacement
Let's imagine you need a knee replacement. Here’s how a policy with inpatient cover would work:
- Diagnosis (NHS or Self-funded): You would likely have your initial diagnosis and consultations via the NHS or by paying for them yourself if you only have inpatient cover.
- Admission: Once your surgery is scheduled, you are admitted to a private hospital. Your inpatient cover kicks in now.
- Treatment: Your insurer covers the cost of your private room, the surgeon's and anaesthetist's fees, the knee implant itself, and all the care you receive during your multi-day stay.
- Discharge: Upon leaving the hospital, your policy might also cover the first few physiotherapy sessions to start your rehabilitation.
In essence, inpatient cover is your safety net for significant, acute medical procedures that require admission to hospital.
What is Outpatient Cover? The Day-to-Day Diagnostic and Treatment Option
Outpatient care refers to any medical consultation, test, or treatment where you visit a hospital or clinic but are not admitted to a bed. You walk in, have your appointment or procedure, and walk out on the same day.
This is the part of your healthcare journey that typically happens before an inpatient stay is deemed necessary. It's all about diagnosis: finding out what's wrong and planning the next steps.
What Outpatient Cover Typically Includes:
- Specialist Consultations: Seeing a consultant (like a cardiologist, dermatologist, or orthopaedic surgeon) after a GP referral to get an expert opinion.
- Diagnostic Tests and Scans: This is a major benefit. It covers MRI scans, CT scans, PET scans, X-rays, and extensive blood tests to diagnose your condition quickly.
- Minor Procedures: Small surgical procedures that can be performed in a day-case unit without needing an overnight stay.
- Therapies: Access to services like physiotherapy, osteopathy, and chiropractic care to treat musculoskeletal issues.
Real-Life Example: Investigating Persistent Back Pain
Let's say you've been suffering from severe lower back pain that isn't improving.
- GP Referral: You visit your NHS GP, who recommends you see an orthopaedic specialist.
- Specialist Consultation: With outpatient cover, you can book an appointment with a private specialist within days, bypassing the potentially long NHS wait. Your policy covers the consultation fee.
- Diagnostic Scans: The specialist suspects a slipped disc and refers you for an MRI scan. Your outpatient cover pays for the scan, which you can often get within a week.
- Follow-up and Treatment Plan: You see the specialist again to discuss the scan results. They recommend a course of physiotherapy. Your policy's therapy cover pays for these sessions.
Without outpatient cover, you would either rely on the NHS for each of these steps, facing significant waiting times, or have to pay for them out-of-pocket, which can be very expensive. A single MRI scan, for example, can cost between £300 and £800 privately.
The Core Difference: Inpatient vs Outpatient Cover Explained
The easiest way to understand the distinction is to think about whether a hospital bed is involved overnight. The table below breaks it down clearly.
| Feature | Inpatient Cover | Outpatient Cover |
|---|---|---|
| Definition | Care that requires admission to a hospital for an overnight stay or longer. | Consultations, tests, or treatments where you visit a hospital or clinic and leave the same day. |
| When It's Used | For surgery, major medical treatments, and post-operative recovery. | For diagnosing a condition, pre-operative assessments, follow-up appointments, and therapies. |
| Examples | Hip replacement, heart surgery, cancer treatment requiring a hospital stay, removal of appendix. | Specialist consultations, MRI/CT scans, blood tests, physiotherapy, allergy testing, minor day-case procedures. |
| Key Purpose | To cover the costs of significant medical treatment and hospitalisation. | To speed up diagnosis and provide access to treatment that doesn't require a hospital bed. |
The Tiers of Private Medical Insurance Cover: Finding Your Level
UK private medical insurance providers structure their policies into tiers, allowing you to choose a level of cover that suits your needs and budget. These tiers are almost always defined by the amount of outpatient cover included.
Tier 1: Basic (Inpatient-Only) Cover
This is the entry-level and most affordable type of private health cover. It focuses on providing for the most expensive potential treatments—those requiring a hospital stay.
- What it Covers: Full inpatient and day-patient treatment. Some basic policies may also include cover for cancer treatment and limited post-operative follow-ups.
- Who it's For:
- Individuals on a tighter budget.
- People who are happy to use the NHS for diagnostics (seeing specialists, getting scans) but want the peace of mind of having private treatment for major issues.
- Those looking to protect themselves against the high costs of surgery and a private hospital stay.
- Pros: The lowest monthly premium. Provides a crucial safety net for serious conditions.
- Cons: You will face NHS waiting times for diagnosis. If you want to speed this up, you'll have to pay for all outpatient consultations and tests yourself.
Tier 2: Mid-Range (Inpatient + Limited Outpatient) Cover
This is the most popular choice for UK consumers, offering a fantastic balance between comprehensive cover and affordability. It includes full inpatient cover plus a financial limit for outpatient services.
- What it Covers: Full inpatient and day-patient treatment, plus a set annual limit for outpatient costs (e.g., £500, £1,000, or £1,500). Once you've used up this outpatient allowance, you would need to self-fund any further outpatient care for that policy year or use the NHS.
- Who it's For:
- The majority of people seeking PMI. It's the "best of both worlds."
- Those who want to bypass NHS waiting lists for diagnosis and get a treatment plan in place quickly.
- Pros: Significantly speeds up the entire patient journey. The financial limit is often sufficient for most diagnostic processes. Offers great value for money.
- Cons: For a very complex condition requiring multiple specialists and numerous scans, you could potentially exceed your outpatient limit.
Tier 3: Fully Comprehensive (Inpatient + Full Outpatient) Cover
This is the premium tier of health insurance, providing the most extensive cover available. It is designed for those who want complete peace of mind and minimal reliance on the NHS for any eligible condition.
- What it Covers: Full inpatient and day-patient treatment, plus unlimited (or a very high limit) cover for all outpatient consultations, diagnostics, and therapies.
- Who it's For:
- Individuals and families who want the highest level of assurance.
- Those for whom budget is less of a concern than having complete coverage.
- Pros: Covers the entire private patient journey from the first symptom to full recovery, without you having to worry about financial limits for diagnostics.
- Cons: The most expensive level of cover.
| Cover Tier | Inpatient Cover | Outpatient Cover | Ideal For |
|---|---|---|---|
| Basic | ✅ Full Cover | ❌ None (or very limited) | Budget-conscious individuals; cover for major surgery is the priority. |
| Mid-Range | ✅ Full Cover | ✅ Capped Limit (e.g., £1,000) | The majority of people; balancing cost with fast diagnosis. |
| Comprehensive | ✅ Full Cover | ✅ Full Cover (or very high limit) | Maximum peace of mind; budget is not the primary concern. |
Critical Information: What UK PMI Does NOT Cover
This is arguably the most important section to understand. Private medical insurance is a specific product designed for a specific purpose. It is not a replacement for the NHS but rather a complementary service.
PMI is designed to cover new, acute conditions that arise after your policy has started.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. A broken arm or appendicitis are classic examples.
There are two key areas that standard UK PMI policies do not cover:
1. Chronic Conditions
A chronic condition is an illness that is long-lasting or recurrent and typically cannot be cured, only managed. Examples include:
- Diabetes
- Asthma
- High blood pressure (hypertension)
- Arthritis
- Eczema
- Crohn's disease
The day-to-day management of chronic conditions will always remain under the care of your NHS GP and specialists. PMI is not designed for this ongoing, long-term care.
2. Pre-existing Conditions
A pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, or sought advice before the start date of your policy.
Insurers handle this through a process called underwriting. The two main types are:
- Moratorium Underwriting: This is the most common method. The policy automatically excludes any condition you've had in the 5 years before joining. However, if you remain treatment-free and advice-free for that condition for a continuous 2-year period after your policy starts, the exclusion may be lifted.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire when you apply. The insurer assesses your medical history and may place specific, permanent exclusions on your policy for any pre-existing conditions. This provides certainty from day one about what is and isn't covered.
Other Common Exclusions:
- Emergency care (A&E visits)
- Routine pregnancy and childbirth
- Cosmetic surgery (unless for reconstructive purposes after an accident or eligible surgery)
- Treatment for alcohol or substance abuse
- Self-inflicted injuries
Do You Really Need Outpatient Cover? A Self-Assessment Guide
This is the million-dollar question. The answer depends entirely on your personal circumstances, your attitude to risk, and your budget. The key value of outpatient cover is speed.
According to the latest NHS England data (published in late 2024), the elective care waiting list remains a significant challenge, with millions of treatment pathways waiting to be started. The median waiting time for consultant-led treatment can be many weeks, and for some specialities in some areas, much longer.
This is where outpatient cover proves its worth. Ask yourself these questions:
Consider a Basic (Inpatient-Only) Policy if:
- Is your primary concern being covered for the high cost of a major operation?
- Are you on a strict budget and need the most affordable premium?
- Are you patient and comfortable using the NHS for all your diagnostic tests and specialist appointments, even if it means waiting?
Consider a Mid-Range (Limited Outpatient) Policy if:
- Do you want to avoid lengthy NHS waiting lists to find out what's wrong with you?
- Do you want a sensible balance between comprehensive benefits and a manageable monthly premium?
- Like most people, do you feel that a financial limit of £1,000-£1,500 for diagnostics offers a great level of security?
Consider a Fully Comprehensive Policy if:
- Is having complete peace of mind, with no financial caps on diagnostics, your top priority?
- Is your budget flexible enough to accommodate the highest level of cover?
- Do you want the reassurance that any eligible condition will be handled privately from the very first consultation to the final therapy session?
For many, the mid-range option is the sweet spot. It addresses the primary frustration with public healthcare—waiting times for diagnosis—while keeping premiums reasonable.
The WeCovr Advantage: Expert Guidance and Added Value
Choosing the right level of inpatient and outpatient cover is a complex decision. This is where an expert, independent broker like WeCovr becomes an invaluable partner. Our role is to understand your unique needs and search the market to find the policy that fits you perfectly.
- Expert, Unbiased Advice: We are authorised and regulated by the Financial Conduct Authority (FCA). Our specialists aren't tied to any single insurer; our advice is focused purely on what's best for you.
- Market Comparison at No Cost: Our service is completely free to you. We compare policies from the UK's best PMI providers to find the optimal combination of cover and price.
- Exclusive Benefits: When you arrange a policy through WeCovr, you get more than just insurance. You'll receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to support your health goals. Furthermore, customers who purchase PMI or life insurance often qualify for discounts on other types of cover.
Our high customer satisfaction ratings reflect our commitment to providing clear, helpful, and personalised service.
Beyond Inpatient and Outpatient: Other PMI Features to Consider
While the inpatient vs outpatient decision is central, there are other elements you can tailor to build your perfect policy.
| Feature | Description | Impact on Premium |
|---|---|---|
| Excess | The fixed amount you agree to pay towards the cost of a claim (e.g., £100, £250, £500). This is usually paid once per policy year, per person. | A higher excess will lower your monthly premium. |
| Hospital List | Insurers have lists of eligible hospitals. A "local" list is cheaper than a "national" one. A list including prime central London hospitals is the most expensive. | A more restrictive hospital list will lower your premium. |
| Six-Week Option | A clause stating that if the NHS can provide your inpatient treatment within six weeks of it being recommended, you will use the NHS. If the wait is longer, your private cover kicks in. | Adding this option significantly lowers your premium. |
| Add-Ons | You can often add extra cover for an additional cost, such as for mental health, dental and optical treatment, or a wider range of therapies. | These will increase your premium. |
Talking through these options with a specialist at WeCovr can help you fine-tune your policy to get the best possible value.
A Note on Wellness: Preventing the Need for a Claim
The best way to manage your health is to stay healthy. Private medical insurance is there for when things go wrong, but a proactive approach to wellness can reduce your risk of needing it. Many insurers now actively reward healthy living.
- Balanced Diet: Focus on whole foods, fruits, vegetables, and lean proteins. Our complimentary CalorieHero app can be a fantastic tool to help you track your nutrition and make healthier choices.
- 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.
- Quality Sleep: Aim for 7-9 hours of quality sleep per night. It's vital for physical healing, mental clarity, and immune function.
- Stress Management: Chronic stress can impact your physical health. Incorporate activities like mindfulness, yoga, or simply spending time on hobbies you enjoy to manage your stress levels.
Can I get private health insurance for a pre-existing condition?
Do I still need to pay National Insurance if I have private medical insurance?
What is a policy excess and how does it work?
Can I add my family to my private medical insurance policy?
Ready to Find Your Perfect Level of Cover?
Understanding the difference between inpatient and outpatient cover is the first step towards choosing a health insurance policy that gives you true peace of mind. The right choice for you will depend on your priorities, your budget, and how you wish to use private healthcare alongside the NHS.
Don't navigate this decision alone. Let the friendly experts at WeCovr do the hard work for you. We'll listen to your needs, explain your options in simple terms, and provide you with a comparison of quotes from leading UK insurers, all at no cost.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
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