Private health insurance gives you access to similar hospital treatments to what's covered by Medicare – but you get other benefits like your choice of doctor, private rooms, and wait times are significantly shorter. The amount you pay for health insurance depends on the tier of hospital cover you have.
If you're treated as a private patient in a hospital (either private or public), Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fee for services that are listed on the MBS.
Your health insurance typically covers the other 25%, plus accommodation costs and theatre fees, depending on your level of cover and provided you have served relevant waiting periods. You will often be out of pocket for costs like the excess, and the gap between the MBS fee and the total cost of your procedure.
Not sure if private health insurance is worth it? Here are some key differences between the public and private healthcare systems in Australia:
| Public system | Private health insurance | |
|---|---|---|
| Doctor | A public hospital will allocate a doctor for you. You don't get to choose. | You can choose which doctor you see. |
| Private room | You'll likely end up in a shared room in a public hospital. | Insurance gives you access to a private room if there's one available. |
| Waiting lists | Waiting lists for elective treatments can range from a few weeks to a few years. | Private insurance usually involves a shorter wait. For some procedures, you may even be able to pick your date. |
| Treatment types | Medicare doesn't cover most dental, hearing aids or other out-of-hospital treatments. | Extras can give you cashback on out-of-hospital services such as optical, dental, psychology and hearing aids. |
| Ambulance costs | In most cases, Medicare won't pay for your ambulance except in Queensland and Tasmania. | Most health funds include cover for an emergency ambulance, even on Basic policies. |
Private hospital insurance covers all the same treatments as Medicare. The difference lies in the standard of care. It's kind of like choosing between a dependable budget car or something flashier. Both will get you from A to B but one is a faster and nicer place to be.
Gary Ross Hunter
Insurance and innovations editor
I've always been a big proponent of private health cover - and geez I was glad I had it when I was diagnosed with breast cancer in 2021. With any unexpected serious illness, the type of treatment - and crucially the speed of it - could make all the difference.
Nicole Pedersen-McKinnon
Freelance finance journalist
Health insurance is heavily regulated in Australia, which makes it easier to compare health insurance policies like-for-like. That said, funds still have different products and prices, so it's still important to make sure you're getting the right cover for you and your family.
Tim Bennett
Finder health insurance publisher
"Changing health insurance had been on my to-do list for ages, but I found it very confusing. Eventually I compared and took advantage of sign-up offers –by switching health insurers, I've saved around $800 so far."
The Medicare Safety Net provides extra financial support to people who incur high out-of-pocket medical costs. Learn more.
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The regional health fund has limited choice, with only two levels of hospital cover. But, it does offer some impressive perks too.
There are a number of reasons why taking out private health cover now rather than later can be a smart thing for singles to do.
My health insurance is with Medibank and it costs $600 a month. My husband & I are both retired & cannotbafgord it. Need help.
Hi Nenita,
There are a few things you can do to bring costs down, I’ll leave some suggestions below.
1. Spend some time looking into what other policies are out there that offer the same coverage. When it comes to hospital cover, all providers have to cover the same things so it’s worth hunting around and seeing who can offer the level you need at a cheaper price. You can do this via our quiz and then sorting by price once the table loads.
2. If the pricing comes back and it’s still unsustainable for your budget, you could look at dropping to a lower level of cover. Of course, you’ll have to decide if this is the right move for you as it will mean losing access to some treatments. Be sure to read what you’ll be covered for and what you won’t be covered for before you decide to do this.
3. Have a look at the discounts available across a few insurers here: https://www.finder.com.au/health-insurance/health-insurance-deals. End of financial year (30 June) is a great time to look at switching providers because it’s when the insurers are offering their best deals and there’s some serious cash to be saved. Keep in mind, that link does not include the full market of health insurers and you’ll often have to hold cover for a minimum period of time before you become eligible for the deal.
I hope this helps and you’re able to find a better deal that works for you!
I am currently insured with Australian Unity. I have Classic Hospital with $750 Excess Silver Plus, with 64% loading. My annual membership is due next week and it will be $4094.99. So my question is are there health insurance providers that are cheaper. I will need to be covered for joint replacements.
Thanks
Hi Nellie, The cost you’ll pay will depend on your age and income, as well as the loading involved. There are certainly silver plans with a lower base cost in our database – if you take the quiz at the top of this guide, you can compare your options. You might also find our guide to health insurance for joint replacement useful. Hope that helps.
Hello,
I have been switching health funds every year for the past few year’s now.
I’d like to think that I’ve saved some but life is getting expensive.
My question is, is this a short term gain? Or is there a possibility of getting a member discount if I stick with one fund for longer?
Hi Angus, Health funds raise their fees annually, and you’re unlikely to score a direct discount just because you’re a long-term member. That said, many health funds do have loyalty schemes that offer increased cover for some extras or specialist treatments – we have a full guide on what’s on offer there. That could provide a reason for sticking with one fund, but otherwise shopping around can still make sense, provided you’re not resetting waiting periods on services that matter to you.
Could you kindly break down the cost for me per person.
For myself I need a very basic Health insurance plan 33 year old male.
For my Wife something that will cover pregnancy, scans etc should that be our luck to fall pregnant.
And then something for a minor , 3 year old that would cover xrays scans, doctor visits etc.
Hi Julian,
The premium is calculated based on all of you as a family. Usually, it doesn’t cost any extra to add a child to a policy. Things like GP visits are generally covered by Medicare and most doctors bulk bill for under 16s, meaning these visits have no cost.
As for you and your wife, as you have different needs, you could look at taking our two seperate policies: yours basic, hers more fully featured to cover pregnancy etc. However it is often cheaper to get a couples policy.
Note that extra are optional, you may want to go without extras cover to reduce the cost of your premiums.
Hope this helps!
Hi, could I please ask which insurance covers HPV treatments, including wart treatment, pap smear and other HPV related treatments if needed?
Hi Hta,
All of these treatments would be managed through a GP, which is linked to Medicare. You would need to go to your GP or a sexual health clinic for treatment, and you would be eligible for Medicare rebates if you’re entitled to Medicare Benefits.
Health insurance could provide some cover if you ever need day surgery related to HPV, but you would still likely be out of pocket (hospital excess, gap payments and doctor’s fees) even with insurance. So if that was your primary reason for taking out health insurance, the financial benefit might not be enough incentive, considering the high cost of premiums.
Of course this is a personal decision, and you have to consider things like your income and the medicare surcharge (more info here if you’re not aware).