Find Health Insurance for Seniors over 65

Published: April 23, 2019

If you're retired and living off your pension, you might want to get private health insurance that will help you reduce the out-of-pocket costs associated with treatments and services received in and out of the hospital, for example, hip replacement, cataract surgery, dentures and palliative care.

Australians over the age of 65 are generally more prone to age-related illnesses and injuries. Seniors health insurance might assist you in maintaining and improving your quality of life, by helping you pay for the healthcare expenses you need to prevent illnesses, reduce the effects of injuries and support you when you need hospitalisation.

Even if you already have health insurance, this might be a good time to review your policy and make sure your cover still suits you at this stage of your life.

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Do pensioners need private health insurance?

In the last few decades the number of seniors needing medical care and support has increased, possibly due to the considerable proportion of Australians over the age of 65, which is 1 in 7 people according to the Australian Institute of Health and Welfare (2017).

Australians pensioners might benefit from private health insurance because of the reduced waiting times for elective surgeries and to help pay for the rise of health care costs. While Medicare generally provides adequate coverage, it doesn’t pay for ambulance services, elective surgeries, a private room in a hospital, most dental examination and treatments, glasses, hearing aids and home nursing.

What does senior’s health insurance cover?

The treatments and services covered by private health insurance depend on your choice of health fund and the type and level of coverage you’ve selected. A combined Gold Hospital & Top Extras policy typically includes:

  • Emergency ambulance services
  • Palliative care
  • Cardiac and cardiac-related services
  • Theatre fees
  • Private room in a public or private hospital
  • Hip and knee replacement
  • Eye surgery (including cataracts)
  • Hearing aids
  • Rehabilitation
  • General and major dental
  • Optical

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What to look for in a health insurance policy according to your age

Australians are living longer than ever before. However, chronic conditions are the leading cause of ill health, according to a 2018 study conducted by Australian Institute of Health and Welfare. Coronary heart disease and lung cancer are the leading ‘natural' causes of death for people between the ages of 45 to 74, and 1 in 11 people aged 65 and over get diagnosed with dementia.

Disability is another important factor relating to ageing and usually results in older people needing additional health care as their bodies start to decline over time.

A focus on prevention and early intervention is shown as one of the best ways to continue leading a healthy life as a pensioner and potentially reducing hospitalisations. Having private health insurance provides you with the opportunity to see a specialist instead of a general practitioner, as well as reducing waiting times for elective surgeries

Private health cover for people over 65

Australians 65 years old older, generally go to the GP about 10 times annually and their hospitalisation rates are four times as high as their younger counterparts. You might want to start investing in preventative services that help you maintain your health, for example, a private health insurance policy that includes access to health management programs, physiotherapy, dental and podiatry.

At age 65, your chances of needing a hip or knee replacement also increase, so you might want a policy that includes joint investigations and reconstruction, to avoid the exorbitant out-of-pocket costs.

Health insurance for seniors over 70

People over the age of 70, are generally at an increased risk of sustaining falls that require emergency room care. Make sure you have emergency ambulance coverage. You are also at a higher risk of fractures in the hip and spine, so make sure you're covered for joint-replacement surgeries.

Your heart's walls are becoming thicker and the valves stiffer, so generally you want to make sure you have a Hospital policy that includes cardiac and cardiac-related services.

As you age, it also becomes more challenging to prevent cavities, so proper oral health care becomes essential. You might want a policy with Extras cover that have higher annual limits for general and major dental services.

Health insurance for senior citizens above 80 years

Because we’re living longer, there’s been a steep increase in the demand for palliative care services to help relieve suffering and improve the lives of older people and those with life-threatening conditions.

While Medicare generally pays 75% of the fee for in-hospital palliative care, the remaining 25% can be extremely costly, which is why private health cover that includes palliative care might be a good option.

You might also want a private health insurance policy that will help pay for home nursing services required after being discharged from the hospital and provides full coverage for rehabilitation.

Help me compare health insurance for seniors

What is the best health insurance plan for senior citizens?

The best private health cover option for seniors in Australia depends on your specific requirements; for example, do you need hearing aids, have a pre-existing medical condition or need palliative care.

Below is a table of some of the health funds in Australia providing comprehensive Hospital and Extras policies. However, the premium for a Gold Hospital and Top Extras policy is generally more expensive.

Comprehensive health insurance for seniors

Company and policy Covered
PeopleCare
Gold Hospital with Premium Extras
  • Emergency ambulance
  • Cataracts
  • Heart & vascular system
  • Joint reconstruction & replacement
  • Palliative care
  • Rehabilitation
  • General dental – No annual limit
  • Major dental - $1,500
  • Optical - $300
  • Podiatry - $500
  • Hearing aids - $1,500
  • Home nursing - $700
Bupa
Ultimate Health Cover
  • Single room guarantee
  • Emergency ambulance
  • Cataract & eye lens procedures
  • Cardiac and cardiac-related services
  • Hip and knee replacement
  • Palliative care
  • Rehabilitation
  • General dental – Unlimited
  • Major dental - $1,600
  • Optical - $420 at Member’s First
  • Podiatry - $400
  • Hearing aids - Unlimited
  • Home nursing - $400
Medibank
Gold Ultra Health Cover
  • Ultra bonus for out-of-pocket expenses
  • Private room promise
  • Emergency ambulance
  • Cataracts
  • Heart and vascular system
  • Joint reconstruction & replacement
  • Palliative care
  • Rehabilitation
  • General dental – no annual limit
  • Major dental - $1,600
  • Optical - $300
  • Podiatry - $600
  • Hearing aids – $1,600
  • Home nursing - $500
myOwn
Gold Hospital & Top 70 Extras
  • Emergency ambulance
  • Cataracts
  • Heart & vascular system
  • Joint reconstruction & replacement
  • Palliative care
  • Rehabilitation
  • General dental – $1,000
  • Major dental - $$1,000
  • Optical - $300
  • Podiatry - $400
  • Hearing aids - $500
  • Home nursing - $700
CBHS
Premium Package (Gold)
  • Emergency ambulance
  • Cataracts
  • Heart & vascular system
  • Joint reconstruction & replacement
  • Palliative care
  • Rehabilitation
  • General dental – No annual limit
  • Major dental - $8,060 in any 5 years
  • Optical - $450
  • Podiatry - $400
  • Hearing aids - $2,200 in any 3 years
  • Home nursing
Source: privatehealth.gov.au (April 2019)

Please review the Standard Information Statement of the health funds you want to compare to see their full list of treatments and services, as well the annual limits and sub-limits that apply.

How much is health insurance for seniors?

The cost of a senior's private health insurance policy depends on the health fund you've selected and the type and level of coverage you purchase. A Bronze Hospital policy with Basic Extras will generally be a lot cheaper than a Gold Hospital policy with Top Extras. However, the more affordable option will usually cover fewer services and treatments and have lower annual benefit limits.

Important: You can expect your private health insurance rebate to increase as you get older, meaning your policy might be cheaper because you can claim more money back. You can claim your rebate as either a premium reduction on the policy price charged by your health fund or as a tax refund when lodging your tax return.

Health insurance rebates for seniors

Rebates for premiums paid 1 July 2017 to 31 March 2018

65 to 69 years old
Tier based on income threshold Rebate entitlement
Base Tier: $90,000 or less for singles & $180,000 or less for couples/family 30.256%
Tier 1: $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 21.612%
Tier 2: $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 12.966%
Tier 3: $140,001 or more for singles & $280,001 or more for couples/family 0%
Source: Australian Taxation Office website (April 2019)
70 years and older
Tier based on income threshold Rebate entitlement
Base Tier: $90,000 or less for singles & $180,000 or less for couples/family 34.579%
Tier 1: $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 25.934%
Tier 2: $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 17.289%
Tier 3: $140,001 or more for singles & $280,001 or more for couples/family 0%
Source: Australian Taxation Office website (April 2019)

Rebates for premiums paid 1 April 2018 to 30 June 2018

65 to 69 years old
Tier based on income threshold Rebate entitlement
Base Tier: $90,000 or less for singles & $180,000 or less for couples/family 29.651%
Tier 1: $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 21.180%
Tier 2: $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 12.707%
Tier 3: $140,001 or more for singles & $280,001 or more for couples/family 0%
Source: Australian Taxation Office website (April 2019)
70 years and older
Tier based on income threshold Rebate entitlement
Base Tier: $90,000 or less for singles & $180,000 or less for couples/family 33.887%
Tier 1: $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 25.415%
Tier 2: $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 16.943%
Tier 3: $140,001 or more for singles & $280,001 or more for couples/family 0%
Source: Australian Taxation Office website (April 2019)

Frequently asked questions and answers

Who offers the cheapest health insurance for pensioners?

The cheapest health insurance policy for seniors is generally the option that provides the cover you require at a price you can afford on your fixed income. The premium you’ll pay depends on whether you choose Hospital or Extras or a combination of both, your level of cover and the hospital excess you pay ($250, $500 or $750); generally the higher your excess the lower your premium.

You might want to request quotes from various health funds and choose the one best suited to your requirements and budget.

Is ambulance cover free for pensioners?

Ambulance cover for retirees is generally free for Australian citizens that have a Health Care Concession Card, Common Wealth Seniors Health Card or Pensioner Concession Card.

What is a Commonwealth Seniors Health Card?

The Commonwealth Seniors Health Care Card provides older Australian citizens with more affordable health care. For example:

  • Cheaper prescriptions through the Pharmaceutical Benefits Scheme (PBS),
  • Bulk billing for some doctors’ appointments,
  • Discounted out-of-hospital medical expenses through the Medicare Safety Net,
  • Increased benefits for general treatments received outside of a hospital,
  • Assistance with hearing devices,
  • Free or reduced ambulance services,
  • Discounts on dental and eye care.

Can you get health insurance for senior immigrants?

Yes, select private health insurers offer health cover for older people emigrating from overseas. If you’re not an Australian citizen, you won’t have access to Medicare and will thus be responsible for all health insurance costs, which can be very expensive.

Where to find the best travel health insurance for seniors

Specific travel insurance policies provide additional protection against the cost of unexpected medical emergencies should you become injured or ill during your trip, for example, ambulance fees, medical evacuation and allowances paid each day you're in the hospital. You can find affordable travel insurance by visiting websites like Budget Direct, Bupa, and Allianz.

What is a good health insurance plan for a pensioner with pre-existing conditions?

Generally, private health funds require that you wait 12 months after starting your policy before you can claim benefits for pre-existing conditions. The best cover for you will depend on your specific condition, and the treatments and services required to keep it under control.

Help me find affordable health insurance for pensioners

Ask an Expert?

14 Comments

  • Patricia Hillion |

    I need a hip operation. I am 79 years old and need insurance to get faster treatment.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Patricia, please note that while private health insurance can help cover the cost of a hip replacement surgery, you can generally expect to wait 12 months for a benefit to be payable for any pre-existing condition.

      Fill in the quote form above and we’ll help you find a health insurance provider that covers the cost of joint replacement surgery.

  • Antoinetta Litjens |

    Hi. My partner and I came to Australia in 2001 under a Subclass 410 retirement visa.
    We are now 73 and almost 77 years old.

    We have Health Insurance, but it does not cover the care that we need at the moment.

    Will you give me advice about what we can do?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Antoinetta.

      As I’m not familiar with your specific circumstances, it would be best to give a health insurance specialist a call on 1300 786 328 to help you find the cover you need.

      However, if you want to stay with your current health cover provider, you could also give them a call and ask them whether you can upgrade, perhaps to a combined Top Hospital and Extras policy, which might cover you for a wider array of services.

  • Irene Smith |

    I am a single 75-year-old female. I enjoy good health. The only medication I am on is blood thinners. I would like to get cover for hospital and extras. Also for heart, optical, chiropractic, acupuncture, naturopathy, remedial massage, hearing aids and Ambulance.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Irene, glad to hear you are in good health.

      To provide you with a quote suited to your individual requirements, we need a bit more information. Please give us a call on 1300 795 560 or fill in the quote form above.

  • Christine ferguson |

    My husband and are in advantage health fund with Nib, with these new changes to my health fund will we still have, Hip and Knee replacements and eye surgery? These are the main things we need at our age.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Christine. Thank you for reaching out.

      It’s always best to contact your health insurance provider directly with concerns to your current policy. At present NIB’s Advantage Hospital policy does cover hip and knee replacement surgery, as well as eye treatments and surgery. However, we do not yet know how NIB will restructure their policies with the new classification system coming into effect on the first of April 2019. Please give NIB a call.

  • John Gibson |

    My wife and I have submitted our application for a 864 Aged Parent Visa. Once our current travel visa expires (Jan 2020) we will remain in Australia on a bridging visa BVA until the 864 has been processed. Apparently 3 to 4 years. We will rent a property fairly close to our daughter.

    What is the best medical cover for a foreigner and then to continue as a PR? We are currently living in South Africa but travel on British passports. Our medical insurance in SA is $850/month but was $1200/month before we down graded. Our main concern is the waiting period for pre-existing ailments, although we don’t currently have anything life threatening, is it possible to overcome this waiting period by paying a higher period?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi John. Thanks for your email.

      The best cover for you and your wife would depend on your specific requirements, for example, do you need cover for future hip and knee replacements, major dental etc. Also, the state you’ll be living in will have an impact on the health fund you might choose. You might want to start your search by filling in the quote above and gathering and reviewing quotes from some of the major health insurance companies in Australia.

      In answer to your second question, waiting periods are standard and generally cannot be waived by paying a higher premium for a longer period. However, waiting periods differ from insurer to insurer, although pre-existing conditions generally have a 12 month waiting period.

  • Carolyn Isgrove |

    Would Health insurance be more affordable for a New Zealand resident with a Veterans Pension card?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Carolyn.

      Certain Health Care Card holders generally benefit from cheaper medications, dental discounts and reduced emergency ambulance services in Australia, but this usually does not include cheaper private health insurance. Please call 1300 795 560 for assistance from a health insurance specialist.

  • PETER WRIGHT |

    I am a 76-year-old Australian aged pensioner, now living in Thailand. Please advise on health insurance options.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Peter.

      As an Australian citizen living overseas, you generally need to purchase international health insurance cover. Such policies are offered by global insurers like Bupa and Allianz for example.