TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. Our goal is to provide clear, expert guidance, cutting through the confusion to help you make informed decisions about your health. WeCovr's expert guides clarify common misconceptions about PMI, NHS value, and exclusions.
Key takeaways
- Emergencies: For accidents and emergencies (A&E), life-threatening conditions like a heart attack or stroke, you will always be treated by the NHS. Private hospitals are not typically equipped to handle these acute emergencies.
- GP Services: Your NHS GP remains your first point of call for any health concerns. They provide the initial diagnosis and, if necessary, a referral for specialist treatment.
- The "Jump": PMI's primary role is to help you bypass NHS waiting lists for non-emergency, specialist consultations and elective treatments. Once your GP refers you, you can use your PMI policy to see a specialist and receive treatment much faster.
- Moratorium Underwriting: This is the most common type. You don't declare your full medical history upfront. Instead, the insurer applies a general exclusion for any condition you've had in the last five years. However, if you go two continuous years on the policy without any symptoms, advice, or treatment for that specific condition, it may become eligible for cover.
- Full Medical Underwriting (FMU): With FMU, you provide your complete medical history when you apply. The insurer then assesses it and explicitly lists any conditions that will be permanently excluded from your policy. It takes more time upfront, but you have absolute clarity on what is and isn't covered from day one.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside and out. Our goal is to provide clear, expert guidance, cutting through the confusion to help you make informed decisions about your health.
WeCovr's expert guides clarify common misconceptions about PMI, NHS value, and exclusions. Most people overestimate what PMI pays for—know the facts. — WeCovrindustry guides
Private Medical Insurance (PMI) is often misunderstood. Many people believe it's a golden ticket to all healthcare, while others dismiss it as an unnecessary luxury. The truth, as is often the case, lies somewhere in between.
In this guide, we'll dismantle the ten biggest myths about private health insurance in the UK. We’ll use real data and plain English to show you what PMI is, what it isn’t, and how it can work alongside our cherished NHS.
Myth 1: Private Health Insurance Replaces the NHS
This is perhaps the most significant misconception. Private medical insurance is designed to complement the NHS, not replace it. The NHS remains a cornerstone of UK healthcare, and you will always have access to it, regardless of whether you have private cover.
How PMI and the NHS Work Together:
- Emergencies: For accidents and emergencies (A&E), life-threatening conditions like a heart attack or stroke, you will always be treated by the NHS. Private hospitals are not typically equipped to handle these acute emergencies.
- GP Services: Your NHS GP remains your first point of call for any health concerns. They provide the initial diagnosis and, if necessary, a referral for specialist treatment.
- The "Jump": PMI's primary role is to help you bypass NHS waiting lists for non-emergency, specialist consultations and elective treatments. Once your GP refers you, you can use your PMI policy to see a specialist and receive treatment much faster.
According to the latest NHS England data from early 2025, the elective care waiting list stands at over 7.7 million treatment pathways. The median wait time for treatment is around 15 weeks, but many patients wait far longer for certain specialities like orthopaedics or ophthalmology. PMI gives you a choice to avoid these queues for eligible conditions.
In simple terms: The NHS is your safety net for everything, especially emergencies. PMI is your tool for speed and choice when it comes to planned, non-urgent care.
Myth 2: PMI Covers Absolutely Everything
Many assume that a private health insurance policy is an all-access pass to any medical treatment you could ever want. This is a dangerous and inaccurate assumption. PMI is designed specifically 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 things like joint replacements, cataract surgery, or hernia repairs.
Here’s a breakdown of what is typically covered versus what is almost always excluded.
| Typically Covered by UK PMI ✅ | Almost Always Excluded from UK PMI ❌ |
|---|---|
| Consultations with specialists | Pre-existing conditions (see Myth 3) |
| Diagnostic tests (MRI, CT scans, X-rays) | Chronic conditions (see Myth 4) |
| In-patient and day-patient hospital treatment | Emergency services (A&E) |
| Surgery for acute conditions | Routine GP services |
| Cancer treatment (often a core benefit, but check policy) | Cosmetic surgery (unless for reconstructive purposes) |
| Mental health support (cover varies significantly) | Normal pregnancy and childbirth |
| Physiotherapy and other therapies (often as an add-on) | Experimental or unproven treatments |
| Out-patient diagnostics and procedures (depending on cover level) | Mobility aids, organ transplants, and routine dental/optical |
It's vital to read your policy documents carefully. Understanding these limitations prevents disappointment when you need to make a claim.
Myth 3: My Pre-Existing Conditions Will Be Covered
This is a critical point of confusion and one of the most important facts to understand about private medical insurance in the UK.
Standard UK PMI policies do not cover pre-existing conditions.
A pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment in the five years before your policy start date.
Insurers use two main methods to deal with pre-existing conditions, known as underwriting:
- Moratorium Underwriting: This is the most common type. You don't declare your full medical history upfront. Instead, the insurer applies a general exclusion for any condition you've had in the last five years. However, if you go two continuous years on the policy without any symptoms, advice, or treatment for that specific condition, it may become eligible for cover.
- Full Medical Underwriting (FMU): With FMU, you provide your complete medical history when you apply. The insurer then assesses it and explicitly lists any conditions that will be permanently excluded from your policy. It takes more time upfront, but you have absolute clarity on what is and isn't covered from day one.
Real-Life Example: Imagine you suffered from knee pain two years before buying a PMI policy. With moratorium underwriting, any treatment related to that knee would be automatically excluded. If you then remained treatment- and symptom-free for two full years after your policy started, your knee could become eligible for cover in the future. With FMU, the insurer would likely place a permanent exclusion on your knee from the outset.
Myth 4: Chronic Conditions are Included in My Cover
This myth is closely linked to the last one. Just as PMI excludes pre-existing conditions, it also does not cover the routine management of chronic conditions.
A chronic condition is defined as an illness that cannot be cured but can be managed through medication and ongoing care. These are long-term conditions that you will likely have for life.
Common examples of chronic conditions include:
- Diabetes
- Asthma
- Hypertension (high blood pressure)
- Crohn's disease
- Arthritis
- Multiple Sclerosis (MS)
PMI is for acute care—treatment that aims to return you to your previous state of health. The day-to-day management of a chronic illness, such as regular check-ups, prescription renewals, and monitoring, remains under the care of your NHS GP and specialists.
However, some policies may offer cover for an acute flare-up of a chronic condition. For instance, if a stable chronic condition suddenly worsens and requires short-term hospitalisation to get it back under control, your PMI might cover that specific acute event. This is a complex area, and the level of cover varies hugely between insurers.
Myth 5: Private Health Insurance is Unaffordable
While premium private health cover can be expensive, many people are surprised by how affordable a basic policy can be. The price you pay is not fixed; it depends on a wide range of factors that you can often adjust to fit your budget.
Key Factors Influencing Your PMI Premium:
| Factor | How it Affects Your Premium |
|---|---|
| Age | The single biggest factor. Premiums are lowest when you are young and increase as you get older. |
| Location | Costs are higher in areas with more expensive private hospitals, such as Central London. |
| Level of Cover | Comprehensive plans with high out-patient limits cost more than basic plans covering only in-patient treatment. |
| Excess | This is the amount you agree to pay towards a claim. A higher excess (£500, £1,000) will significantly reduce your premium. |
| Hospital List | Choosing a more limited list of local hospitals is cheaper than a plan that gives you access to every private hospital in the UK. |
| 6-Week Wait | This option means your PMI will only kick in if the NHS waiting list for your treatment is longer than six weeks. It's a popular way to lower costs. |
By tailoring these options, you can design a policy that provides peace of mind without breaking the bank. An expert broker, like WeCovr, can be invaluable here. We compare policies from across the market to find the best combination of cover and cost for your specific needs and budget, all at no extra cost to you.
Myth 6: You Can Only Use Exclusive, Big-City Hospitals
Many people picture PMI as being tied to a handful of ultra-exclusive hospitals in places like Harley Street. While these facilities are available on top-tier plans, the reality is far more flexible.
Insurers offer a choice of "hospital lists," which are essentially networks of approved facilities. These typically fall into three tiers:
- Local/Trust Network: A curated list of hospitals, often including private wings of NHS hospitals, designed to keep costs down.
- National Network: A broad list giving you access to hundreds of private hospitals across the UK.
- Premium/London Network: Includes the most prestigious and expensive hospitals, often concentrated in Central London.
You choose the list that suits your budget and preferences. For most people, a national list provides more than enough choice, with high-quality private facilities available in every region of the country.
Myth 7: It's Only for the Elderly or Sick
This is completely backwards. The best and most affordable time to take out private health insurance is when you are young and healthy.
Here's why:
- Lower Premiums: Insurers base your price on risk. A healthy 30-year-old is a much lower risk than a 60-year-old, so their premiums will be significantly cheaper.
- No Exclusions: By getting cover before you develop any health issues, you ensure that if something does come up later, it won't be classed as a pre-existing condition and will be eligible for cover.
- Peace of Mind: Illness and injury can happen at any age. Whether it’s a sports injury requiring knee surgery or an unexpected diagnosis, having PMI means you can get treated quickly and get back to your life, work, and family.
Waiting until you are older or already have health problems is a false economy. You’ll pay more, and the very conditions you want cover for will likely be excluded.
Myth 8: Making a Claim is a Complicated Nightmare
The idea of battling with an insurance company can be off-putting, but the claims process for PMI is usually very straightforward and managed. Insurers want you to have a smooth experience.
Here’s the typical claims journey:
- Visit Your NHS GP: You feel unwell or have an injury. Your GP assesses you and, if they feel you need to see a specialist, they will write you a referral letter.
- Contact Your Insurer: You call your insurer's claims line with your GP's referral details.
- Get Authorisation: The insurer checks that the condition is covered by your policy and provides you with an authorisation number. They will also give you a list of approved specialists and hospitals from your chosen network.
- Book Your Appointment: You book your consultation or treatment with the authorised specialist.
- Receive Treatment: You attend your appointments and receive the necessary care.
- Direct Settlement: The hospital and specialists bill your insurer directly. Apart from any excess you've chosen, you shouldn't have to handle any payments yourself.
Modern insurers have streamlined this process with online portals and dedicated claims teams to guide you every step of the way.
Myth 9: I'm Young and Fit, I Don't Need Health Insurance
Being healthy today is no guarantee of being healthy tomorrow. While a good diet, regular exercise, and sufficient sleep are your best defence against illness, they don't make you invincible.
Why young, healthy people benefit from PMI:
- Musculoskeletal Injuries: Sports injuries, back pain, and joint problems are common at any age. PMI can give you fast access to MRI scans, physiotherapy, and orthopaedic surgery, helping you recover faster.
- Unexpected Diagnoses: Serious conditions like cancer can affect anyone. Early diagnosis and treatment are crucial. PMI offers access to the latest cancer drugs and treatments, some of which may not yet be available on the NHS.
- Mental Health Support: Many modern PMI policies include valuable mental health cover, providing access to therapy and psychiatric support with minimal waiting times—a vital benefit in today's stressful world.
Think of it like car insurance. You don't buy it because you plan to have an accident; you buy it for the financial protection and peace of mind in case you do.
As a WeCovr customer, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you stay on top of your health goals. Plus, customers who purchase PMI or life insurance often receive discounts on other types of cover, adding even more value.
Myth 10: My Premium Will Stay the Same Forever
This is a common and costly misunderstanding. You should expect your private health insurance premium to increase each year. There are two main reasons for this:
- Age: As you get older, the statistical risk of you needing medical treatment increases. Insurers factor this in with age-related price increases each year.
- Medical Inflation: The cost of medical technology, new drugs, and hospital services consistently rises faster than standard inflation. This "medical inflation" typically runs at 8-12% per year and is passed on in premium adjustments.
If you make a claim, your premium may also increase at renewal, although this is less common with personal policies than with large company schemes.
Being aware that your premium will rise helps you budget for the future. You can review your cover each year with a broker like WeCovr to ensure it still meets your needs and remains affordable. Sometimes, switching insurers or adjusting your cover level can help manage these increases.
Know the Facts, Make the Right Choice
Private medical insurance in the UK is a powerful tool for managing your health, but only when you understand exactly what you are buying. It offers speed, choice, and comfort, acting as a valuable partner to the NHS.
By seeing past these common myths, you can make a clear-headed decision about whether it’s right for you. It isn't a magic wand, but for many, it provides invaluable peace of mind and timely access to care when they need it most.
Do I still need to pay for the NHS if I have private health insurance?
What is the difference between a chronic and an acute condition?
Will my health insurance premium go up every year?
Can I get private health cover if I have existing medical conditions?
Ready to find out how affordable private medical insurance can be for you?
Get a free, no-obligation quote from WeCovr today. Our expert advisors will compare the UK's leading insurers to find a policy that fits your needs and your budget.
