6 questions to ask before taking out private medical insurance

Private hospital admissions saw a 7% increase between January and September 2023 compared with the same period in 2022, according to the latest data from the Private Healthcare Information Network. 

The majority of these admissions were paid for through private medical insurance (PMI) - with insured admissions at near record levels. 

Despite the NHS remaining fundamental in providing healthcare services to all, long wait times have led to increased demand for PMI, which can provide faster access to treatments.

Here are six questions to ask yourself when weighing up whether to take out a PMI policy.

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1. Do you have any pre-existing medical conditions?

Pre-existing conditions are health issues that you already have when applying for insurance. These are typically long-term conditions such as diabetes, high blood pressure, asthma or Crohn’s disease.

Having a pre-existing condition doesn't mean you're automatically excluded from getting insurance, but insurers generally won't cover the cost of any treatments related to that condition. 

You're also likely to face higher premiums compared to customers who don't have any pre-existing conditions. 

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2. Can you afford to self-fund treatments?

By paying for private treatments yourself, you can choose your preferred clinics, consultants and treatment timelines without worrying about the constraints of insurance policies. This flexibility can be helpful if you need specialised or tailored care.

However, opting to self-fund could leave a big dent in your finances. For example, a knee replacement could cost anywhere from £9,000 to more than £16,000. Plus, if something unexpected happens during treatment, you might end up with more bills than you planned for.

With private medical insurance, you pay a monthly premium and in return the insurer contributes towards the costs of private treatment. This helps to reduce the risk of ending up with a shock bill. 

Insurance policies also offer access to a network of private healthcare providers and specialists, expanding options for care. 

However, since premiums increase as you get older, you might find your policy becomes less affordable over time. 

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3. How old are you?

Private health insurance premiums rise as you get older. Younger people may pay a few hundred pounds a year for comprehensive coverage, while premiums for older people can reach into the thousands.

This reflects the greater the risk of needing medical treatment as you age.

Be sure to regularly review your PMI policy. Compare quotes from different insurers to ensure you're getting the best coverage for your age and circumstances.

The table below provides sample quotes for annual insurance costs for two couples, the first couple are both aged 35 and the other couple are 55. 

Keep in mind that these are just examples; actual prices may differ based on factors such as the coverage options selected, age and medical background.

4. What level of cover do you need?

Tailoring the level of cover to your specific needs can help you save money.

Once you've selected a policy, you can start by thinking about your choice of hospitals. Many insurers offer a list to choose from, and opting for a shorter list may lower your costs.

Decide which other aspects of cover are essential to you. For example, reducing or eliminating outpatient cover (consultations, scans or procedures that don't require a stay in hospital) can take hundreds off your annual premium.

Some insurers also offer the option to reduce comprehensive cancer cover. Instead of full coverage, you can choose coverage only for treatments or drugs not available through the NHS.

Adding an excess to your policy is another way to save. By agreeing to pay a portion of the treatment costs yourself, you can lower your premiums. The higher the excess, the lower your premiums - but make sure you can afford the excess if necessary.

5. How fit and healthy are you?

Private medical insurance premiums are typically based on factors such as age, medical history and lifestyle.

Living a healthy lifestyle can suggest to insurers that you pose a lower risk. Regular exercise and healthy habits, which insurers consider when setting premiums, are associated with lower mortality rates and reduced chances of chronic diseases. 

A smartwatch or fitness tracker can help you track your activity, though in most cases simply owning one won't directly alter your private medical insurance premium.

Some PMI providers may offer incentives or discounts for policyholders who demonstrate healthy behaviours, such as regular exercise.

Aviva's MyHealthCounts scheme, for example, rewards you with up to 15% off your renewal premium if you're fit and healthy. These programmes might involve using fitness trackers or participating in wellness activities. 

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6. Do perks matter to you?

Perks such as free cinema tickets or discounted gym memberships are offered with some private medical insurance policies. While these perks can make your PMI experience more enjoyable, they're unlikely to make up for the cost of the policy itself.

It's essential to think about whether these perks align with your needs and preferences. Understanding what perks are available and whether they add value to your policy can help you decide if they're worth it.

While perks can be nice to have, it's important to prioritise cover levels and cost when choosing the right PMI policy for you.

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