As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the unique challenges freelancers face. This guide explores if private medical insurance in the UK is right for you, demystifying costs, benefits, and those all-important tax rules for the self-employed.
Analysis for freelancers and contractors including costs, risks, and tax guidance
Navigating the world of self-employment is liberating, but it comes with a unique set of responsibilities. Unlike traditional employment, there's no sick pay, no employer-funded health plan, and no safety net if illness strikes. For the UK's 4.25 million self-employed individuals (ONS, 2024), health isn't just personal—it's the bedrock of their business.
This comprehensive guide breaks down everything a freelancer or contractor needs to know about Private Medical Insurance (PMI). We’ll explore whether it's a necessary investment, how much it costs, and critically, whether you can claim it as a business expense.
Why Should Freelancers and Contractors Consider Private Medical Insurance?
When you are your own boss, any time taken off for illness directly translates to lost income. This is the primary reason why so many independent professionals explore private health cover. The core benefit isn't about replacing the NHS; it's about managing the time and uncertainty associated with getting treatment.
The Stark Reality of NHS Waiting Lists
The NHS is a national treasure, providing exceptional care, particularly for emergencies and chronic conditions. However, for elective (planned) treatments, the waiting lists can be extensive.
According to the latest NHS England data (mid-2024), the referral-to-treatment (RTT) waiting list stands at approximately 7.5 million cases. The median waiting time is around 14 weeks, but this figure masks the full picture. Over 300,000 patients have been waiting for more than a year for treatment to begin.
For a freelancer, a 14-week wait for a knee operation or a 6-month delay for a hernia repair isn't just an inconvenience; it can be a financial disaster.
| Risk of Relying Solely on NHS for Elective Care | Impact on a Freelancer |
|---|
| Long Waiting Times | Months of lost income or working in pain, reducing productivity. |
| Uncertainty of Treatment Date | Inability to plan projects or commit to client deadlines. |
| Limited Choice of Hospital/Specialist | Less control over where and when you receive care. |
| Potential for Delays/Cancellations | Further disruption to your work schedule and income stream. |
Private medical insurance is designed to bypass these specific waiting lists for eligible conditions, giving you faster access to diagnosis and treatment.
The Freelancer's Dilemma: No Work, No Pay
Unlike an employee who is entitled to Statutory Sick Pay (SSP) and potentially contractual sick pay from their employer, a freelancer gets nothing. If you can't work, your income stops.
Consider this real-life scenario:
Alex, a freelance graphic designer, develops severe hip pain. An NHS GP refers them to a specialist. The wait for the initial consultation is 12 weeks. After the consultation, an MRI is needed (a further 6-week wait). Finally, surgery is scheduled for 5 months later. In total, Alex faces nearly a year of pain and reduced mobility, making it impossible to sit at a desk for long hours. They lose several major clients, and their income plummets.
With PMI, Alex could have potentially seen a specialist within days, had the MRI the following week, and been scheduled for surgery within a month, dramatically reducing their time off work and protecting their business.
What Does Private Medical Insurance Actually Cover?
This is the most misunderstood aspect of PMI. It's vital to be crystal clear about what you are and are not covered for.
The Golden Rule: Standard UK private medical insurance is designed to cover acute conditions that arise after you take out the policy.
- An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery (e.g., joint-pain requiring a replacement, hernias, cataracts, most cancers).
What is Almost Always Excluded?
Crucially, PMI is not designed for conditions you already have or long-term illnesses that cannot be cured.
- Pre-existing Conditions: Any illness or injury you have had symptoms of, or received advice or treatment for, before the policy start date will not be covered. Some insurers may cover them after a set period (usually two years) if you have had no further symptoms or treatment.
- Chronic Conditions: Long-term illnesses that require ongoing management but have no known cure are not covered by standard PMI. This includes conditions like diabetes, asthma, high blood pressure, and Crohn's disease. While the initial diagnosis might be covered, the long-term management will be handled by the NHS.
- Other common exclusions:
- Emergency services (A&E)
- Routine pregnancy and childbirth
- Cosmetic surgery (unless for reconstructive purposes after an eligible procedure)
- Organ transplants
- Drug and alcohol abuse treatment
- Self-inflicted injuries
What is Typically Included?
Cover is usually split into different levels, but a standard policy will often include:
| Included Treatment | Description |
|---|
| In-patient & Day-patient Treatment | Covers tests and surgery where you need to be admitted to a hospital bed, even if just for a day. Includes surgeon, anaesthetist, and hospital fees. |
| Consultant & Specialist Fees | The cost of seeing a private specialist for diagnosis and treatment planning. |
| Diagnostic Tests | Scans like MRI, CT, and PET, as well as X-rays and blood tests. |
| Cancer Care | Often comprehensive, covering surgery, chemotherapy, and radiotherapy. Access to newer, expensive drugs not always available on the NHS can be a key benefit. |
You can then add optional extras, such as:
- Out-patient Cover: For consultations and tests that don't require a hospital bed. This is a common and highly recommended add-on.
- Therapies: Cover for physiotherapy, osteopathy, and chiropractic treatment.
- Mental Health Cover: Support for conditions like stress, anxiety, and depression.
- Dental & Optical Cover: Usually for major procedures, not routine check-ups.
Understanding the Costs: How Much Does PMI Cost for a Freelancer?
The price of a PMI policy is highly personal and depends on several key factors. There is no one-size-fits-all answer, but we can provide realistic estimates.
Key Factors Influencing Your Premium
- Age: The single biggest factor. Premiums increase as you get older because the statistical likelihood of needing treatment rises.
- Location: Treatment costs vary across the UK. Living in London or other major cities often results in higher premiums due to more expensive private hospitals.
- Level of Cover: A basic policy covering only in-patient care will be much cheaper than a comprehensive plan with full out-patient, mental health, and therapy cover.
- Excess: This is the amount you agree to pay towards a claim. A higher excess (£500 or £1,000) will significantly lower your monthly premium.
- Hospital List: Insurers offer different lists of hospitals you can use. A policy limited to local hospitals will be cheaper than one giving you access to premium central London clinics.
- Underwriting: The method the insurer uses to assess your medical history.
- Moratorium (Most Common): You don't declare your full medical history upfront. The insurer automatically excludes anything you've had symptoms of or treatment for in the last 5 years. These exclusions can be lifted after 2 years on the policy, provided you remain symptom and treatment-free for that specific condition.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer gives you a definitive list of what is and isn't covered from day one. This takes longer but provides more certainty.
Example Monthly PMI Costs for a Freelancer (2025 Estimates)
The table below shows illustrative costs. These are for non-smokers with a £250 excess. Your actual quote will vary.
| Age | Basic Cover (In-patient only) | Mid-Range Cover (In-patient + limited out-patient) | Comprehensive Cover (Full cover + therapies) |
|---|
| 30 | £35 - £50 | £55 - £75 | £80 - £110 |
| 45 | £50 - £70 | £75 - £100 | £110 - £150 |
| 60 | £90 - £130 | £140 - £190 | £200 - £280+ |
Using a specialist PMI broker like WeCovr is the easiest way to navigate these options. We can instantly compare the market for you, explaining the differences between policies from providers like Bupa, AXA Health, Aviva, and Vitality, ensuring you don't overpay for cover you don't need.
The Big Question: Are There Tax Perks for Freelancers with PMI?
This is where your business structure—sole trader or limited company—is critical. The rules are very different.
Disclaimer: The following is for guidance purposes only. You must speak with a qualified accountant for advice tailored to your specific circumstances.
For Sole Traders
The rule here is simple and unambiguous.
If you are a sole trader, private medical insurance is considered a personal expense, not a business expense. You cannot deduct the cost of your PMI premiums from your income to reduce your tax bill.
You pay for the policy out of your post-tax profits. The logic from HMRC is that the insurance benefits you as a person, not exclusively your business. Even though your health is essential for your business to function, the benefit is not deemed to be "wholly and exclusively" for the purpose of trade.
For Limited Company Directors
This is where things become more nuanced and where potential tax efficiencies can be found.
A limited company is a separate legal entity from you, the director. The company can purchase a PMI policy for you as an employee/director.
Here’s how it works:
- The Company Pays: The limited company pays the monthly or annual PMI premium directly to the insurer.
- Allowable Business Expense: This premium is an allowable business expense for the company. This means it can be deducted from the company's profits before Corporation Tax is calculated, thereby reducing the company's tax bill.
- Benefit in Kind (P11D): However, HMRC sees this as a non-cash benefit provided to you, the director. It has a monetary value (the cost of the premium) and is therefore treated as a "Benefit in Kind".
- Reporting: The company must report this benefit to HMRC on a P11D form each year.
- Personal Tax for the Director: The value of the premium is added to your personal income for the year, and you will pay Income Tax on it at your marginal rate (20%, 40%, or 45%).
- National Insurance for the Company: The company must also pay Class 1A Employer's National Insurance Contributions (NICs) on the value of the benefit. For the 2024/25 tax year, this is 13.8%.
Worked Example: Limited Company Director
Let's see how this plays out in practice.
- Director: Sarah, a 45-year-old IT contractor.
- Company: Sarah IT Services Ltd.
- PMI Premium: £1,200 per year (£100 per month).
- Sarah's Income Tax Rate: 40% (Higher Rate).
- Company's Corporation Tax Rate: 25% (assuming profits over £250k).
| Calculation Step | Limited Company | Sarah (Director) |
|---|
| 1. Company pays premium | -£1,200 from bank | n/a |
| 2. Corporation Tax Saving | £1,200 x 25% = +£300 | n/a |
| 3. Employer's NICs (P11D) | £1,200 x 13.8% = -£165.60 | n/a |
| 4. Income Tax on Benefit | n/a | £1,200 x 40% = -£480 |
| Total Company Cost | -£1,200 (premium) + £300 (tax saving) - £165.60 (NICs) = -£1,065.60 | |
| Total Personal Cost | | |
| Overall Net Cost | £1,065.60 (company) + £480 (personal) = £1,545.60 | |
So, is it worth it?
At first glance, the total cost (£1,545.60) is more than the premium (£1,200). So where is the benefit?
The alternative would be for Sarah to pay for the PMI personally. To have £1,200 left over to pay the premium, she would first have to draw that money from her company as a dividend.
- To get £1,200 in her hand, she'd need to take a larger dividend from the company, which would first have been subject to Corporation Tax.
- Let's say she takes a £1,600 dividend from the company's post-tax profits. She'd then pay dividend tax on this.
- The calculation becomes complex, but in many higher-rate scenarios, paying it through the company as a benefit in kind is more tax-efficient than drawing extra dividends to pay for it personally. It also looks cleaner on the company's books.
The key takeaway is that for limited company directors, paying for PMI through the business is a legitimate and common practice. While not a "tax-free perk," it is often a tax-efficient way of funding health cover. Always consult your accountant.
Is PMI Necessary? Weighing the Risks and Rewards
Ultimately, the decision is personal. It’s about balancing cost against peace of mind and financial risk.
Arguments FOR PMI:
- Protects Your Income: The number one reason for freelancers. Less time waiting means more time earning.
- Speed of Access: See a specialist and get diagnosed in days, not months.
- Choice and Control: Choose your specialist and hospital, and schedule treatment at a time that minimises disruption to your work.
- Comfort and Privacy: A private room can make a huge difference to your recovery.
- Access to Advanced Treatments: Some policies offer access to drugs or treatments not yet approved for widespread NHS use due to cost.
Alternatives & Arguments AGAINST PMI:
- Cost: The monthly premium is an ongoing business or personal expense that could be used elsewhere.
- The NHS is Excellent: For emergencies, serious accidents, and chronic care management, you will be using the NHS anyway.
- Self-Insuring: You could put the equivalent of the monthly premium into a high-interest savings account. If you stay healthy, you keep the money. The risk is that a single major procedure could cost £10,000-£20,000+, wiping out your savings instantly. A hip replacement, for example, can cost over £13,000 privately.
- Health Cash Plans: These are a cheaper alternative to PMI. They don't cover major surgery but provide cashback on routine expenses like dental check-ups, eye tests, physiotherapy, and prescriptions. They are a good budget option for everyday health maintenance.
Beyond Insurance: Proactive Health and Wellness for Freelancers
Staying healthy is the best insurance of all. As a freelancer, investing in your well-being is a direct investment in your business's resilience.
- Ergonomics: Invest in a proper office chair, monitor stand, and keyboard to prevent repetitive strain injury (RSI) and back pain.
- Movement: Take regular breaks from your desk to stretch and walk around. A standing desk can be a game-changer.
- Nutrition: Plan your meals to avoid relying on convenience food. Staying hydrated is crucial for focus. Many clients who use WeCovr for their PMI also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support their health goals.
- Sleep: Prioritise 7-9 hours of quality sleep per night. It’s fundamental to cognitive performance, mood, and immune function.
- Mental Health: Freelancing can be isolating. Schedule social interactions, connect with other freelancers, and don’t be afraid to set firm boundaries with clients to prevent burnout.
Many modern PMI policies include excellent wellness benefits, such as gym discounts, free coffee, cinema tickets, and mental health support apps, rewarding you for staying active and healthy.
Furthermore, when you arrange your private medical insurance through WeCovr, we can often provide discounts on other essential cover types, like income protection or life insurance, helping you build a comprehensive financial safety net.
How to Choose the Best PMI Policy: A 5-Step Guide
- Assess Your Needs: What are you most worried about? Is it fast access to diagnostics, cancer care, or physio for a sports injury? Your priorities will determine your ideal level of cover.
- Set Your Budget: Decide what you can comfortably afford each month. This will guide your choice of excess and cover level.
- Choose a Hospital List: Do you need access to top London hospitals, or are you happy with a list of quality local private hospitals? A "national" list provides more choice but costs more.
- Decide on Underwriting: For most, "Moratorium" is the simplest and quickest option. If you have a complex medical history and want absolute clarity from day one, "Full Medical Underwriting" may be better.
- Speak to an Expert Broker: This is the most important step. A broker doesn't charge you a fee; they are paid a commission by the insurer you choose. An independent, FCA-authorised broker like WeCovr works for you, not the insurer. We provide impartial advice, compare the whole market, and handle the application process, saving you time and money.
Ready to protect your health and your freelance business? Let WeCovr's experts find the perfect private medical insurance UK policy for you.
Can I get PMI if I have a pre-existing condition?
Yes, you can still get private medical insurance. However, the pre-existing condition itself, and any related conditions, will be excluded from cover. The policy will only cover new, eligible acute conditions that arise after your policy begins. It is vital to understand that PMI is not for managing existing health problems.
Is private health insurance tax-deductible for a sole trader in the UK?
No. For sole traders, HMRC considers private medical insurance a personal expense, not a business one. This means you cannot claim the premiums as an expense to reduce your income tax or National Insurance liability. You must pay for it from your after-tax income.
How does a limited company pay for a director's health insurance?
The limited company can pay the premium directly. This payment is an allowable business expense, which reduces the company's Corporation Tax bill. However, the premium is treated as a taxable "benefit in kind" for the director, who must pay income tax on the value of the benefit. The company must also pay Class 1A National Insurance on the premium amount. You must declare this on a P11D form. Always consult an accountant for specific advice.
What's the difference between moratorium and full medical underwriting?
With Moratorium underwriting, you don't declare your medical history upfront. The policy automatically excludes conditions you've had symptoms of or treatment for in the last 5 years. With Full Medical Underwriting (FMU), you complete a detailed health questionnaire, and the insurer tells you exactly what is and isn't covered from the start. Moratorium is faster, while FMU provides more certainty.
Take the Next Step
Your health is your most valuable asset. Don't leave it to chance. The experts at WeCovr are on hand to provide clear, independent advice tailored to the needs of freelancers and contractors.
Get your free, no-obligation PMI quote from WeCovr today and discover how affordable peace of mind can be.