Background In the cognitive model dysfunctional beliefs about symptoms and illnesses are pivotal in the conceptualisation of health anxiety. The metacognitive model offers an alternative view in that health anxiety is linked more to beliefs about thinking, that is metacognitive beliefs. This study sets out to test the relative contribution of each type of belief to health anxiety as a rigorous test of each of the respective models. Method In the present study, 377 participants completed measures of neuroticism, health anxiety‐related dysfunctional beliefs and metacognitive beliefs. Results Metacognitive beliefs explained a significant and large proportion (49 %) of the variance in health anxiety, when controlling for dysfunctional beliefs and neuroticism. They were found to be the strongest independent predictors of health anxiety. Conclusions Overall, the findings indicate that metacognitive beliefs have a role in predicting health anxiety and may be more important than the symptom‐related beliefs emphasised in cognitive models. The clinical implications of these findings are briefly considered.