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What is private health insurance?

Private health insurance helps towards the cost of healthcare. It's split into two sections – hospital cover and extras – which both do different things.

  • Hospital cover pays toward certain treatments you receive in a private hospital, such as joint reconstructions, hernia operations and even childbirth.
  • Extras cover helps towards out-of-hospital healthcare, such as dentists, opticians and physiotherapists.
  • Combined cover includes both hospital and extras. These are often separately labelled with names like 'healthy start'.

Just remember though – not all private health insurance policies are created equal. Some will only cover a few treatments while others will cover lots. That's why it's so important to compare policies and make sure you're getting good value for your money.

How does private health insurance work?

Hospital and extras work in different ways, so it's a good idea to start thinking of them separately. Here's a rundown of how they each work:

In the public system, prices are set according to the Medicare Benefits Schedule (MBS) and Medicare pays 100% of the cost. You won't be left out of pocket, but you won't get your choice of hospital, doctor or appointment time either.

In the private system, prices are usually higher than those listed in the Medicare Benefits Schedule and Medicare will only pay 75% of what it would have, had you gone public. Your private health insurance covers the remaining 25%.

If your private doctor charges more than a doctor in the public system, which is usually the case, you'll have to cover the extra expense.

Remember, with hospital insurance, you'll also have to serve waiting periods. For example, if you have a pre-existing medical condition, you'll have to hold your policy for at least a year before your health insurance would chip in towards the cost of treatment.

Extras insurance helps towards non-hospital-related healthcare, such as dental work, new glasses and physiotherapy appointments.

Usually, an extras policy will pay a percentage of your bill – this could be anywhere from 50% to 90%. In other cases, they will cover the whole bill, up to a certain amount.

Extras policies also have waiting limits. For example, you often need to hold a policy for a year before you can claim for orthodontics.

How much does private health insurance cost?

We crunched the numbers from over 10 Australian health funds to give you an idea of what you can expect to pay for hospital and extras cover each month, depending on the level of cover you choose.

TierAverageTreatments included
Basic$79.86
Ambulance cover
Bronze$90.87
Joint replacements, adenoids and cancer
Silver$126.81
Dental surgery, lung, chest and heart issues
Gold$170.90
Pregnancy, IVF and weight loss surgery
Extras coverAverageIncluded benefits
Low$12.85
One no gap dental check-up
Physio
Middle$34.95
Approximately $600 dental limit
Optical, physio, massage and major dental
High$81
No waiting periods on dental and optical
All the above plus hearing aids, laser eye

Prices quoted are based on a single policy in Sydney, earning less than $90,000 with a $500 hospital excess from August 2020.

Live sign-up deals for health insurance

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Want 1 month free? Plus, any 2&6 month waits on extras waived

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Want up to 40,000 Live Better points plus, 2&6 month waits waived on extras? That’s up to $400 worth of gift cards!

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4 benefits of health insurance

Hospital
Choose your hospital

Pick where you go and enjoy a private room while you're there. You can even choose your preferred doctor.
Waiting list
Skip waiting lists

Public waiting lists can stretch months or even years. Go private, and be seen in a matter of days or weeks.
Percentage
Save on tax

If you're earning over $90k, private hospital insurance is a quick way to shave money off your annual tax bill. Easy.
Heart
Peace of mind

Rest easy knowing you'll be top of the list if anything goes wrong, so you can get back to normal in no time.

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.

How do I compare health insurance plans?

Almost every health insurance policy is different, so it's not a case of comparing apples for apples. Instead, you have to look at the bigger picture.

✅ Look at the tiers. If you want hospital insurance, look at what's covered by the different tiers. This is the best way to figure out which tier is right for you. If you're just looking to avoid tax, your needs will be very different from someone who is planning on starting a family.

✅ Consider hospital and extras separately. It's easy to go for a combined package, but choosing policies separately means you can mix and match your level of cover. You can also go with different funds if you prefer.

✅ Look at the benefits. This seems obvious, but look at the specific benefits that are included in your policy. If you're choosing extras, run through exactly what you can claim for. If you want hospital, look out for extra benefits in 'plus' policies.

✅ Look at the limits. Extras policies will have annual limits on the amount you can claim. A higher limit may mean a more expensive policy, but not always.

✅ Look at waiting periods. Both extras and hospital policies will come with waiting periods. That means you won't be able to claim instantly. Look for policies with shorter waiting periods or offers which let you skip certain waiting periods.

✅ Switch and use deals. There are no real downsides to switching funds, as you can carry over your waiting periods and potentially save money too. Make sure you check out any sign-up deals every time you switch.

What impacts the cost of health insurance?

Health insurance is community rated which means you don't have to pay more for pre-existing conditions and the price you pay isn't impacted by your age.

However, here are a few things that can impact your quote:

  • Lifetime Health Cover (LHC) loading. If you haven't taken out private health cover by the time you turn 31, you'll have to pay 2% extra for each year you were uninsured when you do eventually take it out.
  • Medicare Levy Surcharge (MLS). This is an additional tax penalty ranging from 1–1.5% of your annual income, depending on how much you earn, and is applied every year that you do not have an adequate private health insurance policy.
  • Private health insurance rebate. One of the major benefits of having private health insurance is being able to claim the private health insurance rebate. The rebate is determined by your age, your relationship status and your income.
  • Your excess or co-payment. When you take out insurance, you can agree to take some responsibility for the health cover costs in return for lower premiums – this is your excess. You only pay it if you go to hospital. The higher your excess, the lower your premiums will be.
  • Your location. If you live in a regional area of Australia, your insurance might cost you more due to poorer access to health facilities as well as potential travel and accommodation expenses.
  • Which fund you choose. Use the new tiered structure – Basic, Bronze, Silver and Gold. If you shop around, you can find more affordable providers and better value for money.

Frequently asked questions about health insurance


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48 Responses

    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.

    Reply
      Avatarfinder Customer Care
      JamesSeptember 12, 2021Staff

      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

      Reply
      Avatarfinder Customer Care
      JamesSeptember 10, 2021Staff

      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

      Reply
    Default Gravatar
    RobertAugust 28, 2021

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

    Reply
      Avatarfinder Customer Care
      JamesAugust 30, 2021Staff

      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

      Reply
    Default Gravatar
    MaureenNovember 7, 2019

    What is the best health insurance that pays well for natural therapies that is needed weekly

    Reply
      Default Gravatar
      NikkiNovember 8, 2019

      Hi Maureen,

      Thanks for your comment and I hope you are well!

      You can compare and choose health insurance for natural therapies. You can use our comparison table that shows the amount of cover offered by each for natural therapy service. While choosing, don’t forget to read each insurer’s limit, type of policy, price and etc. You can press the ‘Go to site’ button which brings you to the provider’s official page to get a quote and start your application. If you need more options, you may utilize the online form that can be found further down the page. An insurer will contact you upon receipt of your inquiry. At this point, you can also let them know that you would need weekly therapy.

      As a friendly reminder, carefully review the Product Disclosure Statement of the product before applying. You may also contact the insurance provider should you have any questions about their policy.

      Hope this helps and feel free to reach out to us again for further assistance.

      With care,
      Nikki

      Reply
    Default Gravatar
    MariaJuly 13, 2019

    Is there any available private insurance package that covers beauty and plastic surgeries? What package is the most applicable for those procedures?

    Reply
      Avatarfinder Customer Care
      JoshuaJuly 14, 2019Staff

      Hi Maria,

      Thanks for getting in touch with Finder. I hope all is well with you. 😃

      In most cases, elective cosmetic procedures are not covered by health insurance policies. However, reconstructive plastic surgery is likely to be covered. We do have a guide about health insurance covering cosmetic surgery. On the page, you will know which health funds cover medically necessary plastic surgery.

      If you are after health insurance that covers elective surgery, your options might be limited. You may want to fill out our health insurance search form. You can ask the insurers directly whether they cover elective cosmetic surgeries or not.

      I hope this helps. Should you have further questions, please don’t hesitate to reach out again.

      Have a wonderful day!

      Cheers,
      Joshua

      Reply
    Default Gravatar
    SURINDERMarch 10, 2019

    Hi there , is there a health fund which allows me to use my total benefit where ever i like to spend ,instead of their own set breakdown ?

    Reply
      Avatarfinder Customer Care
      JohnMarch 11, 2019Staff

      Hi Surinder,

      You can look for a combined limit on many extras, as an example, AHM just give you one year limit to use. If you use the comparison above, you can see an individual breakdown of every funds policy limits – hope this helps!

      Cheers,
      Reggie

      Reply
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