Martin Lewis and Private Health Insurance: What MoneySavingExpert Says

What does MoneySavingExpert say about private health insurance?

The guide does not say that everyone should buy private medical insurance. Instead, it asks whether the benefits are worth the cost for you.

MSE also says a higher excess can reduce the premium, self-paying can work for some people, and comparing options before you buy is sensible. Some treatments may have a waiting period after a new policy starts.

The broad advice is sound. The harder part is working out what it means for you.

My Health Protected is not affiliated with, sponsored by or endorsed by Martin Lewis or MoneySavingExpert.

What is private health insurance?

Private health insurance is also called private medical insurance, or PMI.

It helps pay for eligible private medical care if you become ill or injured. You pay a monthly premium, or sometimes pay for the year in one go. If you need covered treatment, the insurer pays some or all of the eligible cost.

The plan may include hospital treatment, specialist appointments, tests and scans, physiotherapy, cancer treatment and mental health care. It may also have limits, exclusions and an excess.

PMI normally works alongside the NHS rather than replacing it. For example, you may see your usual GP and then use your policy for an eligible specialist appointment, scan or operation.

Most people buy cover for one or more of three reasons: faster access to some planned care, more choice over where they are treated, and more control over appointment times.

For a deeper explanation, see our guide to how private health insurance works.

What does PMI cover?

Most policies focus on acute conditions. An acute condition is usually a health problem that can improve with treatment. A knee injury that needs surgery is a simple example.

A long-term condition may be treated differently.

Inpatient treatment

Inpatient treatment means care where you are admitted to hospital. It can include surgery, hospital accommodation, nursing care, consultant fees and medicines used during treatment. Some plans also give access to private rooms where available.

Outpatient treatment and specialist consultations

Outpatient treatment does not need an overnight stay. It can include specialist consultations, follow-up appointments, scans and other tests.

Some plans give full outpatient cover. Others set a yearly limit. That limit can matter more than it first appears because many claims begin with a consultation or scan before any treatment starts.

Diagnostic tests

Diagnostic tests help doctors find the cause of symptoms. They can include blood tests, X-rays, ultrasound, MRI scans and CT scans. Some insurers treat major scans separately from other outpatient care.

Physiotherapy

Many plans include physiotherapy. Cover may be given as a set number of sessions or as a money limit. Some insurers also offer direct access for certain muscle, bone or joint problems.

Cancer care

Cancer cover is one of the areas where policy wording matters most. Depending on the plan, it can include specialist appointments, scans, surgery, chemotherapy, radiotherapy, eligible cancer drugs and follow-up treatment.

Insurers can differ on drugs, monitoring, treatment at home and palliative care. Two plans can both say they cover cancer but still offer different benefits.

Mental health cover

Mental health cover is available on many plans. It may include talking therapy, psychology, psychiatry and inpatient care. Limits can apply to the number of sessions or days of treatment.

Is private health insurance worth it?

For some people, yes. For others, no.

The answer depends on what you want from the policy and what you can afford.

• your budget
• your age
• how quickly you want access to planned treatment
• the hospitals you would use
• how much outpatient cover you want
• whether you are happy to pay smaller bills yourself
• your medical history
• whether you already have cover through work
• how concerned you are about NHS waiting lists

It also helps to ask what problem you are trying to solve. If your main concern is getting a diagnosis quickly, outpatient benefits may matter more. If your main concern is the cost of major surgery, hospital cover may matter more.

In our work as brokers, this is often where the answer becomes clearer. The best policy is not the one with the longest list of benefits. It is the one that covers the things you value at a price you can keep paying.

See our full guide to whether private health insurance is worth it.

How does medical underwriting work?

When you apply for cover, the insurer needs a way to deal with your medical history.

For new individual cover, two common routes are moratorium and full medical underwriting.

Moratorium underwriting

With moratorium underwriting, you normally do not give a full medical history when you apply. Instead, the insurer uses rules based on recent health problems.

A common approach looks back at conditions from the five years before the policy started. Some conditions may become eligible later if you go through a set period without symptoms, treatment, medication or advice.

The exact rules vary by insurer, so check the policy wording. The insurer may also review medical records when you make a claim.

Full medical underwriting

With this route, you provide your medical history when you apply. The insurer reviews it before the policy starts and tells you which conditions, if any, are excluded.

This takes more work at the start, but it can give you more clarity from day one. Neither route is always better.

Read our detailed comparison of moratorium and full medical underwriting.

How much does private health insurance cost?

There is no single price.

The main factors are age, postcode, insurer, level of cover, hospital access, outpatient benefits, excess, and whether the plan covers one person, a couple or a family.

Age has a big effect because claims become more likely as people get older. Location matters too. Private care can cost more in London, so plans with wider London hospital access can cost more.

Benefits also affect the price. A plan with broad outpatient benefits will usually cost more than one with a fixed limit. A wider hospital list can also raise the price.

The excess works the other way. A higher excess will often reduce the premium.

This is why a cheap quote is not always better value. It may simply include less.

See our average cost of health insurance guide for more detail.

Should you switch health insurer?

Switching can save money, but medical history makes it more complex than changing home or car insurance.

Imagine your current plan covers a knee problem that started after you joined. Another insurer offers a lower price. If you move on fresh medical terms, that knee may become excluded.

You have saved on the premium but lost valuable cover.

Some people can switch on continued terms, often called CPME. This can help preserve the medical position you already have.

Do not cancel your existing policy until the replacement terms are confirmed in writing and you are happy with them.

In our experience, this is one of the areas where advice can add the most value. A price comparison is easy. Knowing whether the move weakens your cover is harder.

Read our switching health insurance guide and renewal guide.

Which companies offer private health insurance?

The UK market includes insurers such as Bupa, AXA Health, Aviva, Vitality, WPA and The Exeter.

They do not all structure their plans in the same way. The main differences can include hospital access, outpatient benefits, cancer cover, mental health benefits, excess options and claims processes.

That is why we would not choose a provider on brand or price alone.

Compare our independent provider reviews →

What if something goes wrong?

If you are unhappy with an insurer’s decision or service, complain to the insurer first.

If the issue is not resolved, you may be able to take an eligible complaint to the Financial Ombudsman Service.