NHS Waiting List at 7.4 Million Leads More UK Adults to Seek PMI
TL;DR
As an FCA-authorised UK broker that has helped arrange over 900,000 policies, WeCovr has seen a significant shift in how people view their health. With NHS pressures mounting, understanding private medical insurance has never been more vital. This guide breaks down everything you need to know.
Key takeaways
- Accidents and Emergencies (A&E): If you have a serious accident or a medical emergency, you go to your local A&E department.
- GP Services: Your NHS GP remains your first point of contact for health concerns.
- Management of Chronic Conditions: Long-term illnesses like diabetes or asthma are managed by the NHS.
- Acute Condition (Covered): A condition that can be cured. For example, a bone fracture, appendicitis, or the need for a knee replacement. The treatment has a clear beginning and end.
- Chronic Condition (Not Covered): A long-term condition that needs ongoing management but typically cannot be cured. Examples include diabetes, high blood pressure, asthma, and arthritis. The NHS manages these.
As an FCA-authorised UK broker that has helped arrange over 900,000 policies, WeCovr has seen a significant shift in how people view their health. With NHS pressures mounting, understanding private medical insurance has never been more vital. This guide breaks down everything you need to know.
Amid rising NHS treatment delays, demand for private medical insurance has reached a new peak, with 7.6 million adults now covered—1 million more than in 2020
The UK's relationship with healthcare is changing. For decades, the National Health Service (NHS) has been the bedrock of our wellbeing, a promise of care for all, free at the point of use. Yet, in the face of unprecedented strain, this promise is being tested.
According to the latest NHS England data, the waiting list for routine hospital treatment has reached a staggering 7.4 million. This figure represents not just numbers on a spreadsheet, but millions of individuals waiting for procedures like hip replacements, cataract surgery, and vital diagnostic tests—waits that can stretch for months, and sometimes years.
In response, a growing number of UK adults are taking control of their health by turning to private medical insurance (PMI). Industry figures from the Association of British Insurers (ABI) show that the number of people covered by a private policy has swelled to 7.6 million. This is a remarkable increase of over one million people since 2020, highlighting a clear trend: people are no longer just thinking about private healthcare; they are actively investing in it for peace of mind and faster access to treatment.
This comprehensive guide will explore the reasons behind this surge, explain how PMI works, and help you decide if it's the right choice for you and your family.
What is Private Medical Insurance (PMI) and How Does It Work?
Think of private medical insurance as a healthcare safety net that runs alongside the NHS. It's a policy you pay for, either monthly or annually, that covers the cost of private treatment for specific types of medical conditions.
It's not a replacement for the NHS. You will still rely on the NHS for:
- Accidents and Emergencies (A&E): If you have a serious accident or a medical emergency, you go to your local A&E department.
- GP Services: Your NHS GP remains your first point of contact for health concerns.
- Management of Chronic Conditions: Long-term illnesses like diabetes or asthma are managed by the NHS.
So, where does PMI step in?
PMI is designed to cover acute conditions that arise after you take out your policy. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include joint pain requiring a hip replacement, cataracts needing surgery, or hernias that can be repaired.
The Critical Distinction: Acute vs. Chronic Conditions
This is the single most important concept to understand about private medical insurance UK.
- Acute Condition (Covered): A condition that can be cured. For example, a bone fracture, appendicitis, or the need for a knee replacement. The treatment has a clear beginning and end.
- Chronic Condition (Not Covered): A long-term condition that needs ongoing management but typically cannot be cured. Examples include diabetes, high blood pressure, asthma, and arthritis. The NHS manages these.
Similarly, standard PMI policies do not cover pre-existing conditions—any illness or injury you had symptoms of, or received advice or treatment for, before your policy started.
The journey with PMI usually looks like this:
- You feel unwell and visit your NHS GP.
- Your GP diagnoses the issue and recommends you see a specialist.
- Instead of joining the NHS waiting list, you contact your PMI provider.
- The insurer authorises your claim (if the condition is covered).
- You book an appointment with a private specialist at a time and hospital that suits you, often within days or weeks.
- The PMI policy covers the costs of the consultation, diagnostics (like MRI scans), and subsequent treatment, up to the limits of your plan.
The Numbers Unpacked: A Closer Look at the NHS Waiting List Crisis
The 7.4 million figure is more than just a headline; it represents a complex backlog of care. This number, from NHS England's Referral to Treatment (RTT) data, refers to the number of individual cases waiting to start consultant-led elective care.
The delays are not evenly spread. Some specialities are under far greater pressure than others.
| Medical Speciality | Common Procedures | Typical NHS Waiting Time (Median) |
|---|---|---|
| Trauma & Orthopaedics | Hip replacement, knee replacement | 20-22 weeks |
| Ophthalmology | Cataract surgery | 16-18 weeks |
| General Surgery | Hernia repair, gallbladder removal | 18-20 weeks |
| Cardiology | Diagnostic tests, pacemaker fitting | 15-17 weeks |
| Gynaecology | Hysterectomy, endometriosis treatment | 19-21 weeks |
Source: NHS England RTT waiting times data, 2025. Please note these are median waits; many patients wait significantly longer.
For many, a 20-week wait for a new hip isn't just an inconvenience; it's 20 weeks of persistent pain, reduced mobility, and a potential inability to work or enjoy life. It's this "hidden cost" of waiting that is driving the demand for private health cover.
Why Are More People Turning to Private Health Cover?
The decision to invest in PMI is deeply personal, but it's often driven by a combination of practical and emotional factors.
- Speed of Access: This is the primary driver. Bypassing long NHS queues to get diagnosed and treated quickly can dramatically improve your quality of life and health outcomes.
- Peace of Mind: Knowing you have a plan in place to deal with health issues swiftly reduces anxiety for you and your family.
- Choice and Control: PMI offers greater flexibility. You can often choose your specialist or surgeon, select the hospital you're treated in, and schedule appointments at times that fit around your life and work.
- Comfort and Privacy: Private treatment usually means a private room with an en-suite bathroom, more flexible visiting hours, and better food choices—small comforts that can make a big difference during a stressful time.
- Protecting Your Income: For the self-employed, freelancers, or small business owners, a long spell of ill health can be financially devastating. Faster treatment means getting back to work and earning again sooner.
- Rise in Employer Schemes: More companies are offering PMI as a valuable employee benefit to attract and retain talent. It shows they care about their team's wellbeing and helps reduce sickness-related absence.
Understanding Your PMI Options: A Guide to UK Policies
The private medical insurance market can seem confusing, but most policies are built around a few core concepts. Understanding these will help you find the right cover.
Levels of Cover
- Basic / In-patient Only: This is the entry-level option. It covers the costs of treatment when you are admitted to a hospital bed overnight (in-patient) or for the day (day-patient). It won't cover the initial consultations or diagnostics needed to get you there.
- Mid-Range / Standard: This is the most popular level of cover. It includes everything in a basic plan, plus a set amount of cover for out-patient services. This means the specialist consultations and diagnostic tests (like MRI, CT scans, and X-rays) leading up to a hospital stay are also paid for.
- Comprehensive: The top tier of cover. It offers full in-patient and day-patient cover, along with more extensive out-patient cover. These plans often include additional benefits like mental health support, dental and optical cover, and alternative therapies.
| Feature | Basic Cover | Standard Cover | Comprehensive Cover |
|---|---|---|---|
| In-patient/Day-patient Treatment | ✅ | ✅ | ✅ |
| Surgeon & Anaesthetist Fees | ✅ | ✅ | ✅ |
| Private Hospital Costs | ✅ | ✅ | ✅ |
| Out-patient Consultations | ❌ | ✅ (up to a limit, e.g., £1,000) | ✅ (often unlimited) |
| Out-patient Diagnostics | ❌ | ✅ (up to a limit) | ✅ (often unlimited) |
| Mental Health Cover | ❌ | Optional Extra | ✅ (often included) |
| Therapies (Physio, Osteo) | ❌ | Optional Extra | ✅ (often included) |
Key Policy Choices
-
Underwriting: This is how an insurer assesses your medical history.
- Moratorium Underwriting: Quicker to set up. You don't declare your full medical history upfront. Instead, the insurer automatically excludes treatment for any condition you've had symptoms of, or received treatment for, in the last 5 years. If you then go 2 continuous years on the policy without any issues relating to that condition, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer reviews your medical history and explicitly lists any conditions that will be excluded from cover. It takes longer but provides absolute clarity from day one.
-
Excess: This is the amount you agree to pay towards a claim. For example, if you have a £250 excess and your treatment costs £3,000, you pay the first £250 and the insurer pays the remaining £2,750. A higher excess leads to a lower monthly premium.
-
Hospital List: Insurers have different lists of approved hospitals. A policy with a limited list of local hospitals will be cheaper than one that gives you access to premium central London hospitals.
How Much Does Private Medical Insurance Cost in the UK?
The cost of a PMI policy is highly individual. Insurers calculate your premium based on several risk factors:
- Age: Premiums increase as you get older.
- Location: Treatment costs vary across the country, so living in London or the South East is typically more expensive.
- Lifestyle: Smokers pay significantly more than non-smokers.
- Cover Level: A comprehensive plan costs more than a basic one.
- Excess: A higher excess lowers your premium.
Here are some illustrative examples of monthly premiums for a non-smoker on a standard, mid-range policy with a £250 excess.
| Profile | Location | Estimated Monthly Premium |
|---|---|---|
| 30-year-old individual | Manchester | £45 - £60 |
| 45-year-old individual | Bristol | £65 - £85 |
| 55-year-old couple | London | £180 - £250 |
| Family of four (40s parents) | Birmingham | £150 - £220 |
These are estimates for illustrative purposes only. Your actual quote will depend on your specific circumstances and the insurer chosen.
Ways to make your cover more affordable include:
- Opting for a higher excess.
- Choosing a moratorium underwriting basis.
- Selecting a reduced hospital list.
- Considering a "6-week wait" option, where you agree to use the NHS if the waiting list for your treatment is less than six weeks.
Navigating the Market: How an Expert PMI Broker Can Help
While you can go directly to an insurer, using an independent PMI broker like WeCovr can save you time, money, and hassle. A good broker provides a service that is free to you—they earn a commission from the insurer you choose, which doesn't affect the price you pay.
Here’s why using a broker is a smart move:
- Independent Advice: WeCovr isn't tied to any single provider. We compare policies from across the market to find the one that truly fits your needs and budget.
- Expert Knowledge: We understand the small print, the jargon, and the key differences between insurers. We can explain complex terms like moratorium vs. full medical underwriting in simple language.
- Personalised Service: We take the time to understand your personal circumstances, health concerns, and what you want from a policy before making a recommendation.
- Hassle-Free Process: We handle the paperwork and application process for you, ensuring everything is completed accurately.
- Ongoing Support: Our service doesn't stop once the policy is in place. We're here to help if you have questions or need assistance at the point of a claim.
As an FCA-authorised firm with high customer satisfaction ratings, our goal is to provide clarity and confidence in a complex market.
Beyond Treatment: The Rise of Wellness and Preventative Care in PMI
Modern private health cover is about more than just paying for operations. The best PMI providers are increasingly focused on keeping you healthy in the first place.
Many policies now include a fantastic range of value-added benefits, often at no extra cost:
- Virtual GP Services: 24/7 access to a GP via phone or video call, allowing you to get medical advice and prescriptions quickly, without leaving your home.
- Mental Health Support: Access to counselling sessions, support phone lines, and digital tools to help manage stress, anxiety, and other mental wellbeing concerns.
- Wellness Programmes: Discounts on gym memberships, fitness trackers (like Apple Watch or Fitbit), and even healthy food.
- Health Screenings: Proactive health checks to catch potential issues early.
At WeCovr, we enhance this further. When you purchase a PMI or life insurance policy through us, we provide complimentary access to our proprietary AI-powered nutrition app, CalorieHero, to support your health goals. We also offer exclusive discounts on other types of cover, like home or travel insurance, providing even greater value to our clients.
Important Exclusions: What PMI Typically Doesn't Cover
It's just as important to know what isn't covered by PMI to avoid any surprises when you need to make a claim. As mentioned, the main exclusions are for conditions that are not "acute."
Standard UK PMI policies will not cover:
- Pre-existing Conditions: Any medical issue you had before your policy start date.
- Chronic Conditions: Long-term illnesses requiring ongoing management, such as diabetes, asthma, arthritis, or high blood pressure. These remain under the care of the NHS.
- Emergency Services: A&E visits are an NHS service.
- Normal Pregnancy and Childbirth: Uncomplicated maternity care is provided by the NHS. Some policies may cover complications.
- Elective Cosmetic Surgery: Procedures chosen for aesthetic reasons.
- Drug, Substance, or Alcohol Abuse Treatment.
- Self-inflicted Injuries.
Real-Life Scenarios: When PMI Makes a Difference
Scenario 1: Sarah, the Freelance Graphic Designer Sarah, 42, develops severe knee pain that makes it difficult to sit at her desk. Her GP diagnoses a torn meniscus and refers her for surgery. The NHS waiting list is 9 months. For Sarah, this means 9 months of pain and lost income. She uses her PMI policy, sees a specialist in a week, and has keyhole surgery three weeks later. She's back at work within a month.
Scenario 2: David, the Retiree David, 68, experiences chest pains and palpitations. He's worried, and the NHS appointment for a cardiologist is 14 weeks away. His PMI provider's virtual GP service arranges an immediate video call. The GP refers him to a private cardiologist, who he sees within four days. After an ECG and echocardiogram, he's reassured it's just anxiety. The speed and reassurance give him invaluable peace of mind.
Scenario 3: The Patel Family The Patels have a family PMI policy through their employer. Their 5-year-old son, Leo, develops a high fever on a Sunday evening. Instead of waiting until Monday or going to A&E, they use the 24/7 virtual GP service included in their plan. The doctor diagnoses a throat infection and sends an electronic prescription to their local late-night pharmacy. The convenience saves them time and worry.
Can I get private medical insurance if I have a pre-existing condition?
Is private health cover worth the money in the UK with the free NHS?
Does private medical insurance cover cancer?
The healthcare landscape is evolving, and with it, so are our choices. While the NHS remains a cherished institution, the reality of current pressures means that waiting for care has become a new norm. For over a million more people in the UK, private medical insurance has become the definitive answer for regaining control, securing peace of mind, and ensuring swift access to the treatment they need, when they need it.
Ready to explore your options? Get a free, no-obligation quote from a WeCovr expert today and find the right private health cover for your peace of mind.
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.
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