Review: Martin Lewis' In-depth Guide to Private Health Insurance in the UK

Martin Lewis’ 2025 Guide to Private Medical Insurance: A Comprehensive Review

Why More People Are Turning to Private Health Insurance

Understanding Private Medical Insurance: The Basics

• Consultations and diagnostics with specialists (e.g. seeing a consultant privately for tests/scans)
• In-patient hospital treatment (surgery or procedures requiring an overnight stay in a private hospital)
• Out-patient therapy (such as physiotherapy, minor procedures not needing admission) – often up to a limit unless you have comprehensive cover
• Cancer treatment (many policies cover chemotherapy/radiotherapy and cutting-edge drugs not available on the NHS)
• Mental health treatment (on some plans, therapy or psychiatric care is included or optional)

• Underwriting method: When you apply, insurers either ask for your full medical history or use a moratorium clause. With full medical underwriting (FMU), you disclose all pre-existing conditions upfront (the insurer may even contact your GP). The upside is you know exactly what’s covered or excluded from day one, and any future claims should process faster with less doubt. The downside is it takes longer to set up and any pre-existing conditions will almost certainly be excluded. With a moratorium underwriting, you don’t have to detail your history at sign-up; instead, the policy automatically excludes any condition you’ve had in the past few years (usually 5 years prior to the start) until you’ve been symptom-free of it for a continuous period (typically 2 years) after the policy begins. Moratorium policies are quicker and often cheaper initially, but if you claim in the first couple of years, the insurer will check your records and won’t cover anything pre-existing. About 95% of UK individual PMI policies are on a moratorium basis – it’s very common. The key point: pre-existing conditions are generally not covered by new PMI policies (unless you pay more for a specialized policy or have continuous employer cover that “disregards” medical history). So, if you’ve just recovered from something or are in treatment, you usually can’t insure that risk now. However, if you stay healthy for a couple years, a moratorium policy might then start covering the condition going forward. It’s crucial to read the underwriting terms and, if in doubt, speak to a broker or the insurer about how any past illness will be handled.
• Excess: Like car or home insurance, PMI often has an excess – an amount you pay towards claims. You can usually choose the level (common options: £100, £250, £500, sometimes up to £1,000+). A higher excess significantly lowers your premium, because you’re agreeing to shoulder more of the cost for any treatment. For example, an example from Martin’s guide showed a policy costing £31/month with no excess dropped to ~£21/month with a £500 excess – a one-third saving for a sizable excess. Insurers have different ways the excess is applied: some take it per claim (each unrelated claim you pay the first £X), others per policy year (you pay the excess only on the first claim in any year). The latter is preferable if you make multiple claims in one year, but those policies might charge a bit more. A few insurers offer a unique excess structure – e.g. WPA’s “shared responsibility” where instead of a fixed excess, you pay a percentage of each claim (like 25%) up to a cap. Martin suggests thinking about “what level of expense would you not mind paying yourself?”. If you only want insurance for big-ticket surgeries and would pay small stuff out-of-pocket, go with a high excess “emergency only” cover to cut costs. On the other hand, if you want even minor diagnostics covered, accept a higher premium for a low or zero excess. Some people adopt a hybrid strategy: combine a high-excess cheap policy with their own savings pot (self-insurance) for minor costs – this way, the premium is low but you know you have funds for out-of-pocket costs. It’s a bit of a balancing act, but it can yield the best of both worlds: affordable cover and manageable expenses.
• Policy scope (modularity): Most providers let you tailor coverage or choose different plan levels. A basic hospital-only plan might cover inpatient treatments (surgeries, hospital stays) but not outpatient (consultations, scans done without admission) or not include mental health or therapies. Comprehensive plans cover more, or you can often add extras like outpatient cover, mental health cover, dental cover, or worldwide travel insurance as add-ons. Deciding what you need can be tricky – for example, outpatient cover is very useful (it covers the initial investigations leading up to a diagnosis), but including unlimited outpatient benefits can hike the premium a lot. Some cost-saving tweaks include opting for an outpatient cap (e.g. £1,000 per year) instead of unlimited, or removing outpatient entirely if you only worry about big surgeries. Insurers also offer mental health and dental as optional riders – adding them means paying more, so consider if you could instead use the NHS or a separate dental plan. As Martin’s team advises, decide if you want the policy to “cover every eventuality or just big things?” If it’s just a safety net for major issues, you can trim the extras to reduce cost.
• Network/hospital choice: Every policy comes with a list of hospitals where you can receive treatment (the provider network). Insurers often have tiers: local/regional hospitals vs national network vs premium London teaching hospitals. The broader the hospital list, the higher the premium. If you live outside London, you might save by excluding London hospitals (which charge more); if you’re in London, some policies have a surcharge. It’s worth checking which hospitals are included – if you have good local private hospitals, a cheaper limited network is fine. Also, insurers usually require that the specialists you see are approved and fee-assured – if you go to a non-approved doctor who charges above the insurer’s limits, you could face a shortfall. In practice, this is manageable by sticking to the insurer’s list, but always double-check with your insurer before undergoing treatment to ensure it’s covered in full.
• No-claims and renewal increases: PMI is annually renewable, and premiums tend to rise each year, often above general inflation. This is due to age band increases (as you get older, you move into higher risk brackets) plus medical cost inflation (new treatments, etc.). Some policies have a No Claims Discount (NCD) like car insurance – your premium rises more gently if you don’t claim, but a large claim can knock your discount and lead to a jump. Other insurers (like Vitality) forego NCD for a different model (Vitality uses an “A + B + C” pricing formula: Age + Base cost + Claims). Either way, expect costs to creep up. In fact, research shows average PMI premiums rise steeply with age – a 50-year-old pays ~66% more than a 30-year-old for the same cover, and a 70-year-old pays 132% more than a 50-year-old. It underscores why shopping around at renewal or haggling is important (more on that in Martin’s tips below).

Martin Lewis’s Top Tips for Saving on Health Insurance

Family Health Insurance: Covering Your Loved Ones

Health Insurance for the Self-Employed: Staying Fit for Business

Health Insurance for Over-60s and Seniors

• Review and adjust your cover every year. As one over-50s insurance expert says, the single most important thing is to shop around regularly. Never just accept a huge renewal increase without checking alternatives. Some insurers have been known to significantly jack up premiums in later years, assuming customers won’t switch due to fear of losing coverage for existing conditions. While health conditions can indeed lock you in, sometimes competitors might offer a better deal even with an exclusion or a moratorium for that condition that you’re willing to accept. According to the FCA and financial advisers, an annual PMI review in your 60s is wise. Staying active in the market could save you a lot – for instance, one testimonial cites an adviser saving a client £600 per month by finding a more suitable policy for an older couple. That’s extreme, but not impossible if someone had stuck with an overpriced legacy insurer for too long.
• Haggle and consider downgrades. If you want to stick with your insurer (perhaps because they cover your conditions already), try negotiating. Insurers might offer a loyalty discount or suggest ways to reduce cost. You could increase your excess (if you haven’t already) – at 60+, maybe you set aside savings and take a £1,000 excess to cut premiums. You might also remove add-ons: e.g. do you need the optional travel insurance rider if you’re not traveling as much? Remove it to save money. Dental/optical add-ons could go – perhaps you can pay those out of pocket. Scale back outpatient cover if you’re comfortable using NHS for diagnostics then going private for the operation only. Each removed extra can trim the premium.
• Use “guided” or restricted options. Some insurers offer innovations like guided consultant networks – you agree to use the insurer’s chosen specialists (reducing choice) in exchange for ~20% lower cost. This can be fine if you don’t mind which specific consultant you see as long as they’re qualified. Similarly, using a smaller hospital list (like not including London) or adding the 6-week wait option (only go private if NHS wait exceeds 6 weeks) can lower costs significantly. These involve trade-offs in flexibility, so consider carefully. But if price is the barrier, they’re levers to pull.
• Consider switching to an insurer that favours older customers. The market has some specialists or policies more lenient to seniors. For example, Bupa has no upper age limit to join and has competitive pricing for seniors according to myTribe’s research. Bupa being a non-profit can reinvest profits into keeping member costs down. The Exeter accepts new members up to 80 and (as mentioned) tries to be fair on claims impact and exclusions for older clients. Saga partners with an insurer (currently Saga’s health insurance is provided by AXA Health) to target the over-50s market – they might tailor cover for that demographic, possibly with higher excess or unique perks (Saga in the past offered a fixed 2-year price deal, for instance). Vitality will take you up to 80 as well (after 80 you can stay but not buy new). Vitality’s model might benefit very health-conscious seniors who remain active (since tracking exercise can lower premiums). On the other hand, Vitality doesn’t use no-claims discounts, which could be either good or bad depending on your usage.
• Underwriting for older ages: If you’re over 60 and switching insurers, be aware that any pre-existing conditions you’ve developed will likely be excluded under a new policy (or need a special high-premium arrangement). If you have longstanding issues (e.g. past heart attack, diabetes, etc.), a new insurer might simply not cover those. Some insurers offer medical history disregarded enrolment if you join as part of a group or sometimes through certain retirement schemes, but it’s rare for individuals. So switching late in life is tricky. Many advisers recommend if you do have PMI and develop a serious condition in your 60s, you might want to keep that policy for life if you can, because it’s covering something that a new policy wouldn’t. If you’ve been healthy and have no active conditions, switching could save money because you’re effectively like a new customer medically.
• Partial coverage alternatives: If full PMI is too pricey, older people might consider alternatives like hospital cash plans (which pay a set amount per night in hospital), or just a health cash plan for smaller things plus a savings fund for big things. Another approach: some private hospitals offer fixed-price self-pay packages for certain surgeries. You could skip insurance and pay out-of-pocket if something happens – but that’s a gamble, as costs could be very high for complex treatments. Some also turn to limited term insurance – e.g. insure yourself until 75 and then stop. It’s a personal decision on risk tolerance and finances.

Comparing Top UK Health Insurance Providers (2025)

• Bupa is a household name and tends to have very comprehensive coverage. Being non-profit, it often channels profits into member benefits – they had some of the most extensive mental health cover and no upper age limit which makes them popular with older customers. Bupa’s large customer base also means they have lots of feedback; currently rated 4.3/5 on Trustpilot. Bupa’s strengths: huge hospital network, Direct Access services (you can sometimes refer yourself for certain conditions like cancer or mental health without GP referral), and a breadth of plans. Weaknesses: price can still be high for top-tier cover, and their outpatient cover on lower plans can be limited unless you buy full comprehensive.
• AXA Health (formerly AXA PPP) is similarly big. They often price keenly for corporate schemes and reasonably for individual, though maybe a tad more than Bupa at times. They shine in offering modular choices and have a good cancer care reputation. They also have no upper age join limit as far as standard policy (I believe one can join AXA at any age, but check). They partnered with Vitality for some corporate ventures historically but in retail they’re separate.
• Aviva is known for flexibility – e.g., you can opt out of their psychiatric cover or out-patient to save costs. They also have a unique cancer coverage downgrade option (to use NHS for cancer after diagnosis, which not everyone would take, but it’s there). Aviva’s digital GP is a newer addition, showing they keep up with trends.
• Vitality has really disrupted the market in the last decade with its Apple Watch, rewards, and emphasis on wellness. Vitality’s entire model is built on the concept of encouraging healthy behaviour through incentives. Younger customers who like the idea of “interactive insurance” gravitate to it. Vitality’s premiums can increase significantly if you don’t maintain a certain level of activity (their model assumes you will engage; if you don’t, your renewal might reflect higher “risk”). But they do offer some unique things like no annual limit on out-patient by default (instead they trust their risk pricing model). They also exclude some things by policy structure – for example, Vitality’s core plan might not cover out-patient diagnostics unless you buy a certain module. One plus: they don’t have a no-claims bonus, which means if you claim small things, you’re not hit by an NCD step-back (however they do consider claims in their A+B+C pricing). It can make renewal pricing a bit more transparent.
• WPA is smaller but punches above its weight in customer satisfaction. As a not-for-profit like Bupa, they’ve historically been commended. Their “shared responsibility” excess is fairly unique: some self-employed folks or those with savings like it because it automatically halves any bill (since you pay 25% up to a cap you choose). If a claim is huge, you hit your cap and they pay the rest, so you never pay more than (cap + 25% of amount above cap until cap is reached). It can sometimes yield savings if you have medium sized claims. WPA also has specialist plans for certain professions (they have a “Provident” policy for civil service and others, historically).
• The Exeter is known in reviews as a top choice for older policyholders. They have fewer reviews (Trustpilot ~888 reviews, 4.2/5, which is good). They seem to try to individualise underwriting rather than blanket exclude everything you’ve ever seen a GP about, which can be beneficial if you have complex history – they might manually review and say “we’ll cover X, but exclude Y specifically” rather than excluding an entire body system.
• Others: There are also health trusts and cash plan providers but those are outside pure PMI comparison. Some people use something like Benenden Health (a mutual healthcare society) – it’s not insurance but provides access to certain private consultations and short operations for a low flat fee per year. It’s worth mentioning as an alternative: Benenden costs around £11/month and can cover some elective surgeries after NHS wait of a certain time. However, it has limitations (a cap on how many per year etc.).

Digital Healthcare and Wearable Tech: The 2025 Landscape

Regulatory and Market Outlook for 2025 and Beyond

• Insurance Premium Tax (IPT): All insurance premiums in the UK (except life insurance) incur IPT, currently at 12%. There has been growing pressure on this tax because as premiums rise, so do tax receipts – effectively making insurance less affordable. In late 2024, IPT receipts hit a record high, partly “driven by… increased demand for health insurance,” as one industry expert noted. There were worries the government might increase IPT further to raise revenue (it’s been hiked multiple times in the past). However, raising IPT on health insurance is controversial since it’s like taxing people for taking pressure off the NHS. Some argue for a cut or exemption for PMI. The Autumn 2024 budget discussions included these debates. So far no change, but keep an eye out – a future government might freeze or reduce IPT for health policies.
• Tax relief proposals: As mentioned, Reform UK and others have floated the idea of giving perhaps 20% tax relief on PMI premiums (effectively making them tax-deductible). This is not adopted by the major parties yet, but there is an undercurrent of support in some circles as the NHS backlog persists. If such a policy were implemented, it could spur a big increase in PMI membership (making it more affordable for millions). In the near term (2025 general election upcoming), it’s not a promised policy by either the Conservatives or Labour. Labour instead focuses on using private sector via the NHS (outsourcing) rather than incentivising individuals to buy insurance, at least publicly.
• NHS improvements vs continued strain: Government has infused some funding to tackle waiting lists and by early 2025 the list had stabilised or slightly reduced from its peak. If the NHS significantly improves access, the appeal of PMI could dampen a bit. However, with an aging population and staff shortages, most projections show NHS pressure remaining high for years. So, the factors driving PMI interest likely persist in medium term. Some analysts even talk of the UK possibly moving subtly toward a more European model where basic care is public but a significant private insurance sector coexists for faster access – not by explicit policy, but by sheer demand.
• Regulatory protection for consumers: The FCA keeps an eye on insurance pricing practices. In general insurance, they banned “price walking” (loyal customers charged more) for home and motor. PMI was not part of that specific regulation, but there is attention on fair value. If insurers are seen to exploit inertia in older customers, the FCA could intervene. Already, as consumers become more price-savvy (with Martin Lewis banging the drum to compare and haggle), the market hopefully corrects some loyalty penalties. The Financial Ombudsman as mentioned is the avenue for complaints. Notably, PMI complaints sometimes arise around declined claims for chronic vs acute definitions, or rejected pre-authorisations. The ombudsman tends to judge based on policy wording and treating customers fairly – for example, if an insurer’s sales materials misled a customer into thinking something would be covered, FOS might side with the customer. These external checks help maintain trust in PMI.
• Consolidation and partnerships: The PMI industry has seen some consolidation (e.g., AXA took over the PMI book of Ageas, Bupa absorbed CS Healthcare in 2022). This might continue – smaller players finding it hard to compete may merge or exit. However, new insurtech startups could also enter with niche offerings, especially focusing on gig economy workers or providing more flexible short-term cover. None have significantly disrupted yet, but it’s a space to watch. WeCovr and similar platforms try to simplify buying PMI for younger demographics.
• Focus on value and outcomes: We might see insurers differentiating more on quality of outcomes – e.g., offering networks that guarantee quicker recovery or using data to send you to the “best” surgeons (some already do this via guided option). There’s a push for value-based healthcare even in the private sector: insurers partnering with providers to bundle costs and ensure follow-up, etc. For the patient, this might mean more predictable bills (e.g., fixed fees with no surprises) and maybe extra services like rehab programmes included.
• Claims inflation: One reason premiums go up is medical inflation – new treatments cost more. For instance, high-cost cancer drugs or advanced therapies (like proton beam therapy) can be very expensive. Insurers typically cover drugs approved by NICE for NHS use and often beyond that on a case-by-case basis if they think it’s effective. As new treatments emerge (gene therapies, etc.), there will be questions of what PMI covers. This could affect policy terms or optional add-ons (perhaps in future there’ll be an extra-cost option to cover certain cutting-edge treatments). Keep an eye on your policy updates each year – insurers do adjust terms, hopefully for the better, but sometimes with new limitations (they will inform customers of changes at renewal).

Conclusion

• Assess your needs and alternatives: Don’t just buy PMI because others are – make an informed choice. The NHS still provides excellent emergency and chronic care; PMI is mostly about elective treatment speed and convenience. If that’s crucial to you (or your family or work), then PMI can be worthwhile. If not, you might “self-insure” or use NHS + pay-as-you-go private where absolutely necessary.
• If you go for it, get the best price/quality: Use Martin’s tips – compare quotes online, utilise cashback deals and don’t hesitate to negotiate with insurers at renewal. Choose a higher excess or restricted hospital list to bring premiums into a comfortable range, essentially tailoring the policy to cover what you care about and leaving out fluff. Consider specialist advice (brokers) especially if you have any medical history to navigate.
• Leverage the modern benefits: Today’s PMI is not just an insurance policy but a package of health services. Take advantage of that 24/7 virtual GP to avoid hassle for minor issues. Wear that Fitbit and get your rewards if you’re with an insurer like Vitality. Call the counselling helpline if you’re feeling anxious. These services add significant day-to-day value, so make sure you’re aware of everything your insurer provides – often listed in your welcome pack or online portal. Many members under-use their plans, not realising they could get, say, a free flu jab or an annual check-up included.
• Keep an eye on changes: The health insurance landscape can shift with new policies or industry changes. For example, if any government in future re-introduces PMI tax relief, that might save you money. Or if NHS wait times drop below 6 weeks broadly, maybe that 6-week option on your policy becomes an easy choice to save money (since you’d rarely trigger private treatment if NHS is quick). Being aware of the context (like reading guides such as this!) will help you adjust your strategy.