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Health Insurance for Seniors
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Australians over the age of 65 are generally more prone to age-related illnesses and injuries. If this is you, then senior health insurance might assist you in maintaining and improving your quality of life.
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Do pensioners need private health insurance?
Generally, the older you are, the higher your risk of health problems. Medicare doesn’t necessarily provide the level of cover you might need. With private health insurance, you can get cover suited to your requirements, skip waiting lists and access preventative treatments. There are also more substantial government rebates for people 65 years and older, helping you keep your premiums affordable.
However, as a pensioner, if you have a Pensioner Concession Card or Commonwealth Seniors Health Care Card, you can generally get more affordable health care services. 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.
What does senior’s health insurance cover?
A health insurance policy for seniors is typically tailored to your unique requirements, excluding unnecessary services, like pregnancy cover. Instead, health insurance for Australians over 65 will generally include private hospital accommodation in a public or private hospital, heart and heart-related services, ambulance cover, hip and knee replacement, cataract surgery, palliative care, dental, remedial massage, and optical.
Take note: 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 seniors’ Gold Hospital policy typically includes:
- Private hospital accommodation in a public or private hospital
- Emergency ambulance services
- Palliative care
- Cardiac and cardiac-related services
- Theatre fees
- Intensive care fees
- In-patient X-rays, MRI’s and CAT scans
- Lung and chest
- Hip and knee replacement
- Back surgery
- Rehabilitation services
- Prostheses
- Eye surgery (including cataracts)
- Dental surgery
- Renal dialysis for chronic kidney failure
- Organ transplant
- Colonoscopies
- Hernia repair
- Psychiatric treatment
Senior Australians Top Extras cover may include the following:
- Ambulance cover
- Optical for glasses and contact lenses
- General and major dental, including bridges, dentures and tooth extractions
- Hearing aids
- Physiotherapy
- Chiropractic
- Osteopathy
- Podiatry
- Remedial massage to speed up recovery for injuries and sprains
- Blood glucose monitors
- Blood pressure monitors
- Non-PBS pharmaceuticals
- Occupational therapy to help you live a more productive and independent life
- Psychology
- Preventative tests, for example, bone density testing
What is the best health insurance plan for senior citizens?
The best health insurance policy for an Australian senior citizen is one that you can afford for the long-term and provides cover for the treatments and services you require. You might want to look for a policy that provides a high level of coverage for treatments relevant to your age group, for example, heart surgery and removal of cataracts, hearing aids and major dental.
Compare quotes of similar policies from major health insurance companies so you can make an informed decision.
Compare health insurance for seniors
| Cover | PeopleCare Gold Hospital with Premium Extras | Bupa Ultimate Health Cover Gold | Medibank Gold Ultra Health Cover | CBHS Premium Package (Gold) |
| Emergency ambulance | ||||
| Cataract & eye lens procedures | ||||
| Lung and chest | ||||
| Joint reconstruction & replacement | ||||
| Back, neck and spine | ||||
| Palliative care | ||||
| Rehabilitation | ||||
| Dialysis | ||||
| General dental | $1,500 | No annual limit | No annual limit | No annual limit |
| Major dental | $1,500 | $1,600 | $1,600 | $8,060 in any 5 years |
| Optical | $300 | $300 | $300 | $450 |
| Physiotherapy | $600 | $1,500 | $1,000 | $900 |
| Podiatry | $500 | $1,000 | $600 | $400 |
| Hearing aids | $1,500 1 appliance every 5 years | $850 1 appliance every 1 year | $1,600 1 appliance every 5 years | $2,200 in any 3 years |
| Home nursing | $700 | $400 | $500 | $2,800 |
| Average monthly premiums | $405.90 | $507.65 | $530.00 | $364.43 |
Source: privatehealth.gov.au (June 2021: Estimates based on a single adult living in NSW, purchasing a combined Hospital and Extras policy with a $750 excess)
Please review the Private Health Information Statement (PHIS) of the health funds you want to compare their full list of treatments and services, as well the annual limits and sub-limits that apply.
Take note that some Extras might combine annual limits; for example, physiotherapy and chiropractic might share the yearly limit.
What to look for in a health plan, according to your age
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 generally shown to be the best ways to continue leading a healthy life as a pensioner and potentially reducing hospitalisations.
Health insurance for seniors 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, remedial massage, physiotherapy, dental and podiatry.
At age 65, your chances of needing a hip or knee replacement also increase, so you might want a hospital policy that includes joint investigations and reconstruction.
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 might want coverage for joint-replacement surgeries.
At 70 years of age and older, the walls of your heart are becoming thicker and the valves stiffer. You might want to consider 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 cover for senior citizens over 80
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, especially those with life-threatening conditions.
While Medicare generally pays 75% of the fee for in-hospital palliative care, the remaining 25% can usually be covered by private health insurance, depending on your coverage.
You might also want a private health insurance policy that will help pay for home nursing services, which typically provides full coverage for rehabilitation.
How much does pensioners health insurance cost?
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, Gold Hospital and Top Extras usually provide more comprehensive coverage and higher annual benefit limits.
On average, for a single adult living in NSW, a Basic Hospital and Extras policy can cost between $110.50 and $142.30 per month. A Gold Hospital and Top Extras policy can cost anywhere from $246.67 to $483.25 per month (4 October 2019).
Health insurance rebates for seniors
You can expect your private health insurance rebate to increase as you get older, meaning your policy might be cheaper. You can claim the 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.
Rebates for premiums 1 April 2021 to 30 June 2021 for 65 to 69-year olds
| Income threshold | Rebate for 1 July 2020 – 31 March 2021 | Rebate for 1 April 2021 – 30 June 2021 |
|---|---|---|
| $90,000 or less for singles & $180,000 or less for couples/family | 29.236% | 28.710% |
| $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family | 20.883% | 20.507% |
| $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family | 12.529% | 12.303% |
| $140,001 or more for singles & $280,001 or more for couples/family | Not eligible | Not eligible |
Source: ato.gov.au (June 2021)
Rebates for premiums 1 April 2021 to 30 June 2021 for seniors over the age of 70
| Income threshold | Rebate for 1 July 2020 – 31 March 2021 | Rebate for 1 April 2021 – 30 June 2021 |
|---|---|---|
| $90,000 or less for singles & $180,000 or less for couples/family | 33.413% | 32.812% |
| $90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family | 25.059% | 24.608% |
| $105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family | 16.706% | 16.405% |
| $140,001 or more for singles & $280,001 or more for couples/family | Not eligible | Not eligible |
Source: ato.gov.au (June 2021)
Frequently asked questions
Can you get health insurance for senior immigrants?
Yes, select private health insurers offer coverage for seniors immigrating from overseas. If you’re not from a country with a Reciprocal Health Care Agreement, you won’t have access to Medicare. To be able to afford Australia’s expensive health care, you might want to consider a health insurance policy suited to your requirements at this phase of your life.Where to find the best travel health insurance for seniors
Generally, private health insurance will provide coverage Australia-wide, but not for international travel. If you’re planning to go overseas, then travel insurance for seniors can typically be purchased through companies like Seniors Australia, Bupa, Allianz and AllClear, for example.Is ambulance cover free for pensioners?
Ambulance cover for retirees is generally free for Australian citizens that have a Health Care Concession Card, Commonwealth Seniors Health Card or Pensioner Concession Card.What is a good health insurance plan for a pensioner with pre-existing conditions?
Generally, private health funds require that you wait 12 months 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.
