TL;DR
Record NHS waiting lists are prompting more UK residents to use private medical insurance, driving up claims and premiums. As an FCA-authorised UK broker that has helped arrange over 900,000 policies of various kinds, WeCovr explains this trend and how you can manage your health cover costs. Insurers report higher claims as patients bypass NHS delays The UK's private medical insurance (PMI) market is experiencing a significant shift.
Key takeaways
- Advancements in Technology: New, more effective treatments and diagnostic tools are often more expensive.
- An Ageing Population: An older population naturally requires more medical care.
- Increased Demand: As we're seeing now, when an entire population shifts its demand from a public system to a private one, private providers can and do increase their prices.
- NHS Waiting Lists Grow: Patients face long, often painful, waits for diagnosis and treatment.
- Patients Turn to PMI: Those with insurance use it to get seen quickly.
Record NHS waiting lists are prompting more UK residents to use private medical insurance, driving up claims and premiums. As an FCA-authorised UK broker that has helped arrange over 900,000 policies of various kinds, WeCovr explains this trend and how you can manage your health cover costs.
Insurers report higher claims as patients bypass NHS delays
The UK's private medical insurance (PMI) market is experiencing a significant shift. For years, PMI served as a complementary service to the National Health Service (NHS). Now, it's increasingly becoming a primary route to treatment for those who can't afford to wait.
Leading health insurers have reported a sharp increase in the number of claims. This isn't because the nation has suddenly become less healthy. Instead, it's a direct consequence of the unprecedented pressure on the NHS. With NHS England data from late 2024 showing waiting lists for routine treatments involving millions of patient pathways, individuals and employers with PMI are turning to their policies for faster access to care.
This surge in claims has a direct, unavoidable impact on the cost of insurance for everyone. Insurers are paying out more for treatments that, in previous years, might have been handled within the NHS. This increased cost is now being passed on to policyholders in the form of higher premiums at renewal.
The Vicious Cycle: How NHS Delays Fuel PMI Claim Inflation
It's a classic case of supply and demand, but with a critical healthcare twist. The strain on the NHS has created a surge in demand for private healthcare, leading to a phenomenon known as 'medical inflation'.
What is Medical Inflation?
Medical inflation is the rate at which the cost of healthcare—including doctors' fees, hospital charges, and new medical technology—increases. It almost always outpaces general inflation (the Consumer Price Index, or CPI).
There are several reasons for this:
- Advancements in Technology: New, more effective treatments and diagnostic tools are often more expensive.
- An Ageing Population: An older population naturally requires more medical care.
- Increased Demand: As we're seeing now, when an entire population shifts its demand from a public system to a private one, private providers can and do increase their prices.
The current situation creates a feedback loop:
- NHS Waiting Lists Grow: Patients face long, often painful, waits for diagnosis and treatment.
- Patients Turn to PMI: Those with insurance use it to get seen quickly.
- Claims Volume Rises: Insurers see a huge increase in claims for common procedures like hip replacements, cataract surgery, and hernia repairs.
- Insurers' Costs Increase: They pay out more in claims than they had projected.
- Premiums Are Raised: To remain financially stable, insurers increase the price of PMI policies for all customers at renewal.
- The Value of PMI Grows: Despite the cost, the ability to bypass NHS queues makes PMI more valuable, encouraging more people to buy or keep their cover.
Think of it like car insurance. If there were suddenly a huge increase in accidents and repair costs across the country, all drivers would see their premiums go up at renewal, regardless of whether they had made a claim themselves. The same principle applies to private health cover.
What Does This Mean for Your PMI Premiums in 2025?
If you have a private medical insurance UK policy, you have likely noticed your renewal premium is higher than last year. This increase is typically due to two main factors:
- Age-Related Increases: All PMI premiums are priced based on age. As you get older, the statistical likelihood of you needing medical treatment increases, so your base premium rises each year. This is a standard feature of every policy.
- Medical Inflation: This is the market-wide factor driven by the increased claims we've discussed. Insurers adjust their prices to reflect the rising cost and volume of treatments.
According to industry analysis, many policyholders are seeing renewal increases of between 15% and 25% or even higher in 2024 and into 2025, a combination of these factors.
Here is a hypothetical example of how premiums could change for an individual with a comprehensive policy.
| Age | 2024 Monthly Premium | 2025 Renewal Premium (Example 20% Increase) |
|---|---|---|
| 35 | £55 | £66 |
| 45 | £70 | £84 |
| 55 | £95 | £114 |
| 65 | £150 | £180 |
Disclaimer: These figures are for illustrative purposes only. Your actual premium will depend on your specific circumstances, insurer, and level of cover.
The Crucial Role of Private Medical Insurance in the Modern UK
Despite rising costs, the case for having private health cover has arguably never been stronger. The core benefits of PMI directly address the challenges currently facing the NHS.
- Speed of Access: This is the number one reason people buy PMI. Bypassing lengthy waiting lists for consultations, diagnostics (like MRI scans), and surgery can mean the difference between months of pain and a swift return to normal life.
- Choice and Control: PMI gives you more control over your healthcare journey. You can often choose the specialist who treats you and the hospital where you receive care.
- Comfort and Privacy: Treatment in a private hospital typically means a private, en-suite room, more flexible visiting hours, and a quieter, more comfortable environment in which to recover.
- Access to Latest Treatments: Some policies provide cover for new drugs or treatments that may not yet be available on the NHS due to funding decisions.
For employers, offering PMI as a benefit is a powerful tool for attracting and retaining talent. It demonstrates a commitment to employee wellbeing and helps minimise productivity losses caused by staff being on long-term sickness absence while waiting for NHS treatment.
Understanding What Your PMI Policy Covers (and What It Doesn't)
This is the most important section of this article. A misunderstanding of what PMI is for can lead to disappointment and frustration.
UK private medical insurance 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. Think of a cataract, a hernia, or a joint that needs replacing.
- A chronic condition is a disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, it has no known cure, it comes back or is likely to come back.
- A pre-existing condition is any health issue you had, sought advice for, or experienced symptoms of before the start date of your policy.
Standard PMI policies DO NOT cover chronic or pre-existing conditions.
This is a fundamental principle of the UK insurance market. PMI is not a replacement for the NHS; it is a system designed to run alongside it, providing prompt treatment for new, curable conditions. The NHS remains the primary provider for accident and emergency services, GP appointments, and the management of chronic illnesses like diabetes, asthma, and high blood pressure.
| Condition Type | Covered by Standard PMI? | Examples |
|---|---|---|
| Acute Condition (arising after policy start) | Yes | Broken bones, appendicitis, gallstones, most cancers, need for joint replacement surgery. |
| Chronic Condition | No | Diabetes, asthma, high blood pressure, Crohn's disease, epilepsy. The NHS manages these. |
| Pre-existing Condition | No | A knee injury you suffered five years ago; back pain you saw a GP about before buying the policy. |
For more detailed information, you can read our in-depth guide to PMI underwriting.
Strategies to Manage and Reduce Your PMI Costs
While market-wide premium rises are hard to avoid, you are not powerless. There are several effective strategies you can use to ensure your private health cover remains affordable and provides excellent value.
1. Choose a Higher Excess
An excess is the amount you agree to pay towards the cost of a claim. For example, if you have a £250 excess and your treatment costs £3,000, you pay the first £250 and your insurer pays the remaining £2,750.
Opting for a higher excess (e.g., £500 or £1,000) will significantly reduce your monthly or annual premium. It's a trade-off: you pay less for your cover but agree to contribute more if you need to claim. (illustrative estimate)
2. Opt for a Guided Consultant List
Most insurers offer different hospital lists. A comprehensive list allows you to use almost any private hospital in the UK, but it comes at a higher price.
Many insurers now offer "guided consultant" or "guided option" lists. With this option, the insurer will give you a shortlist of 3-4 approved specialists for your condition, all of whom are vetted for quality and outcomes. Because the insurer has pre-negotiated rates with these consultants, choosing this option can reduce your premium by around 15-20%.
3. Consider a "Six-Week Wait" Option
This is a clever way to blend the best of the NHS and private healthcare. With a six-week wait option, your policy will only pay for treatment if the NHS waiting list for that specific procedure is longer than six weeks.
- If the NHS can treat you within six weeks, you use the NHS.
- If the NHS wait is longer than six weeks, your PMI policy kicks in, and you go private.
Because this reduces the likelihood of a claim, it can dramatically lower your premium. It's an excellent way to protect yourself against the very long waits that are currently common, while still saving money.
4. Review Your Policy Annually with an Expert Broker
This is the single most effective action you can take. Never simply accept your renewal quote from your current insurer without checking the market. The best PMI provider for you last year may not be the most competitive this year.
An independent PMI broker can compare policies from all the leading insurers to find you the best cover at the best price. This service is provided at no cost to you.
5. Embrace Wellness Programmes and Benefits
Insurers want you to stay healthy. A healthy customer is less likely to claim. That's why most major providers (like Aviva, Bupa, and Vitality) offer extensive wellness programmes. These can include:
- Discounted gym memberships
- Wearable fitness trackers (like an Apple Watch or Fitbit)
- Points and rewards for healthy activities
- Free coffee or cinema tickets for hitting activity goals
Engaging with these programmes can often lead to direct discounts on your renewal premium. Furthermore, at WeCovr, we support our clients' health journeys by providing complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, when they purchase PMI or Life Insurance through us. We also offer discounts on other types of insurance for our valued health and life clients.
How a Specialist PMI Broker Like WeCovr Can Help
Navigating the private medical insurance UK market, especially when premiums are rising, can be complex and time-consuming. This is where an expert, independent broker provides invaluable assistance.
WeCovr is an FCA-authorised broker with years of experience and a high level of customer satisfaction. We have helped arrange over 900,000 policies of various kinds for individuals, families, and businesses across the UK.
Here’s how we help:
- Whole-of-Market Comparison: We are not tied to any single insurer. We compare policies and prices from all the leading UK providers to find the one that best fits your needs and budget.
- Expert, Jargon-Free Advice: We explain the differences between policies, what the small print means, and help you understand underwriting options like moratorium vs. full medical underwriting.
- Saving You Money: Our primary goal is to find you the right cover at the most competitive price. We know which insurers are offering the best rates and can negotiate on your behalf.
- No Cost to You: Our service is free. We receive a commission from the insurer you choose, which is already built into the premium. You pay the same price (or often less) than if you went directly to the insurer.
- Hassle-Free Switching: If you decide to switch providers for a better deal, we handle all the paperwork for you, ensuring your cover remains continuous.
In a volatile market, having an expert on your side is more important than ever. You can learn more in our complete guide to private medical insurance.
Wellness Corner: Proactive Steps for Better Health
While insurance is there for when things go wrong, the best strategy is to invest in your health to prevent illness in the first place. Taking proactive steps not only improves your quality of life but can also help keep long-term health costs down.
- Balanced Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains. A Mediterranean-style diet has been extensively shown to reduce the risk of heart disease and other chronic conditions. Using a tool like CalorieHero can help you understand your nutritional intake and make healthier choices.
- Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or HIIT) a week, as recommended by the NHS.
- Prioritise Sleep: Most adults need 7-9 hours of quality sleep per night. Poor sleep is linked to a range of health problems, including a weakened immune system, weight gain, and mental health issues. Create a relaxing bedtime routine and a dark, quiet, and cool sleeping environment.
- Manage Stress: Chronic stress can have a significant physical impact on your body. Incorporate stress-management techniques into your day, such as mindfulness, meditation, yoga, or simply spending time in nature.
- Stay Socially Connected: Strong social ties are linked to a longer, healthier life. Make time for friends and family, and engage in community activities.
Taking control of your wellness is the most powerful form of health insurance you can have.
Frequently Asked Questions about PMI Premiums and Cover
Why has my PMI premium increased so much if I haven't made a claim?
Does private medical insurance cover pre-existing conditions?
What is the easiest way to reduce my private health cover premium?
The landscape of UK healthcare is changing, and private medical insurance is playing a more vital role than ever. While rising premiums present a challenge, understanding the reasons behind them and knowing the strategies to manage your costs can ensure you retain access to fast, high-quality healthcare when you need it most.
Take control of your health cover today. Get a free, no-obligation quote from WeCovr and let our experts compare the market to find the best policy for you.
Sources
- NHS England: Waiting times and referral-to-treatment statistics.
- Office for National Statistics (ONS): Health, mortality, and workforce data.
- NICE: Clinical guidance and technology appraisals.
- Care Quality Commission (CQC): Provider quality and inspection reports.
- UK Health Security Agency (UKHSA): Public health surveillance reports.
- Association of British Insurers (ABI): Health and protection market publications.
