Healthplan • Self-pay or Private Medical Insurance.

Self-pay or Private Medical Insurance.

Name: Health insurance
Brand: Healthplan
Rating: 4.8 (231 reviews)

Discover the pros and cons of self-paying for medical expenses and medical insurance. This article covers the differences between self-paying and medical insurance and assists you in making an informed decision about managing your healthcare costs.

When deciding between self-pay and medical insurance, you must consider your personal preferences, financial circumstances, and individual situation. These factors play a significant role in determining which option is best for you. By understanding the importance of these factors, you can decide about the right healthcare coverage for you.

Regardless of which option you choose to cover your medical expenses, it is worth noting that according to the Financial Conduct Authority’s (FCA) Financial Lives report from 2023, nearly 7 million people in the UK hold private medical insurance (PMI). This is a significant increase of 1 million in the past six years. One reason could be that UK residents are concerned about the NHS waiting times and need to take control of their health and well being.

What is the difference between self-pay and medical insurance?

The difference between self-paying for medical treatment and having private health insurance is that with insurance, the provider covers the medical costs on your behalf based on policy coverage, while with self-paying, you pay for healthcare or treatment out of your pocket.

Individuals may opt for self-paying medical care instead of monthly insurance payments and claim procedures. Self-paying can be more cost-effective for treatments like physiotherapy, orthopaedic care, or cataract therapy. However, it can be more expensive, especially for more complex medical procedures.

For example, with an increasing number of people needing knee and hip replacement surgery and the NHS waiting list being painfully long, self-funding patients could be looking at prices ranging from £13,600 to £14,500 per knee and £13,000 to £15,000 for a hip replacement.

Cataract surgery is one of the most common procedures in the UK, with over 330,000 individuals over 65 requiring the operation every year. According to Laser Eye Surgery Hub, the cost of cataract eye surgery is between £1,995 – £3,150 for standard monofocal lenses and £3,495-£4,725 for multifocal lenses. The prices are based on per eye from December 2023.

Self-pay for medical care.

Pros.

One of the main advantages of self-paying for medical expenses is the freedom and flexibility it offers. With self-pay, individuals can choose private hospitals, healthcare consultants, and treatments without worrying about insurance policy restrictions or underwriting. Unlike many insurance policies, self-paying patients with chronic or existing conditions will be treated. Additionally, healthcare providers may negotiate and provide flexible payment options to self-paying patients.

Cons.

You must consider the high medical costs associated with self-paying, and opting for private treatment could leave you significantly out of pocket. Many health conditions require MRI scans, X-rays and diagnostic tests, an extra financial burden for self-paying individuals. Depending on the region in the UK, an MRI scan could cost between £500 and £600.

MacMillan Cancer Support estimates that more than 3 million people living in the UK have cancer.

With this thought in mind, understanding the potential expenses of self-funded private cancer treatment is important. While the cost of private therapy for an average melanoma treatment can be as low as £2,300 – £2,500, chemotherapy costs and treating breast or prostate cancer can accumulate many tens of thousands of pounds. The high-energy Proton Beam therapy for prostate cancer starts at £27,000 and reaches around £120,000 depending on how many treatment sessions are required. While, if you are self-funding for a heart condition, you could be looking at paying around £35,000 for key-hole heart surgery.

Self-paying for healthcare treatment may have some advantages, but it provides no financial protection in case of serious health issues.

Private Medical Insurance.

Pros.

In today’s hectic world, private medical insurance (PMI) is a crucial aspect of healthcare. It provides peace of mind, security and financial support should you require medical assistance.

Insurance policyholders pay a monthly premium to access GPs 24/7, hospital stays, online and telephone GP consultations, counselling support, and other healthcare services. All medical insurance providers now offer digital GP appointments meaning you are getting GP advice and referrals sometimes within hours at a time to suit you. Patients feel more confident about receiving faster private hospital consultation appointments and diagnoses than going through the NHS. They can also control their treatment path and enjoy private facilities.

One of the most significant benefits of medical insurance is financial protection. Paying private medical costs can be expensive, especially in the case of a serious accident or illness. Medical insurance alleviates the economic burden of hospitalisation, surgery, consultations, and additional treatment expenses.

Medical insurance assures individuals that they will have access to a network of top-of-the range healthcare providers and facilities. It benefits individuals in the event of medical care and encourages preventive care through regular check-ups and screenings to help people maintain good health.

Cons.

One major disadvantage of medical insurance for many people is the premium costs. Individuals experiencing the economic squeeze must consider whether they can afford the monthly payments. This results in many people in the UK not having private health insurance and having to endure long NHS waiting lists or facing financial difficulties in the event of a. unexpected medical issue.

Medical insurance can include have an excess, and underwriting for pre-existing conditions may exclude current or recent conditions from cover. There is also a claims process to follow but this can also assist in seeing the correct consultants in a timely manner.

Factors to consider.

When deciding whether to self-pay or obtain medical insurance, weighing each option’s advantages and disadvantages is important. Before deciding, consider your financial circumstances, family size, and any existing health conditions that an insurance policy may not cover.

One of the main differences between self-payment and medical insurance is the cost. Self paying for health care may offer the freedom to pay as and when you need to, but without insurance, you are responsible for covering all medical expenses. Therefore these may only be cost-effective for individuals who do not require expensive medical care.

Private medical insurance usually covers a wide range of medical services, such as 24/7 GP assistance, hospital stays, and access to a network of healthcare providers. Having PMI can give you peace of mind, knowing that you are protected in case of unexpected medical issue. On the other hand, self-pay may cover only certain services or require a higher out-of-pocket cost.

Guideline Examples of PMI policies.

As a guideline, see the below monthly premium costs from the UK’s top insurance providers, based on non-London postcodes as of 16/05/2024.

The policies offer a comprehensive level of cover and include the following:

In/Day-Patient Cover: No annual limit

Outpatient Consultation and tests Cover: No annual limit

Cancer Cover: Comprehensive

Therapies: Included

Mental Health: Included

Digital GP Service: Included

Hospital List: (Guided by insurer)

Excess: £100

Insurer	Age Group	Monthly Cost	Age Group	Monthly Cost	Age Group	Monthly Cost	Age Group	Monthly Cost
Freedom	30 Years	£67.00	47 Years	£106.84	57 Years	£141.83	70 Years	£283.21
AXA	30 Years	£79.40	47 Years	£119.46	57 Years	£173.83	70 Years	£282.79
Aviva	30 Years	£53.28	47 Years	£87.32	57 Years	£137.73	70 Years	£186.83
The Exeter	30 Years	£61.83	47 Years	£88.77	57 Years	£149.34	70 Years	£220.41
Bupa	30 Years	£56.06	47 Years	£89.72	57 Years	£130.09	70 Years	£197.90
Vitality	30 Years	£66.21	47 Years	£88.12	57 Years	£157.20	70 Years	£232.76
Axa Inspire	30 Years	£67.92	47 Years	£103.07	57 Years	£130.71	70 Years	£250.59

To conclude.

In the UK, motor insurance is mandatory and offers financial protection in the event of an accident. If it wasn’t compulsory, would you still insure your car and or take the risk of the consequences of an indemnity claim which could run into hundreds of thousands of pounds. This is why car insurance is compulsory. On the other hand, medical insurance is optional but without it treatment for cancer for example could run into hundreds of thousands of pounds and may not be covered by the NHS. Health insurance is crucial for covering medical expenses. You wouldn’t drive without car insurance.

Ultimately, the choice between self-pay and medical insurance will depend on individual circumstances and healthcare requirements. Medical insurance is a valuable investment that offers financial protection, access to quality healthcare, peace of mind, and cost savings for individuals and families. It is vital to have medical insurance to prepare for unforeseen medical expenses.

Consulting with a healthcare professional or financial advisor can also help you make an informed choice that is tailored to your personal preferences and budget.