NHS or Private Health Insurance - How to Make Your Choice?
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Of all the factors which affect your lifestyle, your health is probably the most important. If you're ill, you want to get things sorted out as quickly as possible.
Of course, the NHS will do the job. But sometimes, there's a long waiting list and you may need extra care. Then maybe you should think about UK private health insurance.
This article tells you what is covered by the NHS, what is not and why you should consider getting private health insurance. Let's dive in!
What's covered by the NHS?
The NHS will cover you for:
- emergency treatment, for instance if you're hurt in a traffic accident or have a heart attack;
- major illnesses and long term conditions such as cancers, heart disease, diabetes;
- prescriptions for less serious illnesses such as flu;
- visits to your GP (family doctor);
- prescribed vaccinations for children;
- flu jabs for the over-65;
- maternity and post-natal care.
Good to know
You may find that some treatment recommended by NHS specialists has to be arranged privately. For instance, chiropody may not be available on the NHS in your area except for diabetics - this is a decision each NHS trust is free to make for itself.
What does the NHS not cover?
But the NHS doesn't cover everything. That could depend on where you live - different NHS trusts have different policies (the 'postcode lottery').
Some trusts will not authorise particular surgical procedures, or may not put forward patients over a certain weight or age for surgery. Opticians' charges aren't covered except for children and pensioners (though cataract surgery is), and many dentists now will not treat new patients under the NHS. Some types of treatment may not be approved, for instance where they are considered too expensive, or where they are relatively new.
You may also be interested to know that the NHS has also restricted certain common surgical procedures, such as
- varicose vein surgery
- surgery to help stop snoring
- dilation and curettage for heavy period bleeding.
That may be sensible, as in many cases the condition can get better on its own, but that's not much consolation if you're suffering and can't get relief.
Why should you consider private health insurance?
The main benefits of getting health insurance are:
- Quicker diagnostic tests
- Quicker treatment
- More choice of timing and treatment
- Specialist and niche treatments
- Better aftercare
Is private health insurance worth it? That's for you to decide. You need to set your private health insurance cost against the benefit of quicker, better treatment. But over 4 million people think it's worth their while, so you'll be in good company if you choose to insure privately.
When do you need to pay towards NHS?
We're used to thinking of the NHS as free at the point of use - unlike in France, for instance, where you have to pay some of your bills yourself and then claim the money back. But in fact, NHS care isn't always free, particularly when it comes to optical and dental care.
You will for instance have to pay for:
- optical care
- dental care
- prescriptions
- wigs and support.
Most people will have to pay a charge to the NHS for those costs, though some people are eligible for partial or full help.
- Free sight tests are available for under-16s, over-60s, those with diabetes or glaucoma (and with glaucoma in the family), and a few others - everyone else pays.
- If you use a computer screen at work, your employer should pay for your sight test.
- Vouchers towards the cost of glasses or contact lenses are even more restricted and may not cover the full cost.
- Free prescriptions are available for under-18s, over-60s, pregnant women and those with babies under 12 months old, NHS inpatients, and war veterans. Otherwise, you'll have to pay £9.15 for any one prescription.
- Free dental care is available for the same groups of people; otherwise, three bands of charges apply, rising from £22.70 for simple treatment to £269.30 for complex work.
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Who pays NHS dental costs? and how much?
Free dental care is available for under-18s, over-60s, pregnant women and those with babies under 12 months old, NHS inpatients, and war veterans; otherwise, three bands of charges apply, rising from £22.70 for simple treatment to £269.30 for complex work.
Whether you're on the NHS or go private, dental bills can be high if you're unlucky enough to need extensive treatment. For instance if you need a couple of crowns you're going to pay over £250 even on the NHS. Dental insurance will cover you for these costs, and many policies will also cover you for emergency dental care abroad.
What are the NHS pay bands?
NHS dental treatment isn't priced per item. Instead, there are three charge bands that cover all dental procedures, depending on their complexity. Band 3 will cover all your appointments and dental work for a single course of treatment (not exceeding three months), so if you need a number of appointments, you will still only pay once.
The dental charges for England are shown below. Wales has the NHS bands but the prices are lower (£14.30 Band 1, £46 Band 2, £199.10 Band 3).
In Scotland and Northern Ireland, there's a co-pay system under which patients pay 80% of the dentist's fee up to a maximum £384. However, in Scotland your dental check-up is free.
| NHS Dental Bands | NHS Dental charges | Covers |
|---|---|---|
| Urgent dental treatment | £22.70 | Covers emergency care (pain relief, temporary filling - primary care service). |
| Band 1 | £22.70 | Covers diagnosis (including radiographs), preventative care, scale and polish, X-rays or planning for further and additional dental treatment. |
| Band 2 | £62.10 | Covers Band 1 dental costs + teeth extractions, fillings, root canal treatment. |
| Band 3 | £269.30 | Covers Bands 1 and 2 treatments, and complex dental procedures (crowns, dentures and bridges). |
What are typical NHS dental charges vs private dental charges in 2020?
You'll find below some of the most common costs of private dental treatment compared to the cost of NHS dental treatment. As you can see, there is not a big difference at the bottom of the scale - private treatment might even be cheaper - but if you need major dental work, private care can cost thousands, while the NHS will only ever charge you £269.30 no matter how much work is required. That's a good reason for considering a healthcare insurance plan if you decide to go private.
Remember that the NHS charges per course of treatment so that if you have a scale and polish at the same time as your regular check-up, you'll pay one £22.70 charge. If you have several fillings and a crown to be fitted, you'll pay a single £269.30 charge for all the work.
| Which dental care? | NHS dental cost | Private healthcare |
|---|---|---|
| Dental check up | £22.70 Band 1 | £15 to £65 |
| Dental X-rays | £22.70 Band 1 | £10 to £40 |
| Dental scale and polish | £22.70 Band 1 | £25 to £90 |
| Planning for further dental treatment | £22.70 Band 1 | £20 to £120 |
| Teeth fillings | £62.10 Band 2 | £30 to £250 (depending of amalgam, metal or composite filling) |
| Root canal treatment for teeth | £62.10 Band 2 | £50 to £980 |
| Removing teeth (extractions) | £62.10 Band 2 | £50 to £365 |
| Dental crowns | £269.30 Band 3 | £250 to £1,200 |
| Dentures | £269.30 Band 3 | £350 to £2,500 |
| Bridges | £269.30 Band 3 | £350 to £2,500 |
| Implants for clinical needs only | £269.30 Band 3 | £2,000 to £2,500 |
To find an NHS dentist near you in England, check the NHS mydentist website.
How can I claim on my NHS dental charges?
You may be eligible for full or partial help for dental healthcare costs if you fall into one of the following groups:
- you are aged under 18, or under 19 and in full-time education
- you are pregnant or recently had a baby (in the past 12 months)
- your dental treatment is carried out by the NHS hospital dentist
- you or your partner receive Income Support, Income-related Employment and Support Allowance, Universal Credit, Income-based Jobseeker's Allowance, Pension Credit Guarantee Credit
- you have a valid HC2 or HC3 certificate giving you access to full or partial NHS help. (To get those, you will first need to apply for the Low Income Scheme and fill in the HC1 form.)
- you have a valid NHS tax credit exemption certificate.
If you (or your children) fall into any of these groups, you'll need to use the HC5(D) Dental Claim Form to claim your dental costs with the NHS.
Watch out!
If you don't want to pay fees in advance, tell the clinic or your dentist that you want an NHS treatment and that you are exempt from paying any fee. You'll be asked to fill a form and you'll need to write in the number of your certificate of exemption. Dentists are not responsible for telling you whether or not you are exempt.
What are the charges for optical treatment on the NHS?
Eye care in the UK is available through the NHS system but is mainly provided by private optometrists. Not all patients will have their optical fees paid by the NHS.
The basic eye test costs £25 (it's free in Scotland) unless you are exempt (see below for details of exemptions).
What are NHS optical vouchers and how do they work?
There are 10 different optical vouchers from £39.10 to £215.50 depending on the glasses or lens you need.
If you've been given an NHS optical voucher, you are free to use it at any glasses supplier of your choice providing they are willing to accept it.
| NHS optical vouchers | NHS optical vouchers value | Covers for glasses with: |
|---|---|---|
| Voucher A | £39.10 | single vision lenses, spherical power inferior or equal to 6 dioptres and a cylindrical power inferior or equal than 2 dioptres. |
| Voucher B | £59.30 | single vision lenses, spherical power of 6 - 10 dioptres, cylindrical power of no more than 6 dioptres or; spherical power less than 10 dioptres and a cylindrical power of 2 - 6 dioptres. |
| Voucher C | £86.90 | single vision lenses, spherical power of 10 - 14 dioptres, cylindrical power of no more than 6 dioptres. |
| Voucher D | £196.00 | single vision lenses, spherical power of less than 14 dioptres, any cylindrical power or cylindrical power of no more than 6 dioptres with any spherical power. |
| Voucher E | £67.50 | bifocal lenses, spherical power of no more than 6 dioptres, cylindrical power of no more than 2 dioptres. |
| Voucher F | £85.60 | bifocal lenses, spherical power of 6 to 10 dioptres, cylindrical power of no more than 6 dioptres or; spherical power of less than 10 dioptres, cylindrical power of 2 to 6 dioptres. |
| Voucher G | £111.20 | bifocal lenses, spherical power of 10 to 14 dioptres, cylindrical power of no more than 6 dioptres. |
| Voucher H | £215.50 | prism-controlled bifocal lenses of any power or; bifocal lenses, spherical power > 14 dioptres with any cylindrical power; or any spherical power, cylindrical power of more than 6 dioptres. |
| Voucher I | £200.80 | glasses prescribed by NHS hospital not falling into one of the above categories. |
| Voucher J | £57.00 | contact lens prescribed by NHS hospital. |
Who can get a free NHS eye test?
Some people are entitled to a free NHS eye test. You can be eligible for free eye test if you:
- are aged under 16 or aged between 16 to 18 in full-time education
- are a senior, aged over 60
- are blind or with partial vision
- are at risk for having glaucoma
- are eligible for a NHS optical voucher (+ or - 10 dioptres)
- you or your partner receive Income Support, Income-related Employment and Support Allowance, Universal Credit, Income-based Jobseeker's Allowance, Pension Credit Guarantee Credit
- you have a valid HC2 or HC3 certificate giving you access to full or partial NHS help. To get those, you will first need to apply for the Low Income Scheme and fill in the HC1 form.
Good to know
If you attend a day centre, are unable to leave your home due to disability, or are in a care home, you may be eligible for a free mobile eye test with an optometrist coming to check your eyes.
How can I get an NHS optical voucher?
You can get NHS optical voucher if you meet the same criteria as listed above.
You will be given your voucher together with your NHS prescription or you will need to complete the HC1 form if you are entitled to get a voucher as part of the Low Income Scheme of the NHS.
How can I claim on my NHS optical care?
If you have been paying for optical care and you are entitled to get a refund from the NHS (for instance if you have a valid HC2 or HC3 certificate because you are enrolled on the NHS Low Income Scheme), then you can claim on your NHS optical charges by filling in the HC5(O) form as explained in our guide.
What does the NHS charge for prescriptions in the UK?
Alongside dental and optical care, you will have to pay for your prescriptions in the UK.
How much is a prescription in the UK in 2020?
In 2020, the prescription charge is £9.15 per item meaning that you will have to pay £9.15 for each item listed on the prescription. The price of prescription in the UK is mainly standardized unlike other European countries - it doesn't matter what the medication is.
Good to know
In Wales, Scotland and Ireland, prescriptions are free for residents or people having a General Practitioner registered in the country.
What is the Prepayment Prescription Certificate (PPC)?
To save costs on your prescription charges, if you have frequent medication (for instance if you have a long term condition like arthritis), you might be entitled to a Prepayment Prescription Certificate (PPC).
A PPC is basically a subscription that you pay for a certain period of time, during which you will be able to get an unlimited number of prescription and drugs for the one off payment you made at the beginning, when getting the certificate.
You can either get:
- a 3 months Prepayment Prescription Certificate which costs £29.65
- a 12 months PPC costing £105.90, payable in 10 monthly installments.
The more prescriptions you need, the more you'll save by getting a PPC. As prescription costs are standardized, it's easy to estimate the savings. For instance, if you take a 12 month PPC, and:
- you need 2 prescriptions per month, or 24 prescriptions per year, you will save more than £110; or
- you need 36 prescriptions per year, you'll save over £215.
You can buy a PPC
- online on the Business Services Authority website
- by phone calling the number: 0300 330 1341
- in any pharmacy which is authorized to sell PPCs.
What does the NHS charge for wigs and fabric supports?
Just like optical or dental care, wigs and supports are available through the National Health System in the UK but you will have to pay for them if you are not eligible for partial or full help with healthcare costs.
| NHS wigs and support charges | |
|---|---|
| Full human hair wig | £287.20 |
| Partial human hair wig | £196.40 |
| Modacrylic wig | £74.15 |
| Abdominal support | £45.35 |
| Spinal support | £45.35 |
| Surgical bra | £30.05 |
Good to know
You must know that a good human hair wig, if you bought it privately and not going through the NHS, could cost you between £650 and £2,000.
Who can get free NHS wigs and support?
Just as for optical and dental care in the UK, you may be entitled to get free wigs and supports if you meet certain criteria such as:
- if you are aged under 16, or between 16 and 18 and in full time education
- if you are an hospital inpatient
- if you are a war disabled person and have a certificate
- if you or your partner receive Income Support, Income-related Employment and Support Allowance, Universal Credit, Income-based Jobseeker's Allowance, Pension Credit Guarantee Credit
- you have a valid HC2 or HC3 certificate giving you access to full or partial NHS help. To get those, you will first need to apply for the Low Income Scheme and fill in the HC1 form.
How can I claim for a refund on an NHS wig or fabric support?
If you have been paying for your wig or fabric support and you are entitled to get a refund from the NHS (for instance because you meet one of the above listed criteria or you have a valid HC2 or HC3 certificate because you are enrolled on the NHS Low Income Scheme), then you can claim on your NHS wigs and support charges by filling in the HC5(W) form as explained in our guide.
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