Self-Pay vs PMI Which Is Better for Surgery Costs
Facing the prospect of surgery can be daunting, but navigating how to pay for it in the UK adds another layer of complexity. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the choice between paying directly (self-pay) and using private medical insurance (PMI). This article provides a definitive cost-benefit analysis to help you decide which path is right for your health and your finances.
A cost-benefit analysis of paying outright vs PMI
When the NHS is unable to provide timely treatment, two main avenues open up in the private sector: paying for the procedure yourself or using a private medical insurance policy. Each has significant implications for your wallet and your peace of mind. Let's dissect the pros and cons of both options to give you clarity.
The Modern UK Healthcare Landscape: NHS vs. Private
The National Health Service (NHS) is a cornerstone of British life, providing incredible care to millions, free at the point of use. However, the system is under unprecedented strain. According to the latest NHS England data, the waiting list for routine hospital treatment stood at around 7.54 million in early 2025. The median waiting time can be several months, and for some specialist procedures like orthopaedic surgery, it can stretch even longer.
This reality has led a growing number of people to consider the private sector for three key reasons:
- Speed: Bypassing long waiting lists to get treatment when you need it.
- Choice: Selecting your preferred surgeon, specialist, and hospital.
- Comfort: Enjoying the benefits of a private room, flexible visiting hours, and other enhanced amenities.
The question isn't whether to go private, but how to fund it.
The Self-Pay Route: Paying for Surgery Directly
Self-pay, sometimes called 'pay-as-you-go' healthcare, is exactly what it sounds like. You pay the private hospital or clinic directly for your surgery and associated care.
The process is straightforward:
- You receive a referral from your GP (or sometimes you can self-refer to a private consultant).
- You have an initial consultation with a private specialist, which you pay for.
- The consultant recommends a procedure and provides a quote, often as a 'fixed-price package'.
- You accept the quote, pay the hospital, and schedule your surgery.
These packages typically bundle the key costs together, including the surgeon's fees, anaesthetist's fees, hospital stay, nursing care, and sometimes one follow-up appointment.
How Much Does Private Surgery Cost in the UK?
Costs vary significantly depending on the procedure, the chosen hospital, and the consultant's reputation. Here is a table of estimated costs for some common surgeries in 2025.
| Surgery Type | Estimated Self-Pay Cost Range | Notes |
|---|---|---|
| Cataract Surgery (per eye) | £2,500 – £4,500 | Price can increase with advanced lens types. |
| Hip Replacement | £12,000 – £16,000 | Includes prosthesis, surgeon fees, and hospital stay. |
| Knee Replacement | £13,000 – £17,500 | A common procedure with a high success rate. |
| Hernia Repair (Inguinal) | £3,000 – £5,000 | Often performed as a day case procedure. |
| Arthroscopy (Knee) | £3,500 – £6,000 | A diagnostic or therapeutic keyhole surgery. |
| Gallbladder Removal | £6,000 – £8,500 | Typically a laparoscopic (keyhole) procedure. |
| Endoscopy / Colonoscopy | £1,800 – £2,800 | A common diagnostic investigation. |
Disclaimer: These are estimated figures for guidance only. Always obtain a formal quote from your chosen provider.
The Benefits of Paying for Surgery Yourself
- Cost Certainty: Fixed-price packages offer transparency. You know the exact cost upfront, with no monthly premiums to worry about.
- Total Control: You have complete freedom to choose any surgeon and any hospital in the country without being restricted by an insurer's network.
- No Underwriting: You don't need to disclose your medical history. If you can pay, you can get the treatment (provided you are medically fit for it).
- Immediate Access: If you have the funds, there's no waiting period. You can book your surgery for the next available slot.
The Drawbacks of the Self-Pay Option
- Exorbitant Costs: As the table shows, major surgery can cost as much as a new car or a house deposit, wiping out years of savings in one go.
- Risk of Complications: A crucial point. The 'fixed-price' package may not cover unforeseen complications that require a longer hospital stay, further surgery, or intensive care. These extra costs can be financially devastating.
- Opportunity Cost: The £15,000 you spend on a knee replacement is money that is no longer saved or invested for your future.
- One-Time Solution: Self-pay only solves one problem. It offers no protection against any other future health issues you might develop.
Private Medical Insurance (PMI): Your Health Safety Net
Private Medical Insurance is a policy you pay for monthly or annually. In return, the insurer covers the costs of eligible private treatment for acute conditions that arise after you take out the policy.
The Critical Point: Acute vs. Chronic & Pre-existing Conditions
This is the single most important concept to understand about UK private health cover.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery (e.g., a cataract, a hernia, a broken bone). PMI is designed to cover these.
- Chronic Condition: A condition that is long-lasting and cannot be conventionally cured, only managed (e.g., diabetes, asthma, high blood pressure). PMI does not cover the routine management of chronic conditions. The NHS remains the best place for this care.
- Pre-existing Condition: Any condition for which you have experienced symptoms, received medication, or sought advice in the years leading up to your policy start date (usually the last 5 years). Standard PMI policies exclude pre-existing conditions.
How Does PMI Work for Surgery?
- You develop a new symptom and visit your NHS GP.
- Your GP refers you to a specialist for diagnosis.
- You contact your PMI provider to open a claim.
- They authorise the consultation and any subsequent diagnostic tests (like an MRI or CT scan).
- If surgery is needed, the insurer authorises this too, and you choose a specialist and hospital from their approved network.
- The insurer pays the bills directly, leaving you to pay only your pre-agreed excess.
The Benefits of Private Medical Insurance
- Manages Unpredictable Costs: It protects your savings from huge, unexpected medical bills. You pay a predictable premium for comprehensive protection.
- Peace of Mind: Knowing you have a plan in place to access prompt medical care is invaluable for your mental wellbeing.
- Comprehensive Coverage: A single policy can cover you for a vast range of potential surgeries, diagnostic tests, and even cancer treatments.
- Added Value: Most modern policies include a wealth of extra benefits, such as:
- 24/7 Digital GP appointments
- Mental health support and therapy sessions
- Physiotherapy and complementary therapies
- Wellness programmes and gym discounts
The Drawbacks of PMI
- Ongoing Cost: You must consistently pay your premiums, even when you are not claiming.
- The Excess: You will need to pay a portion of the claim yourself, known as the excess. This typically ranges from £100 to £1,000.
- Exclusions: As mentioned, pre-existing and chronic conditions are not covered. There may be other specific exclusions in your policy documents.
- Premium Increases: Premiums tend to rise with age and may also increase if you make a claim.
Cost-Benefit Analysis: Self-Pay vs. PMI Head-to-Head
To make the decision clearer, let's compare the two options across several key factors.
| Feature | Self-Pay | Private Medical Insurance (PMI) |
|---|---|---|
| Initial Cost | Very high (e.g., £13,000 for a hip replacement). | Low (e.g., a monthly premium of £50-£100). |
| Ongoing Cost | None, unless complications arise. | Fixed monthly or annual premiums. |
| Cost Predictability | High for a single event (with a package), but zero for future issues. | Very high. You know your premium and your excess. |
| Access Speed | Immediate, if you have the funds. | Very fast, once a claim is approved by the insurer. |
| Choice of Hospital | Unlimited. Any private hospital in the UK. | Limited to the insurer's hospital network (which is usually very extensive). |
| Coverage for Complications | Often not included in the initial package price. Can lead to huge extra bills. | Generally covered as part of the overall treatment episode, up to policy limits. |
| Peace of Mind | Limited. Solves one problem but offers no future protection. | High. Provides a long-term safety net against a wide range of future health concerns. |
| Value for Money | Poor long-term value. Depletes capital for a single event. | Excellent long-term value, protecting against multiple potential health issues over many years. |
Real-Life Scenarios: Putting the Numbers to the Test
Scenario 1: Michael, 58, needs a knee replacement.
- Self-Pay Route: The average cost is £15,000. Michael has this in his savings, but it's a huge portion of his retirement fund.
- PMI Route: Michael has had a mid-range PMI policy for 10 years, paying an average of £90 per month. Total paid in premiums: £10,800. His policy has a £250 excess.
- Analysis: For Michael, using his PMI policy costs him just the £250 excess for the surgery itself. While he has paid premiums over the years, this has protected him from a single £15,000 hit. Furthermore, his policy remains in place to protect him against any other new conditions in the future. PMI is the clear winner.
Scenario 2: Chloe, 32, needs minor hernia repair surgery.
- Self-Pay Route: The cost for this is around £3,500. This is a significant amount but perhaps manageable for her without wiping out her entire savings.
- PMI Route: Chloe took out a policy two years ago at £45 per month. Total paid in premiums: £1,080. Her excess is £500.
- Analysis: To use her insurance, Chloe would pay her £500 excess. The total she has spent on her health protection is £1,580 (£1,080 + £500). This is still less than half the cost of self-funding. Even for a lower-cost procedure, PMI proves more cost-effective and leaves her protected for the future.
Finding the Right Balance: When Is Each Option Better?
Self-Pay might be a reasonable option if:
- You need treatment for a clear pre-existing condition that would be excluded by any new PMI policy.
- You require a relatively low-cost, one-off procedure and have substantial liquid savings you are comfortable spending.
- You are of an advanced age where PMI premiums might become prohibitively expensive.
PMI is almost always the better long-term strategy if:
- You want to protect your savings and avoid catastrophic, one-off medical bills.
- You value the peace of mind that comes from having a comprehensive health plan.
- You are young or middle-aged, when premiums are more affordable.
- You want access to the valuable ancillary benefits like Digital GP services and mental health support.
How to Navigate the World of PMI with an Expert Broker
Choosing the right private medical insurance UK policy can feel complex, but it doesn't have to be. This is where an independent broker like WeCovr provides immense value. We help you cut through the noise and compare options from the best PMI providers in the market.
Key factors we help you consider:
- Level of Cover: From basic plans covering only surgery to comprehensive options including outpatient diagnostics, therapies, and mental health.
- Hospital List: Insurers offer different tiers of hospital access. A London-centric list is more expensive than a national network that excludes prime central London hospitals. We can find the right balance for you.
- Excess Level: Choosing a higher excess can significantly lower your monthly premium. We can model different options to find your sweet spot.
- Underwriting Type: We explain the difference between 'Moratorium' and 'Full Medical Underwriting' in simple terms to help you choose the best application route.
Working with WeCovr costs you nothing. We receive a commission from the insurer you choose, but our advice is always impartial and focused on your needs. Plus, as a WeCovr client, you gain complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, and can benefit from discounts on other insurance products when you buy PMI or life insurance.
A Final Word on Pre-Existing Conditions
It is vital to be transparent about your medical history. Standard private health cover is for unforeseen, acute conditions. If you already have a diagnosis or are awaiting surgery for a known issue, PMI cannot be used to cover it. The self-pay route would be your only private option in this scenario.
Can I get private medical insurance if I already know I need surgery?
Generally, no. If you have already been diagnosed with a condition or are on a waiting list for surgery, this is considered a 'pre-existing condition'. Standard Private Medical Insurance (PMI) policies are designed to cover acute conditions that arise *after* your policy begins and will exclude pre-existing conditions from cover.
Does PMI cover the entire cost of a private surgery?
Yes, in most cases. Once you have paid your chosen policy excess (a one-off contribution per claim or per year), your insurer will cover all eligible costs associated with the surgery, up to the limits of your policy. This typically includes consultant fees, anaesthetist fees, hospital charges, and diagnostic tests. It's crucial to ensure your treatment is pre-authorised by the insurer.
What happens if my private surgery has complications?
This is a key advantage of PMI. If complications arise that are a direct result of the surgery, your insurance will typically cover the costs of the additional treatment needed, such as a longer hospital stay or further procedures. With a self-pay package, you may be liable for these extra costs yourself, which can be substantial.
Is it better to use a broker like WeCovr to buy PMI?
Using an independent broker like WeCovr does not cost you any more than going directly to an insurer. The benefit is that you receive expert, impartial advice and a comprehensive comparison of the market. A broker can help you find the best PMI provider and policy for your specific needs and budget, potentially saving you money and ensuring you have the right level of cover.
Ready to explore your options and secure your health? The expert team at WeCovr is here to help. Get a free, no-obligation quote today and discover how affordable peace of mind can be.
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!
There is no need to wait until the renewal of your current policy.
We can look at a more suitable option mid-term!
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.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
Our Group Is Proud To Have Issued 900,000+ Policies!
We've established collaboration agreements with leading insurance groups to create tailored coverage
Working with leading UK insurers
How It Works
1. Complete a brief form
2. Our experts analyse your information and find you best quotes
3. Enjoy your protection!
Any questions?
Learn more
Who Are WeCovr?
WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!