Inpatient vs Outpatient Health Insurance Cover Explained
As an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, WeCovr is here to demystify private medical insurance in the UK. This guide breaks down the crucial difference between inpatient and outpatient cover, empowering you to choose the right policy for your needs.
WeCovr's simple guide to understanding different types of private healthcare cover
Navigating the world of private medical insurance (PMI) can feel like learning a new language. Terms like ‘inpatient’, ‘outpatient’, ‘excess’, and ‘underwriting’ are everywhere. But understanding these concepts is the key to unlocking the peace of mind that the right health cover can provide.
The most fundamental choice you'll make when selecting a policy is your level of cover, which boils down to three main categories:
- Inpatient Cover: Care that requires admission to a hospital bed.
- Day-Patient Cover: Care that requires a hospital bed for a procedure but allows you to go home the same day.
- Outpatient Cover: Consultations, tests, and treatments that do not require a hospital bed.
In this guide, we will explore each of these in detail, explain how they affect the cost of your premium, and help you decide which level of private health cover is right for you.
First things first: What is Private Medical Insurance?
Private Medical Insurance, often called PMI or private health cover, is an insurance policy that pays for the cost of private medical treatment for acute conditions.
Its primary purpose is to help you bypass potential NHS waiting lists and access specialist consultations, diagnostic tests, and treatments more quickly. In late 2024, NHS England reported that the number of people waiting for routine hospital treatment stood at over 7.5 million. PMI offers a valuable alternative for those who wish to be seen and treated faster.
Crucial Point: It's vital to understand that PMI is designed for acute conditions—illnesses or injuries that are sudden, unexpected, and curable—that arise after your policy begins. Standard UK PMI policies do not cover pre-existing conditions or long-term, incurable chronic conditions like diabetes or asthma.
The Core Difference: Inpatient vs Outpatient Cover
At its heart, the distinction is simple and comes down to one thing: whether you need to be formally admitted to a hospital and stay overnight.
| Feature | Inpatient Cover | Outpatient Cover |
|---|---|---|
| Primary Definition | Medical care that requires admission to a hospital for at least one night. | Medical care where you visit a hospital or clinic but are not admitted. |
| Typical Scenarios | Surgery requiring overnight recovery, major illness treatment. | Specialist consultations, diagnostic scans (MRI, CT), blood tests, physiotherapy. |
| Hospital Bed? | Yes, you are allocated a bed in a ward or private room. | No, you attend an appointment and leave the same day. |
| Cost Impact | This is the core of all PMI policies. | This is an optional add-on that significantly affects the premium. |
Think of it like this:
- Inpatient is for when you are ill or injured enough to need to stay in the hospital.
- Outpatient is for when you need to pop out to the hospital or a clinic for an appointment or test.
A Deep Dive into Inpatient Cover
Inpatient cover is the foundation of every private medical insurance policy in the UK. You cannot have a policy without it. It is designed to cover the most significant—and expensive—aspects of private healthcare.
What does inpatient cover typically include?
When you are admitted to a hospital as an inpatient, your policy will usually cover:
- Hospital Accommodation: The cost of your bed, usually in a private room with an en-suite bathroom, TV, and other home comforts. This is a major benefit over potentially being on a busy NHS ward.
- Nursing Care: All care provided by the hospital's nursing staff during your stay.
- Surgeon and Anaesthetist Fees: The fees charged by the specialists performing your procedure.
- Specialist Consultations: Any consultations that take place while you are admitted to hospital.
- Operating Theatre Costs: The charges for using the surgical facilities.
- Medications and Dressings: Drugs and supplies administered during your stay.
- Diagnostic Tests: Scans (MRI, CT, X-ray) and pathology tests conducted while you are an inpatient.
- Prostheses and Implants: The cost of items like a replacement hip joint or an artificial lens for cataract surgery.
Real-Life Example of Inpatient Care
Imagine you tear a ligament in your knee playing football. Your GP refers you to an orthopaedic surgeon.
- Investigation (Outpatient): You might first have an MRI scan as an outpatient to diagnose the extent of the damage.
- Treatment (Inpatient): The surgeon confirms you need reconstructive surgery. You are admitted to a private hospital the day before your operation. You have the surgery and stay for two nights to recover under medical supervision.
- Cover: The costs for the surgery, the anaesthetist, your private room, meals, nursing care, and medication are all covered by your inpatient benefits.
Exploring Outpatient Cover in Detail
While inpatient cover handles the major events, outpatient cover deals with the journey to a diagnosis and post-treatment recovery. It is almost always an optional extra that you can add to a basic inpatient policy.
Adding outpatient cover is one of the biggest factors that increases the price of a PMI premium. However, it's also what gives you a truly end-to-end private healthcare experience.
What does outpatient cover typically include?
- Specialist Consultations: The initial appointments with a consultant after a GP referral. This is often the first step in the private medical journey and helps you bypass the long wait to see a specialist on the NHS.
- Diagnostic Tests & Scans: Any tests needed to diagnose your condition, such as MRI scans, CT scans, X-rays, ultrasounds, and blood tests.
- Minor Procedures: Small procedures that can be performed in a consulting room, like mole removal or injections.
- Post-Operative Physiotherapy: Sessions with a physiotherapist to help you recover after surgery.
Insurers offer different levels of outpatient cover. Some may provide a set number of consultations per year, while others may offer a monetary limit (e.g., up to £1,000 per year). Comprehensive policies will offer unlimited outpatient cover.
Real-Life Example of Outpatient Care
Let's say you've been suffering from persistent, severe headaches.
- GP Referral: Your GP is concerned and refers you to a neurologist for specialist investigation.
- Consultation (Outpatient): With outpatient cover, you can book a private appointment with a top neurologist within days. This consultation fee is covered.
- Diagnostics (Outpatient): The neurologist recommends an MRI scan of your brain to rule out serious issues. You have the scan the following week at a private imaging centre. The cost of this scan is covered.
- Follow-up (Outpatient): You have a follow-up consultation where the neurologist confirms the scan is clear and diagnoses you with tension headaches, prescribing medication and lifestyle changes. This follow-up is also covered.
Without outpatient cover, you would have had to pay for these consultations and the MRI scan yourself (which can cost £400 - £1,500+) or wait for them on the NHS.
Day-Patient Cover: The In-Between Category
Day-patient cover is a simple but important concept. It covers procedures where you are admitted to hospital and require a bed, but you are discharged on the same day.
This is included as standard alongside inpatient cover on virtually all UK policies.
Common Day-Patient Procedures:
- Cataract surgery
- Endoscopy or colonoscopy
- Arthroscopy (keyhole joint surgery)
- Hernia repair
- Wisdom tooth extraction (if done in a hospital)
The key distinction is the need for a bed for recovery, even if it’s just for a few hours. This separates it from a standard outpatient appointment.
How Do These Cover Levels Affect Your Policy Price?
This is the million-dollar question (or rather, the £50-£150 per month question). The level of cover you choose is the single biggest driver of your monthly premium.
| Level of Cover | Description | Impact on Premium | Who is it for? |
|---|---|---|---|
| Basic (Inpatient Only) | Covers you only if you're admitted to hospital. You pay for all diagnostic tests and consultations leading up to admission. | Lowest Cost. | Someone on a tight budget who wants a safety net for major surgery/illness, and is happy to use the NHS or self-pay for diagnostics. |
| Intermediate (Limited Outpatient) | Inpatient cover plus a limit on outpatient costs (e.g., £500, £1,000, or £1,500 per year). | Mid-Range Cost. | A good compromise. Provides cover for the initial diagnostic journey but keeps premiums manageable. |
| Comprehensive (Full Outpatient) | Full cover for inpatient, day-patient, and outpatient treatment, with no annual financial limits. | Highest Cost. | Someone who wants complete peace of mind and a seamless private journey from the very first consultation to full recovery. |
To make this clearer, here’s an illustrative cost breakdown for a healthy 40-year-old non-smoker in the UK:
| Cover Level | Illustrative Monthly Premium | What's Covered |
|---|---|---|
| Inpatient Only | £45 | Surgery, hospital stays, major treatments. |
| Inpatient + £1,000 Outpatient | £70 | All of the above, plus specialist consultations and diagnostic scans up to £1,000 per year. |
| Comprehensive | £110 | All of the above, with no financial limit on outpatient care. Plus, often includes more therapy options. |
Note: These are illustrative figures. Your actual premium will depend on your age, location, medical history, and chosen insurer. A specialist PMI broker like WeCovr can provide you with precise quotes tailored to you.
Building Your Ideal Health Insurance Policy
Think of building your policy like choosing toppings for a pizza. The base (inpatient cover) is essential, but the toppings (outpatient, therapies, dental) are up to you.
- Start with the Core: Decide if you want Inpatient-only or if you want to include Outpatient cover. This is your biggest decision. If you have savings and are comfortable paying for a few consultations or a scan yourself, an inpatient-only policy can be very cost-effective. If you want the insurer to handle everything from day one, you need outpatient cover.
- Choose Your Outpatient Limit: If you opt for outpatient cover, do you want a limited amount (e.g., £1,000) or a comprehensive, unlimited option? The limited option is often a sweet spot for balancing cost and coverage.
- Consider an Excess: An excess is a fixed amount you agree to pay towards your first claim each year (e.g., £100, £250, £500). Choosing a higher excess will lower your monthly premium.
- Select Your Hospital List: Insurers offer different tiers of hospitals. A national list is standard, but adding access to expensive central London hospitals will increase your premium.
- Add Optional Extras: Do you want cover for dental, optical, or mental health? These can be added for an additional cost.
Navigating these choices can be daunting. This is where WeCovr excels. Our experts can walk you through these options, explain the pros and cons, and compare policies from leading UK insurers to find the perfect balance for your needs and budget—all at no cost to you.
The Critical Exclusion: Chronic and Pre-existing Conditions Explained
This is the most important rule of UK private medical insurance, and it's essential to be crystal clear.
PMI is for new, curable conditions that arise after you join.
It is not designed to cover:
- Pre-existing Conditions: Any illness, injury, or symptom you have (or have had symptoms of) in the years before your policy starts. Most insurers look back five years. If you go two continuous years without symptoms or treatment for that condition after your policy starts, it may become eligible for cover.
- Chronic Conditions: Long-term illnesses that cannot be cured, only managed. This includes conditions like diabetes, asthma, high blood pressure, arthritis, and Crohn's disease. The day-to-day management of these will always remain with the NHS.
An acute condition is a disease, illness or injury that is likely to respond quickly to treatment and lead to a full recovery. A broken bone, a hernia, appendicitis, or the need for a joint replacement are all examples of acute conditions that PMI is designed to cover.
WeCovr's Added Value: More Than Just an Insurance Policy
We believe in supporting our clients' overall health and wellbeing, not just providing a policy for when things go wrong. When you arrange your private medical insurance through WeCovr, you get more than just cover.
- Complimentary Access to CalorieHero: All our PMI and life insurance clients receive free access to our exclusive AI-powered calorie, nutrition, and activity tracking app, CalorieHero. It’s a powerful tool to help you manage your diet, stay active, and take proactive steps towards a healthier lifestyle.
- Expert, Unbiased Advice: Our team of FCA-authorised specialists are experts in the UK private health insurance market. We're not tied to any single insurer, so our advice is always impartial and focused on your best interests.
- Discounts on Other Protection: We value your loyalty. Our PMI clients are often eligible for discounts when they take out other policies with us, such as life insurance or income protection.
- High Customer Satisfaction: We pride ourselves on the positive feedback we receive from our clients. Our high satisfaction ratings on independent review websites reflect our commitment to excellent service.
Staying Healthy: A Partner to Your PMI Policy
While having private medical insurance provides a fantastic safety net, the best way to manage your health is to live a healthy lifestyle. This can reduce your risk of developing many acute conditions and help you feel your best.
- Balanced Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains. A balanced diet is fundamental to everything from maintaining a healthy weight to supporting your immune system. Using a tool like CalorieHero can make tracking your nutrition simple and insightful.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, swimming, or dancing. It's great for your heart, muscles, bones, and mental health.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Sleep is when your body repairs itself. Poor sleep is linked to a host of health problems, including a weakened immune system and high blood pressure.
- Manage Stress: Chronic stress can have a significant physical impact. Find healthy coping mechanisms that work for you, whether it's mindfulness, yoga, spending time in nature, or a hobby you love. Many PMI policies now offer access to mental health support services as part of their package.
Frequently Asked Questions (FAQs)
Is it worth getting outpatient cover on my health insurance?
Can I buy a policy that is just for outpatient cover?
Does private medical insurance cover cancer treatment?
How does an excess work with inpatient vs outpatient claims?
Take the Next Step with WeCovr
Understanding the difference between inpatient and outpatient cover is the most important step towards choosing the right private medical insurance. Now, let us help you with the rest.
At WeCovr, we make the complex simple. Our friendly, expert advisors can give you no-obligation advice and compare quotes from the UK's leading insurers to find a policy that fits you perfectly.
Ready to find your perfect private health cover? Get your free, personalised quote from WeCovr today!
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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