Health insurance guides
Chronic conditions and health insurance
Key takeaways: Chronic conditions and health insurance
Most health insurance plans cover new and unexpected medical issues that respond quickly to treatment. They’re not designed to cover chronic conditions – conditions that are predictable, last a long time or are likely to come back.
You can still get private health insurance if you have a chronic condition, but that condition is unlikely to be covered. You might be able to get some cover for short-term treatment or flare-ups, but if your condition is chronic, private health insurance probably won’t continue covering it long term. It’s worth considering whether private health insurance is the right option for you before buying cover.
What's in this article
Jump to sections:
- What is a chronic condition?
- How do I know if my condition counts as chronic?
- Examples of chronic medical conditions
- Will health insurance cover treatment for a chronic condition?
- What happens if my insurer has been covering treatment and my condition becomes chronic?
- Does cancer count as a chronic condition?
- Can I get health insurance if I have a chronic disease?
- Is it worth taking out private health insurance if I have a chronic condition?
What is a chronic condition?
Most health insurers define a chronic condition as one where one or more of the following apply:
- It needs ongoing or long-term monitoring through check-ups, tests, examinations or consultations.
- It needs long-term control or relief of symptoms.
- It requires long-term rehabilitation or special training to help you cope with the illness.
- It continues indefinitely.
- It has no known cure.
- It comes back or is likely to come back.
Individual insurers may use a different definition, so it is worth checking the membership or policy documents for the health insurance you are considering.
How do I know if my condition counts as chronic?
The definition above is a useful starting point, but whether a particular condition is treated as chronic can depend on your insurer, your plan and the circumstances of your condition. If you are unsure, check with your health insurer before buying cover so you know whether the plan meets your needs. If you already have cover, you can check with your insurer when you need treatment.
Your insurer may ask for permission to contact your GP or specialist for more information about your diagnosis and how they expect your condition to progress.
Examples of chronic medical conditions
The conditions below are examples of illnesses that might be treated as chronic medical conditions. This is not a definitive or exhaustive list, and a condition may not always be treated as chronic in every circumstance. You should check what is covered with your health insurer.
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Will a health insurer cover any treatment for chronic conditions?
If your symptoms start before your health insurance starts
Most health insurers don’t cover conditions you’re already aware of when your health insurance starts.
Find out more in our guide on pre-existing conditions.
If your symptoms starts after your health insurance starts
If your symptoms first start after your health insurance starts, and then become chronic, you will generally be covered for short-term treatment only. This will depend on the health insurer, so it’s always worth checking with them before arranging any private treatment. For example private health insurance usually doesn’t cover:
- Routine follow-up consultations for chronic conditions.
- Monitoring a medical condition.
- Treatments that only offer temporary relief from symptoms and don’t deal with the condition itself.
What happens if my insurer has been covering treatment and my condition becomes chronic?
This depends on your health insurer and the rules of your plan.
If you are with AXA Health, we will tell you when we think your condition has become chronic and explain what happens next, including whether we will stop covering treatment. If cover stops, you may need to pay for treatment yourself or receive it through the NHS. We will tell you in advance so you can discuss your options with your GP or specialist.
Does cancer count as a chronic condition?
Health insurers usually treat cancer differently to other chronic conditions. You’ll find information about how they cover cancer in your membership documents.
If your cancer starts after you take out your health insurance, your insurer may cover longer-term follow-ups and monitoring that they wouldn’t cover for another condition.
If you’ve had cancer before, please be aware that most insurers – including AXA Health – will only cover new cancer that starts after you join. They won’t cover any cancer you’ve had before starting your health insurance, including if it comes back or spreads.
Can I get health insurance if I have a chronic disease?
Yes. You’ll still be able to get health insurance if you have a chronic disease, but your insurance may not cover that condition. Instead, you could have treatment for it on the NHS or pay for private treatment yourself.
Is it worth taking out private health insurance if I have a chronic condition?
Deciding to take out private health insurance is a personal decision that will depend on your circumstances. If getting cover for a chronic condition is the main reason you’re considering taking out private health insurance, you may decide that private health insurance isn’t the best option for you. However, you might decide to take out private health insurance for the reassurance of quick access to healthcare for any new conditions.
Find out more in our guide: Do I need private health insurance?