Health Insurance for Seniors

Published: October 8, 2019

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.

While Medicare can subsidise some of the medical cost for seniors’ health needs, private health insurance might considerably reduce out-of-pocket costs. For example, a Hospital policy to help cover treatments for heart disease, eye surgery and joint replacement. And an Extras policy to provide benefits toward remedial massage, occupational therapy, dental and palliative care.

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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

myOwn

Gold Hospital & Top 70 Extras

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 $1,000 No annual limit
Major dental $1,500 $1,600 $1,600 $1,000 $8,060 in any 5 years
Optical $300 $300 $300 $300 $450
Physiotherapy $600 $1,500 $1,000 $600 $900
Podiatry $500 $1,000 $600 $400 $400
Hearing aids $1,500
1 appliance every 5 years
$850
1 appliance every 1 year
$1,600
1 appliance every 5 years
$500 $2,200 in any 3 years
Home nursing $700 $400 $500 $2,800
Source: privatehealth.gov.au (4 October 2019)

The above information is based on a single adult living in NSW, purchasing a combined Hospital and Extras policy. Do not limit yourself to just these insurers, compare similar plans from all major health funds in Australia.

Please review the Private Health Information Statement (PHIS) 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.

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.

Request quotes for health insurance for seniors over 65

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 2018 to 2019 for 65 to 69-year olds

Income threshold Rebate 1 July 2018 to 31 March 2019 Rebate 1 April 2019 to 30 June 2019
$90,000 or less for singles & $180,000 or less for couples/family 29.651% 25.059%
$90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 21.180% 20.883%
$105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 12.707% 12.529%
$140,001 or more for singles & $280,001 or more for couples/family Not eligible Not eligible
Source: Australian Taxation Office website (August 2019)

Rebates for premiums 2018 to 2019 for seniors over the age of 70

Income threshold Rebate 1 July 2018 to 31 March 2019 Rebate 1 April 2019 to 30 June 2019
$90,000 or less for singles & $180,000 or less for couples/family 33.887% 33.413%
$90,001 to $105,000 for singles & $180,001 to $210,000 for couples/family 25.415% 25.059%
$105,001 to $140,000 for singles & $210,001 to $280,000 for couples/family 16.943% 16.706%
$140,001 or more for singles & $280,001 or more for couples/family Not eligible Not eligible
Source: Australian Taxation Office website (August 2019)

Frequently asked questions and answers

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.

Request and compare health insurance for seniors

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16 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.

  • Trev |

    We are migrating from South Africa to Australia Perth to be with our two children who are both Au citizens.
    We are aged parents 78 and 82. Thankfully, at present, we are both in good health but have had ops in the past.
    We are looking at visa types to apply for when we visit in December.

    Can you advise on medical insurance for the visa types as follows:
    Non-contributory 804 plus bridging visa A bridging visa B.
    Contributory 864 173 143.
    Is there an advantage to take out contributory visa over non-contributory?
    Some idea of budget costs would be a great help. Anneke thank you so much and have a great day.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Trev.

      It’s always best to reach out to the Australian Government Department of Home Affairs regarding visa requirements. It seems that a Contributory visa application might be faster (24 to 36 months) compared to a Non-Contributory visa (10 to 30 years). Take note, when applying for an 864 Contributory Aged Parent Visa, you need to apply from inside Australia. Should you be granted an 864 Visa, you can generally claim benefits from Medicare – Australia’s Public health system.

      For December when visiting Australia, you’ll generally need to apply for a Visitor Visa (subclass 600). Such a visa typically requires you to purchase Overseas Visitors Health Cover (OVHC) which is only available from select health funds, for example, Medibank, nib, Bupa and HCF. We aren’t able to currently compare prices for visa health insurance, so you might want to visit the insurer’s website to determine which one provides coverage suited to your requirements.

      Best of luck.