As NHS waiting lists surpass seven million, largely due to disruptions from the pandemic, many individuals are turning to private healthcare options to avoid extended delays.

In 2024’s first three quarters, private medical insurance financed a remarkable 492,000 treatments, an increase from 460,000 in the same timeframe the prior year, according to the Private Healthcare Information Network, an independent organization that gathers health data.

Currently, around 7.6 million adults in the UK, which is about 14 percent of the population, possess private medical insurance, a notable rise from 6.7 million in 2020, as reported by consultancy firm Broadstone.

Private medical insurance can assist in covering treatment costs while providing quicker access to consultations, diagnostic tests, therapies, and private hospital facilities, along with the option to select one’s treating physician. However, the potential expenses associated with such insurance can deter many.

Insurance costs are influenced by several factors including age, health status, location, medical history, and the type of coverage selected. Sarah Coles from investment platform Hargreaves Lansdown notes, “Premiums tend to increase with age. For older individuals who may require more frequent medical attention, comprehensive coverage could approach £200 monthly.”

MoneyHelper, a government advisory website, estimates annual insurance costs for a typical family—two adults in their 40s and two children under ten—ranging from £700 to £1,800. A 50-year-old living in the southeast could face quotes between £66 monthly (£794 annually) to £111 monthly (£1,327) for a mid-range plan with a £500 excess.

While having insurance can provide significant peace of mind, individuals must consider whether the price aligns with their needs or if they are willing to endure NHS wait times for free treatment.

‘Private Care after Waiting Two Years on the NHS’

Sara Thornton, a 50-year-old from Amersham, Buckinghamshire, found herself grateful for her medical insurance after navigating a lengthy NHS waiting list for surgery to fix a poorly healing broken arm.

Thornton and her husband Jack pay £258 monthly for comprehensive family health coverage with insurance provider Axa. “Despite the cost, we believe it is worthwhile,” said Thornton, who works as a weather presenter and operates the holiday weather app, Vacay Weather. After fracturing her arm while ice skating on New Year’s Eve 2021, she was initially told it was a minor injury.

However, the injury did not heal properly, causing her significant limitations. After months of persistence, she finally secured an NHS appointment, where surgery was suggested. However, she felt discouraged by the staff. Eventually placed on a waitlist of nine months to a year, Thornton was still waiting nearly two years later and opted for private care in May 2024.

“My surgeon performed excellently and my arm has healed,” she said, adding that ironically, it was the same surgeon she had been waiting to see through the NHS. “I was treated in a private ward at the same hospital where he typically works for the NHS.”

Thornton estimates her surgery cost around £5,000. “I am incredibly thankful for my insurance, as it allowed me to get the surgery I desperately needed without financial stress,” she said, expressing concern for those who cannot advocate for their health needs.

Understanding Your Health Insurance Coverage

Private medical insurance generally covers diagnosis processes including tests, scans, and consultations, as well as treatment procedures such as surgeries and hospital fees. Common claims involve procedures like cataracts, colonoscopies, knee surgeries, joint replacements, and hernias, while claims related to heart health and cancer tend to be more expensive.

Before purchasing a policy, it’s crucial to know what is not covered, including emergency treatments and the management of chronic health issues. Notably, most insurers now offer virtual GP services accessible via smartphone.

Be mindful of the excess you must pay when claiming, which will vary by policy. Generally, a higher excess results in lower premiums, but it should always remain affordable. Walters mentions, “In most cases, the excess is payable once per person per policy year rather than per claim, though there are exceptions.”

Insurance typically excludes pre-existing conditions from coverage, either fully or for a specified duration.

Many plans are now categorized as “guided,” meaning insurers direct you toward specific consultants and possibly hospitals. Such plans tend to be 10-30% more affordable but may not suit you if you prefer choosing your own healthcare provider.

Ways to Reduce Healthcare Costs

Determine whether you really need a policy; you may already have coverage through your employment, where group schemes can offer better prices or terms including coverage for existing conditions.

Compare different policies, not just on price but by evaluating levels of coverage and any extra benefits like 24/7 phone support or gym discounts. Keep in mind that while additional perks are advantageous, coverage level and cost remain paramount. Healthy lifestyle choices or switching insurers annually may also yield savings.

Consulting an independent broker can help you understand the full market offering. You can locate a local adviser via the Association of Medical Insurers and Intermediaries (amii.org.uk).

Alternatives to Private Insurance

Self-insuring is a popular option, where you regularly set aside savings to fund treatment if necessary, allowing for greater flexibility in choosing providers without insurance constraints.

However, if you require treatment before building sufficient savings, this strategy poses risks. An alternative is a cash plan, where you pay upfront for treatments but receive reimbursements later, which may allow you to recover more than you’ve initially spent.

Such plans generally don’t provide the same level of coverage as private insurance but can offer more budget-friendly solutions. According to Coles, “These plans let you claim back some costs for check-ups or treatments like dental work up to an annual limit, with some starting as low as £10 monthly.”

Broadstone reports a rise in demand for healthcare cash plans, with 5.1 million holders in 2024, up from 4 million in 2020.

It’s essential to remember that the NHS remains a viable option, offering free services. Consumer group Which? notes that private care often mirrors the quality of NHS procedures, as many private practitioners also serve the NHS.

Ultimately, the NHS will deliver quality care; the trade-off is simply the waiting time. It’s crucial to assess personal financial situations against health benefits when deciding between private insurance and NHS services, as suggested by Coles: “You must evaluate when NHS care is sufficient and continue utilizing those services.”

‘My £368-a-Month Insurance Gives Me Confidence’

Angus Maclean has held a private medical insurance policy with Bupa for a decade, arranged through Regency Health, and currently pays £368 for a platinum plan that covers his wife, Tor, 46, and their two children, 17-year-old Charlie and 14-year-old Lucy.

“My father was diagnosed with cancer at 24, so providing coverage for my family has always been vital to me,” shared Maclean. “I lost my mother to cancer at 55, making it a priority to have insurance ready in case of emergencies.” As a Cheltenham resident running his own gin company, Copper Lion, Maclean has made only a handful of minor claims but appreciates the reassurance his policy offers. “While it’s costly, I believe it’s a necessary expense. Especially with my upcoming participation in a charity boxing event in London, I value having coverage for potential injuries or health issues that may arise.”

“Though I don’t anticipate anything going awry, having private insurance allows for fast diagnosis and treatment without financial concerns,” he added.