By Clare Yates
5 min read
It’s not always easy to know whether private health insurance is worth it or how it compares with NHS care. Yes, the NHS provides comprehensive healthcare free at the point of delivery, including A&E facilities that fall outside of private healthcare. But there are times when waiting lists, appointment availability, or the desire for extra comfort and choice can make private options appealing.
Let’s look at what the NHS covers, what private insurance offers, the potential costs, and how you can make the choices that work best for you.
NHS: free for everyone, at the point of use
It’s easy to take it for granted sometimes, but the NHS is something many countries can only dream of: free healthcare when you need it. You don’t have to worry about bills for:
GP appointments: Talk to a doctor without paying a penny (though prescriptions cost a small fee in England).
Emergency care: 999 or A&E treatment is covered.
Hospital care: Including surgery and specialist treatment.
Maternity care: Pregnancy, birth and postnatal care.
Vaccinations and routine screenings: Keeping you healthy and preventing illness.
Sure, waiting times can be frustrating for non-urgent procedures, and you might not always see the consultant of your choice, but it’s still a huge safety net. You can get surgery or specialist care without worrying about whether your bank balance can cover it.
Private health insurance: speed, comfort and choice
Private medical insurance (PMI) doesn’t replace the NHS, but it goes a long way in complementing and taking some real pressure off it. Here’s what one leading insurer offers to give you an idea of what’s out there:
Acute conditions: Cover for short-term illnesses or injuries that respond quickly to treatment.
Access to hundreds of hospitals: Choose from private units including Circle, Nuffield, Spire, and NHS private facilities.
Cancer care: Diagnosis, treatment, and aftercare included as standard.
Hospital charges and specialist fees: Outpatient tests, consultations, radiotherapy, chemotherapy and specialist treatment.
Mental health support: Up to £2,000 for therapy or counselling, plus access to helplines and wellbeing services.
24/7 video GP access: Speak to a GP any time for advice, prescriptions or referrals, all from the comfort of home.
Home nursing: Available following inpatient or day patient treatment.
Private ambulance: Full cover where medically necessary.
Parent accommodation: One parent covered if a child under 16 receives covered treatment.
Private health insurance policies don’t cover everything though, so it’s worth knowing the main exclusions. Policies do vary, so always check exactly what’s included and excluded before choosing your plan and insurer. Here’s what the same insurer as above excludes from their policy:
Chronic conditions: Ongoing illnesses like diabetes, arthritis, epilepsy and asthma are usually excluded.
Pre-existing conditions: Conditions you had before joining may not be covered unless your policy allows it.
Pregnancy and childbirth: Standard maternity care isn’t included, though some related complications may be covered.
Cosmetic or overseas treatment: Elective cosmetic procedures and treatment outside recognised providers are generally not covered.
Quick note: all private health insurance in the UK does not cover emergency care like A&E visits or 999 ambulance calls – those are still handled by the NHS.
Out-of-pocket costs
Even after paying your monthly premiums, you may still face some costs when claiming on your health insurance policy. Here’s what could come out of your own pocket when you choose to go privately:
Excesses: A fixed amount you pay when you make a claim.
Co-pays or contributions: Some policies require you to pay a portion of certain treatments.
Limits on cover: Policies may cap how much they pay for specific treatments or per year, leaving you to fund the remaining amount or return to NHS care.
Excluded treatments: Procedures not covered by your policy must be paid for yourself.
Paying privately when you need treatment
Of course, you don’t have to take out private health insurance to access private care. Many people stick with the NHS for most routine or urgent care, then pay privately when they want faster treatment or more choice.
For example, an elective knee replacement procedure at one Spire private hospital starts from around £16,104, depending on the consultant and facility. This approach lets you avoid monthly premiums while still getting quicker access and more personalised care when it matters most.
There are also payment options to spread the cost, so you don’t have to find that kind of money in one go. In the above hospital’s example, you’d be looking at around £367 a month for two years, with an APR of 9.9%.
With this approach, you can see a private GP for faster appointments, then choose whether to have surgery privately or through the NHS. Essentially, it’s a ‘pay-as-you-go’ approach where you feel you can afford private care outright, instead of via the protection against big bills that health insurance can bring.
Another option is to take out a health cash plan. This works a bit like health insurance, but you pay a monthly premium and then claim money (up to an annual limit) towards appointments and treatment. It’s designed for routine care such as dental check-ups, eye tests and physiotherapy. It doesn’t extend to the more serious treatments and care covered by health insurance.
NHS or private - Which is right for you?
For many people, the NHS offers a trusted system that gives peace of mind, especially for emergencies. Private health insurance is more about speed, flexibility and comfort for non-urgent treatment or elective procedures.
You might opt to rely on the NHS for routine care and emergencies, and use private cover as a top-up when you want a little extra choice or convenience. Comparison sites are an ideal place to start, so you can compare health insurance policies and find a plan that fits your needs and budget.