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What is health insurance in Australia?

Australian residents are covered by Medicare, a Commonwealth government program which provides Australian citizens with free or subsidised cover for in-hospital treatments and some out-of-hospital services. However, Medicare might not provide cover for all your health care requirements, for example, you’ll generally have to pay for ambulance services, IVF, optical, and most dental treatments.

Because Medicare might not cover all the health services you need, Australians are encouraged to purchase private health insurance.

Is private health insurance worth it?

Private health insurance can help you pay for medical services and treatments not fully covered by Medicare. Additionally, if you earn more than $90,000 annually and don’t have private cover, you’ll pay an additional 1% to 1.5% in tax, called the Medicare Levy Surcharge (MLS). Health insurance might be worth it if you want to avoid certain tax consequences, are starting a family or have specific health concerns.

Another factor to consider is that when you do not have private health insurance by the 1st of July following your 31st birthday and decide to get cover later, you're required to pay a Lifetime Health Cover (LHC) loading. This LHC ads 2% extra on your health insurance premium each year you were not covered, and goes up to a maximum of 70%.

Whether private health insurance is worth it for you or not is a personal decision only you can make and should be based on your health, stage of life and budget.

Benefits of private health insurance

There are many advantages to having private health insurance when living in Australia. You’ll generally be covered for treatments and services excluded or only partially covered by Medicare, and have more control over your choice of doctor and hospital appointment times. Having private coverage allows you the benefit of being treated as a private patient in a private or public hospital.

Other health insurance benefits you can look forward to, include:

  • Protects you from unforeseen, high medical costs.
  • Shorter waiting times for elective surgeries.
  • Privacy, comfort and control with private hospital rooms.
  • Provides you the option of choosing your preferred doctor and surgeon to treat you.
  • Generally, you’ll be able to mix and match hospital and extras cover options to fit your specific requirements.
  • Might coverspart or all the costs of general treatments like dental, physiotherpay and optical depening on the Extras policy you have.
  • Get money back from Australian government rebates.
  • Avoid financial penalties like Medicare Levy Surcharge and Lifetime Health Cover loading.
  • Gain access to membership discounts and special offers, like gym memberships and vouchers.
  • Reduce the burden on the public health system.
  • 24/7 telephonic support from heart and cancer nurses from select insurers.
  • People living in rural areas might find access to private services more practical.

From Quote to Application We Guide You Through The Process

What type of health insurance policies are available?

Private health insurance varies from company to company. Generally, there are 3 options available. 1. Hospital policies that cover the costs incurred in the hospital, including accommodation. 2. Extras cover provides benefits for out-of-hospital treatments, like optical and physio. 3. You can choose to combine hospital and extras cover into one policy.

Requests quotes from a variety of companies and do I thorough private health insurance comparison before you choose the type of policy best suited to you and your family’s circumstances

Hospital cover

Provides cover for some or all of the costs associated with being admitted and treated in hospital. Generally, the medical services listed in the Medicare Benefits Schedule (MBS) will be covered. Levels of cover, exclusions, restrictions and excesses paid differ from insurer to insurer and depend mainly on the level of coverage you’ve chosen.

4 general categories of hospital cover

  • Gold/Top: Usually the most comprehensive coverage that includes medical treatments provided by doctors in a hospital, as well as pregnancy-related services, heart and eye surgeries and chronic pain devices.
  • Silver/Medium:  Exclusions and restrictions are placed on some MBS items, for example, birth-related services, hip replacements, cataract and eye lens procedures, and dialysis.
  • Bronze/Basic: Excludes or restricts one or more of the MBS items, including cardiac and cardiac-related services, rehabilitation and palliative care.
  • Public: Covers minimal benefits for treatment in public hospitals only. You may be placed on a hospital waiting list if you’re not a private patient.

Extras cover

Also known as general treatment policies, covers ancillary treatments, like dental, optical and physiotherapy. The cover amount and services depend on your chosen health insurer and policy type.

3 general Extras cover options

Comprehensive cover

The most extensive plan that includes a range of services, for example, major dental, hearing aids and psychology services. This plan generally also has higher benefit limits.

Mid cover

Covers a more full range of services compared to the basic plan, with increased limits. Usually includes major dental, occupational therapy and podiatry.

Basic cover

Generally, the cheapest option, providing a limited number of general treatment services, like general dental, chiro and optical.

Combined cover

Most health funds in Australia offers pre-packaged options combining Hospital and Extras cover, thus providing you with the opportunity to receive both in-hospital and out-of-hospital services. The way these policies are mixed and matched depends on your insurer. For example, you might have a plan that combines top hospital cover with mid extras.

Ambulance only cover

Generally, ambulance cover is available in both Hospital and Extras policies. However, select health funds offer stand-alone ambulance cover, that usually provides Australia-wide emergency ambulance services, with some insurers also covering non-emergency services.

Before you choose a policy, you might want to shop around first and compare health insurance quotes from some of the leading companies in Australia. It’s also very important that you read the health insurers Standard Information Statement (SIS) to review the policy features, benefit limits, waiting periods.

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Do I need private health insurance in Australia?

Not every Australian needs private health insurance. If you're able and willing to cover the Medicare Levy Surcharge and have enough money saved to pay for services and treatments not covered by Medicare, you might not need private cover. However, if the burden of paying for medicines and procedures not covered by Medicare might jeopardise your financial future, then private health insurance is worth considering.

How to compare health insurance in Australia

  • Step 1

    Decide which policy type will suit your requirements.

  • Step 2

    Visit a comparison site and request health insurance quotes

  • Step 3

    Compare policy pricing, benefit limits and waiting periods.

  • Step 4

    Choose a health insurance plan you feel confident will provide you with value for money.

How much is private health insurance in Australia?

The cost of private health insurance in Australia depends on the company you choose, your policy type, and the excess amount you’re willing to pay. Although the price is important, it shouldn't be the only factor you take into consideration when comparing health insurance policies. The best health insurance plan for you and your family depends on your stage of life, specific requirements and what you can afford.

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How to claim health insurance

Hospital claims are generally automatically sent from the hospital to your health insurer on your behalf. However, there are several ways to lodge an Extras claim, including:

  • Using your membership card to claim on the spot, when a healthcare provider has a terminal available.
  • Via a mobile application, available from select health insurers, generally allowing you to submit photos of receipts directly to the insurer.
  • Claiming online through your health insurer's membership portal.
  • Emailing or posting your completed claim forms and original receipts to your health insurer.

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