The pros and cons of private health insurance

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Private health insurance refers to an insurance policy taken out to ensure that if you need medical treatment in the future, you will be covered for treatment in a private medical practice or private hospital. If you’re covered privately, your health insurance will pay some or all of the bills associated with your treatment.

There are some big advantages to having private medical insurance such as being able to access prompt referrals to specialists and tailored healthcare at locations and times convenient to you.

However, as with anything, there are some disadvantages too. In this article, we’ll look at both and how you can make a decision as to whether it is something that is right for you and your family. 

As with all things, research is key to ensuring you make the right decision for yourself and your family. Ask questions, read the small print and if you do decide to take out private medical insurance, ensure you only place your money with reputable providers and that you have looked into all the various options available to you before making a final decision.

The Advantages of Private Medical Insurance

Most of us wouldn’t consider not insuring our car or home, so why don’t we take the same precautions with our health? The benefits of private health insurance are very many, and they include:

Shorter waiting times

Everyone hates waiting and never more so than when it involves a health problem. For most people, this is the most important reason for having private medical insurance.

With NHS waiting times as long as they are, and growing, waiting can mean the difference between getting a problem identified and resolved early enough to stop it in its tracks, and missing that golden window of opportunity.

The beauty of this type of insurance is that you are free to choose whichever health facility suits you, and in addition, you can jump the queue and receive the essential medical attention you need without having to go through that long, nervous wait for an appointment.

You get to choose your own doctor

The beauty of this kind of policy is that you get to choose your very own doctor, and you can see that doctor consistently, allowing for continuity of care and ensuring that you are able to build up a relationship of trust with your healthcare professional that means they know you and your health inside out.

Unlike NHS services where you may see a different doctor every time you attend a clinic, and often that doctor will not be familiar with your case and your concerns. With private medical insurance, you can choose any doctor within the network or even outside of it.

With private health insurance, the choice is yours, and you are free to request doctors at the top of their field.

Better facilities

With better hospitals comes better facilities. Private health care facilities are usually less crowded, more luxurious and better equipped than most public healthcare facilities, with the highest quality treatment options available to ensure your medical care is the best it can be, and your visits and your stays are as pleasant and comfortable as they can be. 

When you use private health care services, you are assured of excellent, modern, state-of-the-art facilities and as a result, a better experience of care.

Unrestricted visiting hours

This is one of those points that you can only appreciate if you have ever been a patient or had a loved one admitted into hospital.

Hospitals can be very strict on opening hours, and the number of visitors you are allowed by your bedside.

This can be especially frustrating when you want to be with your loved one for longer periods than the allocated visiting time.

With private health insurance, visiting hours are a thing of the past. In-patients are allowed access to their friends and family at all times, with no-one telling them to leave!

Private rooms

Privacy is a basic human right, and something we all value, especially at the times in our lives when we feel unwell, vulnerable and emotional. Busy, noisy, crowded public hospital wards can leave patients wanting for privacy, and the necessary peace and quiet needed to rest and recover.

Private conversations can be overheard by those in the beds next to you and the noisy conversations of others around you can impede your ability to rest.  

With private health insurance, you are guaranteed your own private room if a hospital stay becomes necessary.

You can have as much privacy as you need, conversations are not overheard by others, and examinations happen behind closed doors, and not just a pulled curtain.

Better customer care

Have you ever called your insurance company and struggled to get someone to respond straight away to your enquiry? We’ve all been there, and know how frustrating it can be.

With private health insurance, there are no worries about not being able to get through to someone when you need to speak to them. 

As part of your policy you can have access to your own customer care rep, who will be following your progress, and even visit you if you are in hospital to check everything is to your satisfaction, that you are comfortable and all your needs are being taken care of. 

The disadvantages of private medical insurance


Unless you get private medical insurance through your employer, you will need to pay for it, and depending on the type of cover you need, your age and your existing health conditions, it can be very costly compared to other types of insurance. 

Health insurance premiums aren’t fixed. This means that the costs can and will rise over time to reflect your age and your likelihood to need treatment.

In addition, you can’t shop around in the way you would for other types of insurance as most providers will not take you on if you have a pre-existing condition so anything that you have developed since taking out your first cover will make you ineligible in the eyes of other insurance companies, which means you are then stuck with the provider you are with, whatever their premiums are. 

There are sometimes ways to reduce costs but if you have very little spare money left over at the end of the month after paying all of your other bills, then private medical insurance is not something you’re going to be able to manage..

Limited coverage

This is another big issue with private health insurance. If you are considering taking insurance out then make sure you read very carefully what is covered and what is not, as policies do not cover all conditions.

Health insurance is not designed to cover every health issue that you might face; it is only designed for acute conditions that begin after your policy is taken out.

Many chronic and pre-existing conditions such as arthritis and asthma are not included as standard and injuries incurred through sports might also not be covered as they are considered a lifestyle choice. 

Typically,the following conditions are not covered;

  • Dental Services
  • Organ Transplant
  • Normal Pregnancy
  • Infertility
  • Drug Abuse
  • HIV/AIDs
  • Kidney Dialysis
  • Cosmetic Treatment
  • Deliberately Self-Inflicted Injuries

It is vital to get accurate information about which conditions are covered if taking out a policy as it can lead to problems further down the line if you are not aware of the policy’s limitations.

It can also lead to conflict if you believe you should be covered for something that the company are refusing to pay for, and some policy holders have been forced to go to court in the past to try and get the cover they believed they had paid for. At a time of illness and stress anyway, this would be the last thing you’d want to have to do.

Out-of-pocket expenses

In addition to not covering some conditions and injuries, many medical insurance companies will require you to pay some out-of-pocket expenses too.  

An out-of-pocket expense is basically anything that the insurance company will expect you to pay in addition to your premiums.

These could include elements of your health management that you were paying before you took that insurance out, or just standard up-front costs that they will not refund for you at a later time. 

Most health insurance companies will, in fact, only cover 80% of your costs. You must therefore be prepared to budget for some additional expenses.


Health insurance has many advantages over public healthcare provision. However, it also has its limitations and won’t be right for everyone or every circumstance.

Even those who do have private health insurance find themselves choosing the NHS in some situations and some of those who would like to have private medical insurance find that they’re not able to due to pre existing medical conditions.

It is therefore only suitable for some people. When it works well, however, it can provide quicker, better treatment and in more comfortable, luxurious surroundings. 

As with all things, research is key to ensuring you make the right decision for yourself and your family. Ask questions, read the small print and if you do decide to take out private medical insurance, ensure you only place your money with reputable providers and that you have looked into all the various options available to you before making a final decision.

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