Private Medical Insurance in the UK: Who It’s For And Why I Recommend It

When I speak with clients, especially those with demanding careers, high incomes, and little time to spare, Private Medical Insurance (PMI) often comes up as a priority. And it’s no surprise. In recent years, routine NHS waiting times have grown sharply, and for many people, speed, control and certainty matter too much to leave to chance.

PMI isn’t about replacing the NHS. It’s about ensuring that when you do need treatment, you get it quickly, privately, and on your terms. In this article, I’m going to walk you through who PMI is really for, how it works, and what you should look for if you’re considering it.

What Private Medical Insurance Actually Covers

Private medical insurance pays for private medical treatment when you become unwell with an acute condition - that's something that can be treated and hopefully never impact your health again.

Most policies include:

• Inpatient treatment (surgery, hospital stay, nursing care etc)

• Outpatient consultations, diagnostic scans and tests

• Specialist therapies, often with limits

• Certain drugs unavailable on the NHS

  
  

What it typically doesn’t cover:

• Chronic conditions such as diabetes

• Pre-existing conditions (unless agreed upfront)

• Routine maternity care

• A&E or emergency admissions

• Cosmetic procedures

  
  

If you develop symptoms that lead to a diagnosis of a chronic condition, the tests are usually covered, but the ongoing treatment then moves back to the NHS.

Who PMI Is Really For

From my experience working with clients across the UK, particularly high-earning professionals and families, PMI tends to be most valuable for people who:

1. Can’t afford long waiting times

If you run a business, manage a team, or simply can’t take weeks or months out of your life waiting for appointments, PMI gives you access to faster diagnostics and treatment.

2. Want more control over their care

Private healthcare gives you choice:

• Your specialist

• Your hospital

• Your appointment times

And in many cases, a private room with better facilities.

3. Want access to treatments not routinely offered on the NHS

This includes certain cancer drugs, therapies, or advanced procedures.

4. Prefer comfort, privacy and reduced uncertainty

The NHS will always be the backbone of emergency care - but for non-urgent conditions, PMI removes much of the stress and unpredictability.

How Much Private Medical Insurance Costs

PMI is priced individually, and costs vary significantly depending on age, postcode and the level of cover.

Typical monthly premiums you can expect to pay:

• Individual: Starting from £40 per month

• Couples: From £75 per month

• Families: £100 per month

• Older clients (e.g., 70+): These typical costs are higher due to age

Your premium will depend on:

• Age & Postcode - These are the two main drivers of cost

• How comprehensive your cover is

• Excess

• Health and lifestyle

• Dental and Optical, Travel cover etc

Clients who choose comprehensive outpatient cover will naturally pay more - but they also gain far greater coverage.

Choosing the Right Underwriting Type

One of the biggest decisions you’ll make is how the insurer assesses your medical history. This is where we help you make the best decision.

The main options include:

• Moratorium underwriting: Quick to set up, but exclusions can apply for recent conditions in the last 5 years.

• Full Medical Underwriting (FMU): This where we disclose health history to the insurer and you will know any exclusions at the application stage.

• CPME: ideal for switching providers without moving on worst terms

• Medical History Disregarded: Often available through employer schemes, offering the highest level of flexibility.

  
  

If you value certainty, FMU or CPME often provide the clearest picture of what is and isn’t covered. This is where the value of advice comes in so you don't have any suprises at the claim stage.

Reducing Costs Without Reducing Peace of Mind

For some clients, a smart way to balance cost and cover is to:

• Choose a higher excess such as £250 or even £500.

• Chose a Guided Option to ensure you see the correct Consultant the for your treatment and care. It's not all about the hospital choice,

• Combine PMI with self-insuring for small, routine treatments. Insurers love a small claim and this may impact future premiums !

This approach keeps premiums manageable while still protecting you from high-cost procedures.

The Role of Hospital Lists

Every policy includes a group of hospitals you can access.

Options typically include:

• Standard lists (most affordable)

• Extended national lists

• London lists (highest cost due to fees in the capital)

If you live or work near major private hospitals - especially in London - the hospital list you choose will make a noticeable difference.

Is PMI Worth It?

For many of the clients I work with, the answer is yes - but for different reasons.

Some just want peace of mind. Some want specialist choice. Some want the reassurance that, if something happens, they are covered privately from start to finish. PMI is not essential for everyone - but it’s incredibly valuable for those who prioritise time, privacy and control over their health journey.

Final Thoughts

Private medical insurance is a personal decision, but if you’re someone who values fast access, top-tier specialists, and greater certainty around your healthcare, it can be one of the smartest investments you make.

And with policies varying so widely, taking the time to choose the right one is crucial.

If you’d like personalised guidance…

I help clients compare policies, understand the true differences between cover levels, and choose a plan that fits their lifestyle and expectations.

If you're considering PMI, or simply want clarity on your options - you can book a consultation with me online anytime. It’s a straightforward conversation, and it’s completely tailored to you Book Online | Well Financial