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How it works

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What does private health insurance cover that Medicare doesn't?

Private health insurance gives you access to the same hospital services covered by Medicare – but you get access to your own doctor, private room and waiting times are significantly shorter.

Extras insurance cover does cover healthcare costs that aren't typically covered by the public healthcare system, such as dental, physiotherapy and optical.

If you go to a private hospital as a private patient, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee. Your health insurance covers the other 25%, plus accommodation costs and theatre fees. Sometimes there's a gap between the MBS fee and the total cost of your procedure. You may need to pay this unless your health insurance has no gap cover.

Public vs private health insurance comparison

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
DoctorA public hospital will allocate a doctor for you. You don't get to choose.You can choose which doctor you see.
Private roomYou'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 listsWaiting 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 typesMedicare 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 costsIn 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.

Pros and cons of health insurance

Pros

  • Cover for treatment in a hospital if you need it
  • Access to private hospitals and reduced wait times
  • Save on tax by avoiding the medicare levy surcharge (MLS)

Cons

  • Can be expensive and go unused
  • Waiting periods mean you pay before you can use
  • Coverage limitations and excesses mean you'll still have to pay something

Learn more about private health insurance

Hospital Cover

Hospital cover helps pay for a range of hospital treatments in a private hospital. This can include joint reconstructions, hernia operations and childbirth.

Extras Cover

Extras cover helps towards out-of-hospital healthcare. This includes trips to the dentist, eye care by an optometrist, physiotherapists and natural therapies.

Health insurance rebate

The private health insurance rebate makes health insurance cheaper for most people. Your exact rebate is determined by your age and income.

Private health and tax

Whether you're a high earner or turning 30, there are a few things you need to know about private health insurance at tax time.

Switching health funds

Switching health funds is quick and easy. You can transfer your waiting periods, while potentially saving money with new sign-up deals.

Alex Holderness

Getting health insurance had been on my to-do list for the longest time, but I found it very confusing. I realised it was actually split into two parts - hospital cover (anything in the hospital and the more expensive part) and extras cover (for the dentist and those new specs). I've actually switched policies 3 times in the last 4 years to take advantage of the sign up offers funds give when you join. I've saved around $800 so far.
— Alex Holderness, head of publishing

Frequently asked questions about health insurance

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Insurance Expert

Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio

Tim's expertise
Tim has written 116 Finder guides across topics including:
  • Personal finance
  • Financial comparison
  • Heath insurance
  • General insurance
  • Life insurance

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53 Responses

    Default Gravatar
    JulianJune 19, 2024

    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.

      AvatarFinder
      SarahJuly 2, 2024Finder

      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!

    Default Gravatar
    HtaMay 21, 2024

    Hi, could I please ask which insurance covers HPV treatments, including wart treatment, pap smear and other HPV related treatments if needed?

      AvatarFinder
      SarahMay 24, 2024Finder

      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).

    AvatarFinder
    TimMarch 6, 2024Finder

    Hi Jason, thanks for your question.

    Health insurance premiums will be going up by 3.03% on average in 2024. The government has to approve these increases each year – this year took a little longer for that to happen. The price rise should happen on April 1 2024.

    Be sure to check the news article I linked – it’s got the breakdown of how much each health fund is increasing premiums. 3.03% is just an average across all funds – your fund will probably be slight more or less than that.

    Have a good one!
    Tim

    Default Gravatar
    JohnSeptember 4, 2021

    Hi,

    Are there any such plans that cover foreign hospital treatments for people seeking treatment for cancer? I have pre-existing medical conditions and looking for health cover for overseas treatment. Please advice.

      AvatarFinder
      JamesSeptember 12, 2021Finder

      Hi John,

      Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance that specifically covers overseas medical expenses may help.

      Make sure you read each policy’s Product Disclosure Statement (PDS) with care so that you know what cover is available.

      Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.

      Regards,
      James

      AvatarFinder
      JamesSeptember 10, 2021Finder

      Hi John,

      Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance (https://www.finder.com.au/travel-insurance) that specifically covers overseas medical expenses may help. Make sure you read each policy’s Product Disclosure Statement (PDS) with care, so that you know what cover is available.

      Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.

      Regards,
      James

    Default Gravatar
    RobertAugust 28, 2021

    I would like a real time answer to my request for cover .

      AvatarFinder
      JamesAugust 30, 2021Finder

      Hi Robert,

      Can which cover you are referring to, please? I’ll wait for your response. If possible, please return to our website and click on the chat button found on the lower right corner of our to chat with us in real-time.

      Moreover, please feel free as well to get in touch with the specific insurer you have chosen. They should be able to provide you with more details of the cover you’re interested in.

      Regards,
      James

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