Health Insurance Excess Explained: How It Works & What to Choose
Excess is one of the four things that decide your premium — and one of the most misunderstood. Here’s exactly what it means, how it works on a claim, the difference between £0, £250 and £500, and how to pick the level that’s right for you.
Quick Answer
Excess is the amount you pay towards a claim before your insurer pays the rest — usually £0, £100, £250 or £500 on UK health insurance, and charged once per policy year, not per claim. Pay a £250 excess and you cover the first £250 of your eligible private treatment in the year; the insurer covers the rest.
It’s a premium lever: a higher excess means a lower monthly premium (you’re taking on more risk), a lower excess means a higher premium but less to pay when you claim.
Choosing the level is a bet on how often you’ll claim — and if you’re specifically weighing a £0 excess, we’ve a dedicated guide for that decision.
On this page
What Excess Means
Your excess is the amount you agree to pay towards a claim before your insurer starts paying. It’s one of four main levers that set your premium — alongside your outpatient limit, your hospital list, and your overall cover level. On UK private medical insurance the excess is usually offered at £0, £100, £250 or £500, and you choose it when you set up the policy. The higher the figure you pick, the lower your monthly premium, because you’re agreeing to shoulder more of any future claim yourself. It’s the single easiest dial to turn when you’re trying to bring a quote down — or up, if you’d rather pay less at claim time.
How Excess Works on a Claim
A worked example
Say you have a £250 excess and need private treatment costing £2,000. You pay the first £250; your insurer pays the eligible £1,750 above it. Crucially, because excess is annual, not per-claim, if you need a second lot of treatment later the same policy year, you’ve already paid your excess — that second claim usually carries no further excess. On a family policy, the excess typically applies per person per year, so each insured member has their own.
£0 vs £250 vs £500: The Difference
| Excess level | Effect on premium | You pay at claim time | Best for |
|---|---|---|---|
| £0 (no excess) | Highest premium | Nothing | Frequent claimers, families, predictability |
| £100–£250 | Middle | First £100–£250/yr | The common all-round choice |
| £500+ | Lowest premium | First £500/yr | Healthy, rare claimers with savings |
If it’s specifically the £0 end you’re weighing — whether paying a higher premium to avoid any excess is worth it — that’s a decision in its own right, and we work through it fully in health insurance with no excess: is £0 worth it?. This page covers the whole spectrum and how the mechanism works; that one focuses on the no-excess choice.
Which Excess Level to Choose
The honest way to decide is to be realistic about how often you’ll actually claim. Pick a higher excess (£250–£500) if you’re generally healthy, rarely see a doctor, have savings to cover the excess if you do claim, and mainly want the policy for peace of mind against something major — you’ll bank the lower premium every month. Pick a lower or £0 excess if you expect regular claims, are covering children who need more visits, want completely predictable costs, or would find several hundred pounds hard to produce at short notice. Neither is universally right. The clean test: estimate your likely claims in a year, add the excess you’d pay to the annual premium at each level, and compare the totals — the health insurance calculator makes that quick.
How Excess Affects Your Premium
Raising your excess is one of the most reliable ways to cut a premium — often the first lever a broker reaches for when a quote comes in high. But it’s not the only one, and if your real goal is affordability, it’s worth pulling several together: a guided hospital list can save 10–25%, a sensible outpatient limit trims more, and no-claims discounts reward claim-free years. Equally, if premiums have jumped at renewal, the excess is one of the things you can adjust to bring it back down — see why premiums rise and how to negotiate your renewal. And you’re not locked in: you can generally change your excess at renewal each year.
Common Excess Mistakes
Three things people get wrong
1. Assuming no excess means everything’s covered. It doesn’t — a £0 excess only removes your contribution to eligible claims. Pre-existing exclusions, waiting periods and treatment limits all still apply.
2. Choosing the excess in isolation. The excess interacts with everything else — a low excess on a policy with a tiny outpatient limit can still leave you out of pocket. Look at the whole policy, not one number.
3. Never revisiting it. Your ideal excess changes with your health, age and budget. Most people set it once and forget it — but renewal is the moment to check it still fits.
Health Insurance Excess FAQs
What is excess on health insurance?
Excess is the amount you agree to pay towards a claim before your insurer pays the rest. On UK private medical insurance it’s usually set at £0, £100, £250 or £500, and typically applied once per policy year rather than per claim. So with a £250 excess, you pay the first £250 of your eligible private treatment in the year, and the insurer covers costs above that. It’s one of the main levers that sets your premium: a higher excess means a lower monthly cost.
How does excess work on a health insurance claim?
When you make a claim, your excess is deducted first. If your excess is £250 and your treatment costs £2,000, you pay £250 and the insurer pays the eligible remainder. Because excess is almost always annual, once you’ve paid it on your first claim of the policy year, further eligible claims that year usually carry no additional excess. The excess applies per member per year on most policies, so on a family plan each insured person may have their own.
Is excess charged per claim or per year?
On UK private medical insurance, excess is almost always charged per policy year, not per claim — so you pay it once in the year regardless of how many times you claim after that. This differs from some other insurance types. A few older or unusual policies apply excess per condition or per claim, so it’s always worth checking your specific policy wording, but annual is the standard and what most major insurers use.
What excess should I choose?
It’s a trade between premium and predictability. A higher excess (£250–£500) lowers your monthly premium and suits the healthy, the rarely-claiming, and anyone comfortable self-funding a few hundred pounds if they claim. A £0 or low excess raises the premium but means little or nothing to pay when you claim — better for frequent claimers, families with children, or anyone who wants predictable costs. Price both levels on the same policy and compare; the right answer depends on how often you expect to use it.
Does a higher excess lower my premium?
Yes — raising your excess is one of the most direct ways to cut your monthly premium, because you’re taking on more of the cost of any claim yourself. Moving from £0 to £250, or £250 to £500, typically trims a noticeable amount off the monthly price. The saving only pays off if you don’t claim often, though: if you claim most years, a low excess can work out cheaper overall despite the higher premium. It’s a bet on your own likely usage.
Can I have no excess at all?
Yes — most insurers offer a £0 excess option, meaning you pay nothing towards eligible claims, in return for a higher premium. It suits people who want fully predictable costs, expect to claim regularly, or are covering children. But no excess doesn’t widen your cover — pre-existing exclusions, waiting periods and treatment limits still apply. Whether £0 is worth the extra premium is a separate decision, which our dedicated no-excess guide works through in detail.
Can I change my excess?
Usually only at renewal, not mid-policy. Each year when your policy renews you can move to a higher or lower excess — raising it to cut the premium, or lowering it for more predictable claims. Reducing your excess may prompt fresh underwriting or a terms review and will increase the premium. Renewal is the natural moment to revisit it as your health, budget or family situation changes, rather than assuming your original choice is fixed.
Is excess the same as a co-payment?
Not quite. An excess is a fixed amount you pay before the insurer pays, usually once a year. A co-payment (or co-insurance) is a percentage of each claim you pay, sometimes up to a capped limit — more common on some cancer or high-cost benefits and on certain overseas policies. A few UK policies combine an excess with a co-payment on specific benefits, so when comparing, check for both rather than assuming the excess is your only contribution.
Important Information
This guide is general information, not financial or insurance advice. Excess options, premiums and terms vary by insurer, age, postcode, underwriting and benefits — always read the policy wording and obtain personalised quotes, and take regulated advice where needed. Excess does not remove pre-existing condition exclusions, waiting periods or treatment limits. For a personal recommendation, speak to an FCA-regulated adviser or broker. If you compare quotes through this site, we may receive a commission from our FCA-regulated partners at no cost to you; this does not influence our editorial guidance.
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