Private health insurance in Australia
Private health insurance in Australia consists of 38 profit and not-for-profit health insurance companies, which provides you with services inside and outside of the hospital in exchange for a premium. Although Australia’s public health system, Medicare, provides free or subsidised cover for some treatments and services, it might not pay for everything you require.
For example, ambulance services, IVF, optical, and most dental treatments are not paid for by Medicare and could result in high out-of-pocket costs.
Do I need private health insurance?
Not every Australian needs private health insurance. If you’re willing to cover the 2% Medicare Levy Surcharge (MLS) 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.
Is private health insurance worth it?
Private health insurance can help you pay for medical services and treatments not covered by Medicare. It also enables you to avoid the Medicare levy surcharge and lifetime health cover (LHC) loading. However, whether health insurance is worth it for you depends on your health, stage of life and budget.
Choosing health insurance at different life stages
What are the benefits of private health insurance?
Private health insurance in Australia helps reduce your out-of-pocket costs for treatments and services not covered by Medicare, for example, elective surgeries, orthodontics, and physiotherapy. Health insurance gives you control over your choice of doctor and the option of being treated as a private patient in either a private or public hospital.
Health insurance advantages include:
- Protects you from unforeseen, high medical costs.
- Shorter waiting times for elective surgeries.
- Privacy, comfort and control with private hospital rooms.
- Provides you with the option of choosing your preferred doctor and surgeon.
- You can usually tailor your cover to fit your specific requirements.
- Might cover part or all the costs of general treatments like dental, physiotherapy and optical depending 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.
- Reduce the burden on the public health system.
- People living in rural areas might find access to private services more practical.
Types of health insurance in Australia
Private health insurance varies from company to company. Generally, there are 4 options available:
- Hospital policies cover the costs of treatments received inside, including accommodation.
- Extras cover provides benefits for out-of-hospital treatments, like optical and physio.
- Combine Hospital and Extras cover into one policy.
- Ambulance cover provides ambulance transport, usually by land, sea and air.
Hospital cover
Provides cover for some or all 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 the Excess you’ll pay differ from insurer to insurer and depends mainly on the level of hospital cover you choose.
The 4 general categories of hospital cover
Gold Hospital
Comprehensive in-hospital coverage that usually includes birth and pregnancy-related services, heart and major eye surgeries.
Silver Hospital
Usually provides mid-level coverage and includes dental surgery, joint investigations and reconstructions.
Bronze Hospital
A more affordable option that typically includes the investigation and removal of appendix, tonsils and hernias.
Basic Hospital
Generally, the cheapest Hospital policy that provides for restrictive rehabilitation, psychiatric services and palliative care.
Extras cover
Also known as general treatment policies, covers ancillary treatments like dental, optical and physiotherapy. The type of services and the benefit amount you can claim depends 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 fuller 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, emergency ambulance cover is available in both Hospital and Extras policies. However, select health funds offer stand-alone ambulance cover, that usually provides state and/or Australia-wide emergency ambulance services, with some insurers also covering non-emergency services.
Before you choose a policy, you might want to shop around and compare health insurance quotes from some of the most significant companies in Australia. It’s also vital that you read the health insurers Standard Information Statement (SIS) for a complete list of policy features, benefit limits, and the waiting periods that apply.
How to compare health insurance in Australia
- Decide which policy type will suit your requirements, stage of life and budget.
- Fill in the above quote form and request health insurance quotes.
- Compare policy pricing, features, benefit limits and waiting periods.
- Apply for a policy that 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 you’re willing to pay each time you’re admitted to hospital. 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.
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.
