Key takeaways: Health insurance vs self pay vs NHS

Deciding whether to have treatment through the NHS or privately is a personal decision that will depend on your circumstances.

If you choose to have treatment privately, you can pay for treatment yourself, or take out private health insurance. With private health insurance some conditions may not be covered,  such as chronic conditions and conditions you already have signs or symptoms of when your plan starts.

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Health insurance vs paying for treatment yourself vs NHS

Choosing whether to have healthcare on the NHS or privately – whether you pay for it yourself or through private health insurance – is a personal decision that will depend on your circumstances.

While cost is likely to be an important factor in making the decision, you also may want to look into waiting times, where and when you can have treatment, and what treatment is available through each option.

Health insurance will typically not cover treatment of conditions that have been diagnosed or that you've had signs or symptoms of, before taking out your plan.

Why do some people choose private healthcare when we have the NHS? 

With private healthcare, you pay for healthcare yourself or pay for a health insurance policy that will cover eligible treatment for you. Here are a few of the reasons why some people may choose private healthcare:

Quick access to care

Many people choose private healthcare if they are worried about long NHS waiting lists.

Flexibility on time and place of appointments

Private healthcare can often give you flexibility about when and where your appointment or treatment is, so you can fit appointments in around your work or family.

Choice of specialist

With private healthcare, you can usually choose a specialist or hospital. If you have health insurance, you may also be able to choose which hospitals or specialists you can use, depending on the rules of your plan.

Private facilities

You’ll usually be able to have treatment in a private hospital or clinic, with a private room – often with an en-suite bathroom – and more flexible visiting times.

Find out more in our guide, What is private healthcare?

 

Can I still use the NHS if I have private healthcare? 

Yes. Private healthcare isn’t intended to replace the NHS, and you’ll still be able to use the NHS. There are some treatments such as accident and emergency care that aren’t available through private healthcare.

Instead, private healthcare can offer different options and may give you more freedom over where and when you have your treatment.

How does health insurance work?

Private health insurance helps patients access private healthcare by covering some of the costs of private care. You pay a premium yearly or monthly, and then your insurance will cover the cost of treatment if you need to claim (so long as it’s treatment that your plan covers).

What you’re covered for will depend on the health insurer, your individual circumstances and the plan you choose – many have options.

As well as covering you for treatment, you often get additional services with your health insurance to support your health and wellbeing. For example, with AXA Health, you’ll get:

  • A 24/7 health support line for any health information you need
  • Access to our 24/7 online GP service, subject to appointment availability.

What’s not covered by private health insurance? 

Private health insurance won’t cover you for everything. It’s always a good idea to check and compare what different health insurers cover.

However, here are some of the things most health insurers won’t usually cover. If you’re looking for treatment for any of them, health insurance might not be right for you.

Pre-existing conditions

Health insurance is designed to cover new conditions. If you have signs or symptoms already – whether you’ve seen a doctor or not – your health insurance won’t usually cover these.

Find out more about pre-existing conditions: Can I get health insurance to cover a pre-existing condition?

Chronic health conditions

Most health insurers won’t cover long-term treatment of chronic conditions. These are conditions that need long-term treatment or monitoring, have no known cure, or are likely to come back.

Emergency treatment

The NHS is best placed to provide emergency care. Private hospitals don’t usually have A&E departments.

Routine maternity and fertility treatments

Health insurance doesn’t usually cover routine pregnancy and childbirth, as these are not seen as medical conditions, and there aren't usually any waiting lists involved with this kind of care. Health insurance would usually cover the cost of treatment needed for any medical conditions that happen during pregnancy and childbirth. Health insurance doesn't usually cover fertility treatment of any kind.

Anything your health insurer tells you they don’t cover

You’ll find details of these in your plan’s handbook or other documents.

How to decide what’s best for you

Deciding what’s best for you will be a personal decision based on your individual circumstances. You may want to consider:

Your budget

  • Using the NHS: you won’t have to pay for treatment you receive through the NHS, other than fixed costs for prescriptions.
  • Using health insurance: this gives you a set amount that you pay each month or year. There are usually ways to get the cost of health insurance down, such as increasing your excess level. 
  • Self-paying: If you’re paying for treatment yourself, your specialist and hospital should be able to give you an estimate of costs. Remember to factor in any on-going treatments costs. Hospital networks often have payment plans that allow you to spread the cost.

 

How flexible you can be around treatment

  • Using the NHS: you will usually have some choice over your specialist or hospital, but the NHS may be less flexible with appointment times. For example, if you turn down a surgery date more than a couple of times, you may need to start the referral process again. Not everyone can fit NHS appointments in around work commitments or take extended periods of time off work while they wait for treatment.
  • Using health insurance: private healthcare could give you some flexibility around where and when your treatment takes place. You may be able to choose a specialist or hospital. However, this may depend on your insurer and your plan, so it’s worth checking. With some plans, the insurer will need to source your specialist for you.
  • Self-paying: you will have the flexibility to choose where and when you want your treatment to take place, including your choice of specialist and hospital. However, some will charge more than others.

How long you are prepared to wait for treatment

  • Using the NHS: NHS waiting lists vary according to area and what type of treatment you need. Your GP or hospital may be able to give you an idea of how long you might have to wait for NHS treatment. The NHS has targets for particular types of treatment, such as cancer diagnosis.
  • Using health insurance or self-paying: you can usually get many types of treatment quickly if you use private healthcare. 

The treatment you need, and the condition it’s for

  • Using the NHS: the NHS will carry out most treatment. However, sometimes there are limits on treatment and they won’t carry out some kinds of treatment.
  • Using health insurance: your health insurer will send you information to explain which treatment they do and don’t cover. Remember, private health insurance doesn’t usually cover pre-existing or chronic conditions, so you’d need to have treatment for them on the NHS or pay the full cost of private treatment yourself.
  • Self-paying: if you pay for treatment yourself, it doesn’t matter which condition the treatment is for. It doesn’t matter if it’s a pre-existing condition, chronic condition or a cosmetic treatment.

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