Top 10 Myths About Private Health Insurance in the UK

As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr brings clarity to the often-misunderstood world of private medical insurance in the UK. This guide debunks the top 10 myths, empowering you to make an informed decision about your health.

WeCovr separates fact from fiction about PMI

Private Medical Insurance (PMI) is a significant decision, yet it's a subject clouded by misconceptions and outdated beliefs. Many people rule out private health cover based on myths that simply aren't true in today's market. From concerns about cost to confusion over how it works with the NHS, these fictions can prevent you from accessing the valuable benefits of private healthcare.

At WeCovr, we believe in clarity and transparency. Our goal is to empower you with accurate information. In this comprehensive guide, we will systematically tackle the ten most common myths about private health insurance in the UK, using facts, figures, and expert insights to separate reality from rumour.

Myth 1: Private Health Insurance is Only for the Wealthy

The Myth: A pervasive belief is that PMI is a luxury product, with premiums so high that it's only accessible to the top 1% of earners. Many assume the monthly cost is equivalent to a mortgage payment.

The Reality: This is perhaps the most persistent myth of all. While comprehensive, top-tier plans can be expensive, the UK private medical insurance market is incredibly diverse and flexible. The cost of a policy is not a fixed, one-size-fits-all figure. It is determined by a range of personalisable factors, meaning you can often build a policy that fits your budget.

Key Factors Influencing Your Premium:

• Level of Cover: You don't have to buy a policy that covers every eventuality. You can choose from basic (inpatient only), mid-range (inpatient and some outpatient), or comprehensive plans.
• Excess (illustrative): This is the amount you agree to pay towards a claim. Choosing a higher excess (e.g., £500 instead of £100) can significantly reduce your monthly premium.
• Hospital List: Insurers have different lists of hospitals where you can be treated. Opting for a more restricted local list rather than a nationwide list including premium London hospitals will lower the cost.
• Age and Health: Younger, healthier individuals typically pay less.
• No-Claims Discount (NCD): Similar to car insurance, you can build up a discount for every year you don't make a claim, making your policy more affordable over time.

Think of it like buying a car. You can choose a basic, reliable model or a high-performance luxury vehicle. Private health insurance is similar; you tailor the features to match your needs and budget. An expert PMI broker like WeCovr can navigate these options for you, finding the sweet spot between comprehensive cover and affordability.

Sample Monthly Premiums (Illustrative Examples)

Note: These are estimates. Your actual quote will depend on your specific circumstances and choices.

Myth 2: I'm Young and Healthy, So I Don't Need It

The Myth: Young professionals and families often feel invincible. With no current health issues, they believe paying for health insurance is an unnecessary expense, especially when the NHS is available.

The Reality: While the NHS provides excellent emergency care, private health insurance is primarily designed for acute conditions—illnesses or injuries that are likely to respond quickly to treatment. It's about what might happen tomorrow, not just how you feel today.

Unfortunately, NHS waiting lists for elective procedures remain a significant challenge. According to NHS England data, the median waiting time for consultant-led elective care was 14.5 weeks in early 2025, with hundreds of thousands waiting over a year for treatment. These delays can impact your ability to work, care for your family, and enjoy your life.

PMI is valuable for the young and healthy for several reasons:

1. Faster Diagnosis and Treatment: If you develop symptoms like persistent joint pain or worrying digestive issues, PMI can provide rapid access to specialist consultations and diagnostic tests like MRI or CT scans, often within days or weeks instead of months.
2. Protecting Your Income: A long wait for something like a hernia operation or knee surgery can mean extended time off work. Faster treatment gets you back on your feet and back to earning sooner.
3. Choice and Comfort: PMI gives you more control over your healthcare. You can often choose your specialist, schedule treatment at a time that suits you, and recover in a private room.
4. Lower Premiums: The best time to get private health insurance is when you are young and healthy, as your premiums will be at their lowest. You can lock in cover before any health conditions develop that might later be excluded.

Consider this: a sports injury like a torn ACL could leave you waiting months for surgery on the NHS, significantly impacting your active lifestyle. With PMI, you could be seen by a top orthopaedic surgeon and have the operation scheduled promptly.

Myth 3: PMI Covers Everything, Including My Pre-Existing Conditions

The Myth: A common and dangerous assumption is that once you buy a policy, the insurer will pay for any and all medical treatments you might need, including ongoing management of conditions you already have, like diabetes or asthma.

The Reality: This is unequivocally false and the single most important concept to understand about private medical insurance in the UK. Standard PMI is designed to cover new, acute conditions that arise after your policy begins. It does not cover:

• Pre-existing Conditions: Any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment in the years before your policy started (typically the last 5 years).
• Chronic Conditions: Illnesses that cannot be cured and require long-term management, such as diabetes, hypertension, asthma, Crohn's disease, or multiple sclerosis. The NHS remains the primary provider for managing these conditions.

Acute vs. Chronic: The Decisive Factor

Even if a chronic condition is diagnosed after you take out a policy, PMI will typically only cover the initial diagnostic phase and stabilisation. The long-term, ongoing management will then revert to the NHS.

How Insurers Handle Pre-existing Conditions:

When you apply, you'll choose one of two underwriting methods:

1. Moratorium Underwriting (Most Common): You don't declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had in the last 5 years. However, if you remain symptom-free and receive no treatment or advice for that condition for a continuous 2-year period after your policy starts, it may become eligible for cover.
2. Full Medical Underwriting (FMU): You provide your complete medical history. The insurer reviews it and states explicitly from the outset what is and isn't covered. This provides more certainty but means pre-existing conditions are permanently excluded.

Understanding this distinction is crucial to avoid disappointment at the point of claim.

Myth 4: Private Health Insurance Replaces the NHS

The Myth: Some people believe that taking out PMI means they can opt out of the NHS entirely, using private services for everything from a GP visit to A&E.

The Reality: Private medical insurance is designed to work in partnership with the NHS, not replace it. The two systems are complementary, each with distinct strengths. You will always be entitled to use the NHS, and in some situations, you will have to.

How PMI and the NHS Work Together:

• Emergencies: For any life-threatening emergency, such as a heart attack, stroke, or serious accident, you should always call 999 and go to an NHS A&E. Private hospitals are not typically equipped for emergency admissions.
• GP Services: You will keep your NHS GP. In almost all cases, your journey into private treatment begins with a visit to your NHS GP, who provides a referral to a specialist. Some PMI policies offer access to a private virtual GP service for convenience, but your registered NHS GP remains your primary care provider.
• Chronic Condition Management: As detailed in Myth 3, the NHS remains responsible for the long-term care of chronic conditions.
• Elective Treatment: This is where PMI shines. For non-urgent, planned treatments (known as elective care), PMI provides a parallel route that allows you to bypass NHS waiting lists.

A Typical Patient Journey with PMI:

1. You feel unwell (e.g., persistent knee pain).
2. You visit your NHS GP.
3. Your GP diagnoses a likely cartilage tear and refers you to an orthopaedic specialist.
4. You contact your PMI provider with the referral.
5. Your insurer pre-authorises a consultation with a private specialist.
6. The specialist confirms the diagnosis via an MRI scan (covered by PMI) and recommends surgery.
7. The insurer authorises the surgery, which is performed in a private hospital.
8. Aftercare, such as physiotherapy, is also covered by your PMI policy.

The NHS is the safety net for everyone; PMI is the choice for faster, more convenient access to planned care.

Myth 5: All Policies Are the Same

The Myth: People often think "health insurance is health insurance," assuming all policies from different providers offer the same benefits and just vary slightly on price.

The Reality: This is far from the truth. The UK PMI market is highly competitive, and policies can differ dramatically in their scope of cover, benefits, and limitations. Choosing the best PMI provider depends entirely on your individual needs.

Policies are generally structured in tiers, but the specifics within each tier vary significantly.

Common Tiers of Cover:

Beyond the Tiers: Key Differences to Look For:

• Cancer Cover: This is a core benefit, but the level varies. Some policies offer full cover for chemotherapy, radiotherapy, and surgery, while others may have limits or exclude newer, more expensive treatments.
• Mental Health Cover: The extent of mental health support is a major differentiator. Basic policies may offer none, while comprehensive plans can provide access to psychiatrists and a significant number of therapy sessions.
• Hospital List: As mentioned, the network of hospitals you can use affects the price and your access to care.
• Added Benefits: Many providers now include wellness services like gym discounts, digital GP apps, and health screenings to encourage proactive health management.

The team at WeCovr specialises in breaking down these complex options into simple, understandable choices, ensuring you only pay for the cover you actually need.

Myth 6: Making a Claim is Complicated and My Premiums Will Skyrocket

The Myth: There's a fear that the claims process is an administrative nightmare designed to prevent you from getting treatment, and that a single claim will cause your future premiums to become unaffordable.

The Reality: Reputable insurers want you to use your policy; a smooth claims process is a key selling point. While there are steps to follow, they are generally straightforward. Furthermore, while a claim will affect your premium, the impact is often managed by a structured No-Claims Discount (NCD) system.

The Standard Claims Process:

1. GP Referral: Visit your NHS GP to discuss your symptoms. They will provide an open referral letter if they feel you need to see a specialist.
2. Contact Your Insurer: Call your provider's claims line with your policy number and referral details.
3. Pre-authorisation: The insurer will check that the condition is covered and pre-authorise the consultation or treatment. They will give you an authorisation code and a list of approved specialists or hospitals.
4. Book Your Appointment: You book your appointment, providing the authorisation code.
5. Direct Settlement: In most cases, the hospital or specialist bills the insurer directly. You only have to pay your chosen excess.

The Impact on Premiums and the No-Claims Discount (NCD):

Most PMI policies use an NCD scale, often ranging from 0% to 75%.

• No Claim: For every year you don't claim, you move up the NCD scale, and your discount increases. This helps to offset age-related price increases.
• Making a Claim: If you make a claim, your NCD level will typically drop by a few levels (e.g., from 70% down to 50%) at your next renewal. It doesn't drop all the way to zero.
• NCD Protection: Some insurers offer the option to protect your NCD for an additional fee, allowing you to make one or two claims without it being affected.

So, while a claim will increase your net premium (as your discount is reduced), the NCD structure prevents it from "skyrocketing" in an uncontrolled way.

Myth 7: I Can Just Pay for Treatment Myself if I Need It

The Myth: Some people prefer to "self-insure," setting money aside in a savings account to pay for any private treatment they might need, assuming this is more cost-effective than paying a monthly premium.

The Reality: While this might work for a one-off consultation or a few physiotherapy sessions, the costs of significant medical procedures can be astronomical and far exceed what most people can save. A single serious diagnosis could wipe out a lifetime of savings.

Relying on self-funding is a high-stakes gamble. Private medical insurance works by pooling the risk; your relatively small monthly premium contributes to a large fund that can cover enormous costs if you're unlucky enough to need it.

Average Costs of Common Private Procedures in the UK (2025 Estimates)

Source: Analysis based on data from private hospital groups and industry reports.

As the table shows, the cost of a single major operation can be more than a decade's worth of PMI premiums. A complex cancer diagnosis requiring surgery, chemotherapy, and advanced drugs could lead to bills well into six figures, a sum that is simply out of reach for the vast majority of UK households.

Myth 8: I Have to Switch My GP

The Myth: A common point of confusion is whether taking out a private policy means you must leave your trusted NHS GP and find a private doctor for all your primary care needs.

The Reality: This is incorrect. You absolutely keep your NHS GP. In fact, your NHS GP is a crucial part of your private healthcare journey. They act as the gatekeeper, providing the initial diagnosis and the all-important referral that allows you to start the claims process with your insurer.

The relationship is symbiotic:

• You maintain continuity of care with your local GP, who knows your medical history.
• The insurer relies on the GP's professional judgement to ensure referrals are medically necessary.

Some modern policies offer access to a Private Digital GP service as an added benefit. This is a fantastic perk for convenience—allowing you to get a video consultation quickly for minor issues, advice, or prescriptions. However, this service is an addition to, not a replacement for, your registered NHS GP, who remains central to your overall care and the referral process for specialist treatment.

Myth 9: Mental Health Isn't Covered

The Myth: Traditionally, mental health was a common exclusion on health insurance policies, leading to the belief that PMI is only for physical ailments.

The Reality: The landscape of mental health cover has changed dramatically for the better. Recognising the vital link between mental and physical wellbeing, most leading UK insurers now offer some level of mental health support, with comprehensive policies providing extensive cover.

The stigma around mental health is reducing, and insurers have responded. This is one of the most significant positive developments in the private health cover market in the last decade.

What Can Be Covered?

• Outpatient Support: The most common form of cover is for outpatient treatment. This can include:
  • Consultations with a psychiatrist or psychologist.
  • A set number of talking therapy sessions, such as Cognitive Behavioural Therapy (CBT).
• Inpatient Treatment: More comprehensive policies will cover the costs of a stay in a private psychiatric hospital if intensive treatment is required.
• Digital Mental Health Platforms: Many insurers now partner with apps and services that provide on-demand access to counselling, mindfulness exercises, and self-help resources.

Important Considerations:

• Limits: Cover is not always unlimited. A mid-range policy might offer, for example, up to £1,500 for outpatient therapy or 8-10 sessions per year.
• Exclusions: As with physical health, chronic, long-term psychiatric conditions may be excluded. The focus is on treating acute episodes of conditions like anxiety, depression, or stress.
• Policy Level: The amount of cover is directly tied to the policy tier you choose. Basic plans may offer very little, so if mental health support is a priority, you need to look at mid-range or comprehensive options.

Proactive Mental Wellbeing: Taking care of your mental health is just as important as physical fitness. Simple practices like regular exercise, a balanced diet, sufficient sleep (7-9 hours per night), and mindfulness can build resilience. PMI can be the safety net you need if you require professional support.

Myth 10: It's Just About Treatment; There Are No Other Benefits

The Myth: People see PMI purely as a reactive product—something you only use when you're ill. They assume there's no value in it during the years when you are healthy and not making claims.

The Reality: The best PMI providers in the UK have evolved. They are no longer just passive payers of medical bills; they are proactive health and wellness partners. Insurers have realised that it's better (and cheaper) to help you stay healthy than to pay for expensive treatment down the line.

This has led to a wealth of value-added benefits and wellness programmes designed to provide value every single day, not just when you're sick.

Examples of Added Benefits and Wellness Perks:

• Digital GP Services: 24/7 access to a GP via phone or video call, perfect for quick advice and prescriptions without waiting for an NHS appointment.
• Wellness and Fitness Discounts: Significant discounts on gym memberships, fitness trackers (like Fitbit or Garmin), and sportswear.
• Health Screenings: Proactive health checks to catch potential issues early.
• Mental Health Support Lines: Access to confidential phone lines for stress and anxiety support.
• Nutrition and Diet Support: Some insurers offer consultations with nutritionists or access to diet-planning apps.

The WeCovr Advantage:

At WeCovr, we enhance this value even further for our clients. When you arrange a Private Medical Insurance or Life Insurance policy through us, we provide:

• Complimentary Access to CalorieHero: You get free access to our premium AI-powered calorie and nutrition tracking app, CalorieHero. It's a powerful tool to help you manage your diet, achieve your health goals, and build sustainable healthy habits.
• Discounts on Other Insurance: As a valued client, you become eligible for discounts on other types of cover you may need, such as life insurance or income protection, helping you build a complete financial safety net for less.

These benefits mean your health insurance policy is working for you all the time, actively supporting your journey to a healthier, happier life. Our high customer satisfaction ratings reflect this commitment to providing holistic value beyond the core policy.

Frequently Asked Questions (FAQs) About UK Private Health Insurance

1. What is the difference between moratorium and full medical underwriting? Moratorium underwriting is the most common type. You don't declare your medical history, but any condition you've had in the 5 years before the policy starts is automatically excluded. If you then go 2 continuous years without symptoms, treatment, or advice for that condition, it may become covered. Full Medical Underwriting (FMU) requires you to disclose your full history upfront. The insurer then gives you a clear list of what is permanently excluded, providing more certainty from day one.

2. Does private health insurance in the UK cover cancer? Yes, cancer cover is a cornerstone of almost all PMI policies. However, the level of cover varies. Basic policies will cover surgery and core treatments like radiotherapy and chemotherapy. More comprehensive policies provide access to the latest, most advanced drugs and therapies (including some not yet available on the NHS), as well as supportive care like home nursing and palliative options. It is vital to check the specifics of the cancer cover on any policy you consider.

3. Can I add my family to my private health insurance policy? Yes, you can usually cover your partner and your children on the same policy. Insurers often provide a small discount for adding family members compared to buying separate individual policies. Children can typically remain on a family policy until they are 18 or, if they are in full-time education, up to their early twenties (e.g., 21 or 24, depending on the provider).

4. How does the excess on a PMI policy work? The excess is a pre-agreed amount that you pay towards the cost of a claim each policy year. For example, if you have a £250 excess and your claim for a series of physiotherapy sessions costs £1,000, you would pay the first £250, and the insurer would pay the remaining £750. You typically only pay the excess once per policy year, regardless of how many claims you make. Choosing a higher excess is a common way to lower your monthly premium.

Take the Next Step with WeCovr

Navigating the world of private medical insurance can feel complex, but you don't have to do it alone. The myths we've debunked show that modern PMI is a flexible, accessible, and valuable tool for taking control of your health.

The expert, FCA-authorised team at WeCovr is here to provide personalised advice tailored to your unique needs and budget. We compare policies from leading UK insurers to find the right fit for you, at no extra cost.

Ready to separate fact from fiction for yourself? Get your free, no-obligation quote today and discover how affordable peace of mind can be.

Sources

• Department for Transport (DfT): Road safety and transport statistics.
• DVLA / DVSA: UK vehicle and driving regulatory guidance.
• Association of British Insurers (ABI): Motor insurance market and claims publications.
• Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.