TL;DR
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the nuances of the UK private medical insurance market. A common question we encounter is whether securing cover is possible later in life. This guide explains the reality of getting PMI for those aged 80 and over.
Key takeaways
- Limited Choice of Insurers: Not all mainstream providers will offer new policies to applicants over 80.
- Higher Premiums: Age is the single most significant factor in calculating PMI costs.
- Strict Underwriting: Insurers will pay close attention to your medical history.
- Exclusions for Pre-existing Conditions: This is a fundamental rule of PMI that becomes more pronounced with age.
- Developing new medical conditions.
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the nuances of the UK private medical insurance market. A common question we encounter is whether securing cover is possible later in life. This guide explains the reality of getting PMI for those aged 80 and over.
Can you still get PMI at 80+? WeCovr explains the reality
The short answer is yes, it is often possible to get private health insurance (PMI) if you are over 80 in the UK. However, the reality is more complex than a simple yes or no. While the door isn't closed, the path to securing a policy is narrower, the options are fewer, and the cost is significantly higher.
Many people assume that once you reach a certain age, private health cover becomes unavailable. This is a myth. Several specialist UK insurers have designed policies specifically for the older market, recognising that many people wish to bypass NHS waiting lists for eligible treatments well into their retirement.
The key challenges you will face are:
- Limited Choice of Insurers: Not all mainstream providers will offer new policies to applicants over 80.
- Higher Premiums: Age is the single most significant factor in calculating PMI costs.
- Strict Underwriting: Insurers will pay close attention to your medical history.
- Exclusions for Pre-existing Conditions: This is a fundamental rule of PMI that becomes more pronounced with age.
In this comprehensive guide, we'll break down these challenges, explore the costs, and explain how you can navigate the market to find the right cover for your needs.
Understanding the Insurer's Perspective: Risk and the Over-80s
To understand why getting PMI over 80 is challenging, it helps to see things from the insurer's point of view. Insurance is fundamentally about balancing risk. Insurers calculate premiums based on the statistical likelihood of a person making a claim.
As we age, the probability of needing medical treatment naturally increases. According to the Office for National Statistics (ONS), the UK has an ageing population. Projections suggest that the number of people aged 85 and over is set to rise substantially in the coming decades. This demographic trend means insurers anticipate a higher volume of claims from older policyholders.
For an insurer, an older applicant represents a higher risk of:
- Developing new medical conditions.
- Needing more frequent or complex treatments.
- Having longer recovery times, which can increase the cost of in-patient care.
This increased statistical risk is directly reflected in the premiums charged. It's not a personal judgement; it's a commercial reality based on vast amounts of population health data.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the most important concept to grasp when considering private medical insurance at any age, but especially over 80.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, or a joint injury requiring replacement. PMI is designed to cover acute conditions that arise after you take out the policy.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known cure, is likely to recur, or requires palliative care. Examples include diabetes, arthritis, high blood pressure, asthma, and COPD. Standard UK PMI policies DO NOT cover the management of chronic conditions.
Furthermore, any condition you have received medical advice or treatment for before taking out a policy is considered a pre-existing condition. These will also be excluded from your cover. For an applicant in their 80s, it's highly likely they will have one or more pre-existing or chronic conditions, which will be excluded from any new policy.
Key Takeaway: You are buying insurance for new, unforeseen acute health problems, not for the management of existing or long-term illnesses. The NHS remains your port of call for chronic condition management and emergencies.
What Does PMI for Over 80s Typically Cover and Exclude?
While policies vary, the core structure of what is covered remains consistent. The main benefit is gaining faster access to diagnosis and treatment for eligible conditions, allowing you to bypass potentially long NHS waiting lists. As of early 2025, NHS England data shows millions of people on the waiting list for consultant-led elective care, with a median waiting time of several months. PMI offers a way to circumvent this for specific treatments.
Here’s a typical breakdown of what you can expect to be included and excluded.
| Feature | Typically Included | Typically Excluded |
|---|---|---|
| Hospital Treatment | In-patient and day-patient treatment in a private hospital. | Treatment in a hospital not on the insurer's approved list. |
| Consultations | Consultations with specialists and consultants. | Consultations for conditions not covered by the policy. |
| Diagnostic Tests | Scans like MRI, CT, and PET scans, and other diagnostic tests. | Routine health screenings not related to specific symptoms. |
| Cancer Care | Comprehensive cover for cancer diagnosis and treatment is a core feature of most policies. | Experimental treatments; monitoring of pre-existing cancers. |
| Mental Health | Some cover for acute mental health conditions (often with limits). | Chronic mental health conditions. |
| Therapies | Physiotherapy, osteopathy, etc., often following a hospital procedure. | Therapies for chronic conditions like arthritis. |
| Pre-existing Conditions | N/A | Any condition you had before the policy started. |
| Chronic Conditions | N/A | Diabetes, high blood pressure, asthma, arthritis, etc. |
| Emergencies | N/A | Accident & Emergency services are provided by the NHS. |
| Other Common Exclusions | N/A | Routine dental, optical care, cosmetic surgery, mobility aids. |
The Big Question: How Much Does Private Health Insurance for Over 80s Cost?
This is often the deciding factor. Premiums for this age group are the highest in the market. The cost is determined by a combination of factors:
- Age: The primary driver. Premiums increase steeply with each passing year.
- Location: Treatment costs are higher in major cities, particularly London, so postcodes in these areas attract higher premiums.
- Level of Cover: A comprehensive plan with outpatient cover and cancer care will cost more than a basic plan covering only in-patient treatment.
- Excess: This is the amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will lower your monthly premium.
- Hospital List: Choosing a policy with a limited list of local hospitals is cheaper than one with nationwide access.
To give you a realistic idea, here are some estimated monthly premiums for an 82-year-old.
Important: These are illustrative examples only. Your actual quote will depend on your specific circumstances and the insurer you choose.
| Location | Basic Cover (In-patient only, £500 excess) | Comprehensive Cover (In/Out-patient, full cancer care, £250 excess) |
|---|---|---|
| Outside London (e.g., Manchester) | £250 - £400 per month | £450 - £650 per month |
| Greater London | £300 - £480 per month | £550 - £800+ per month |
As you can see, the costs are substantial. It requires a careful budget assessment to determine if the benefits of faster treatment for new acute conditions justify the significant ongoing expense.
How to Find the Best PMI Policy When You're Over 80
Given the limited options and high costs, a scattergun approach of applying to multiple insurers directly is rarely effective. A strategic approach is essential.
1. Work with a Specialist PMI Broker
This is the most efficient way to navigate the market. An independent broker, like WeCovr, understands the landscape and knows which insurers are most receptive to older applicants.
Benefits of using a broker:
- Expert Knowledge: We know the underwriting criteria for each specialist provider (such as The Exeter, Saga, and WPA).
- Market Access: We can compare policies and prices from the whole market, saving you the time and effort of doing it yourself.
- No Cost to You: Our service is free. We receive a commission from the insurer if you decide to take out a policy.
- Application Support: We can help you complete the application forms accurately, which is crucial for underwriting.
2. Understand Your Underwriting Options
When you apply, the insurer needs to know about your medical history to decide what they will exclude. There are two main ways they do this:
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire, disclosing your full medical history. The insurer then reviews this and tells you upfront exactly what will be excluded from your policy.
- Pro: You have complete clarity from day one. There are no grey areas about what's covered.
- Con: The application process is longer and more intrusive.
- Moratorium Underwriting: You do not have to disclose your medical history upfront. Instead, the policy automatically excludes any condition for which you have had symptoms, medication, or advice in the 5 years prior to starting the policy. These exclusions can be lifted if you go 2 continuous years without any treatment or advice for that condition after your policy starts.
- Pro: Quick and simple to set up.
- Con: You don't know for certain if a condition is covered until you make a claim. This can lead to disappointment and rejected claims.
For applicants over 80, Full Medical Underwriting is almost always the recommended path. It provides certainty and avoids potential disputes later on.
3. Be Realistic About What You Need
Don't pay for cover you don't need. Consider these ways to manage the cost:
- Increase your excess: Opting for a £1,000 excess can significantly reduce your premium.
- Choose a '6-week wait' option: Some policies reduce the cost if you agree to use the NHS if the required treatment has a waiting list of less than 6 weeks.
- Limit your hospital list: If you are happy to be treated at local private hospitals, you don't need to pay for a plan that includes expensive central London facilities.
Alternatives to Private Medical Insurance
Given the high cost, it's wise to consider the alternatives. PMI is not the right choice for everyone.
-
Self-Funding Treatment: You could choose to pay for private treatment on a case-by-case basis as and when you need it. This avoids monthly premiums, but you need significant savings to cover potential costs.
- Private cataract surgery: £2,500 - £4,000 per eye.
- Private hip replacement: £12,000 - £15,000.
- Private MRI scan: £400 - £800. This can be a viable option if you have the funds readily available and prefer to avoid ongoing insurance costs.
-
Health Cash Plans: These are not insurance policies but rather savings plans that help you budget for routine healthcare costs. You pay a small monthly fee and can then claim back cash for expenses like dental check-ups, eye tests, glasses, and physiotherapy, up to an annual limit. They are much cheaper than PMI but do not cover the cost of surgery or major treatments.
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Relying on the NHS: The NHS provides excellent care, especially for emergencies and complex, chronic conditions. For many, continuing to rely solely on the NHS is the most sensible financial decision. The primary trade-off is the potential for long waits for elective procedures.
Live Well: Health and Wellness Tips for Your 80s and Beyond
Insurance is a safety net, but the best strategy is to invest in your health. Staying active and engaged can have a profound impact on your quality of life.
- Stay Active: Gentle, regular exercise is key. Walking, swimming, tai chi, or chair-based exercises can improve mobility, balance, and heart health. Aim for at least 20-30 minutes of moderate activity most days of the week, as advised by your GP.
- Eat a Balanced Diet: Focus on a diet rich in fruits, vegetables, lean protein, and whole grains. Staying hydrated is also crucial, as the sensation of thirst can diminish with age.
- Keep Your Mind Engaged: Reading, puzzles, learning a new skill, or socialising are fantastic ways to maintain cognitive function.
- Prioritise Sleep: Aim for 7-8 hours of quality sleep per night. Establish a regular routine and make your bedroom a calm, dark, and quiet environment.
- Stay Socially Connected: Loneliness can have a negative impact on both mental and physical health. Make an effort to connect with family, friends, and community groups.
As a WeCovr client, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you manage your diet and stay on track with your health goals.
The WeCovr Verdict: Is PMI at 80+ a Good Idea?
Whether private medical insurance is a worthwhile investment in your 80s is a deeply personal decision. It hinges on your financial situation, your attitude towards risk, and your health priorities.
It might be a good idea if:
- You have the disposable income to comfortably afford the high monthly premiums.
- The peace of mind that comes with fast access to private treatment for new conditions is very important to you.
- You understand and accept the exclusions, particularly for pre-existing and chronic conditions.
It might not be the right choice if:
- The high cost would put a strain on your retirement budget.
- Your primary health concerns are chronic conditions, which PMI will not cover.
- You are comfortable relying on the excellent care provided by the NHS.
The best first step is to get a clear picture of what's available to you. An expert broker can provide a no-obligation overview of the market, tailored to your age and health. At WeCovr, we help you compare quotes from the UK's leading specialist insurers, explain the policy details in plain English, and empower you to make an informed decision. We can also offer discounts on other types of insurance, such as travel or home cover, when you take out a health or life policy with us.
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Ready to explore your options? Get a free, no-obligation quote from WeCovr today. Our expert advisors will help you understand the costs and benefits, allowing you to make the best choice for your health and your future.
