As the cost of private health insurance continues to rise in line with spiralling healthcare costs, recent surveys indicate widespread public dissatisfaction with health funds. They also indicate that a growing number of people are thinking about reducing or ending their cover.
But do the figures support this? Let's take a look at the latest health insurance statistics from the side of industry and consumer to see how health funds are performing, who has cover, what they’re getting in return for it and whether Australians really are ditching their health insurance.
Industry statistics covered
- Health funds by market share
- Average annual policy premium
- Average health fund admin fees per policy
- Industry premium price rises for 2017
- Health fund premium rises since 2010
- Complaints by market share
Consumer statistics covered
- Percentage of Australians covered by age
- Percentage of Australians covered by region
- The type of cover people are getting
- The most popular extras services
- Average out-of-pocket expenses
- Australians dropping cover
Tips, tricks and deals
Find out what to look for when comparing, how to avoid common pitfalls and what deals are currently available from participating funds.
Health insurance types
Unsure of what type of policy you need, or what's even available? Explore your health insurance options.
Health insurance for life stages
An ideal policy when you are single and 20 may not be when you are 40 and have a family, or when you are enjoying retirement.
Plain text version: State of the health insurance industry
Which statistics are you interested in?
Jump to...Health funds by market share
| Health fund | Market share | Average policy value |
|---|---|---|
| Medibank Private Limited | 27.60% | $3,313 |
| Bupa Australia Pty Limited | 27.00% | $3,494 |
| HCF Limited | 10.30% | $3,595 |
| NIB Health Funds Limited | 8.10% | $3,022 |
| HBF Health Limited | 8.00% | $2,960 |
| Teachers Federation Health Limited | 6.40% | $3,851 |
| Australian Unity Health Limited | 3.10% | $3,286 |
| GMHBA Ltd | 2.10% | $3,126 |
| Defence Health Limited | 1.80% | $3,554 |
| CBHS Health Fund Limited | 1.40% | $3,973 |
| Health Insurance Fund of Australia Limited | 0.90% | $2,669 |
| Latrobe Health Services Limited | 0.70% | $3,419 |
| Westfund Limited | 0.70% | $3,653 |
| CUA Health Limited | 0.60% | $3,412 |
| Health Partners Limited | 0.60% | $3,441 |
| Lysaght Peoplecare Limited | 0.50% | $3,808 |
| Railway and Transport Health Fund Limited | 0.40% | $4,364 |
| St Luke's Medical and Hospital Benefits Association Limited | 0.40% | $3,809 |
| Grand United Corporate Health Limited | 0.40% | $5,413 |
| Queensland Country Health Fund Limited | 0.30% | $4,442 |
| Navy Health Limited | 0.30% | $3,726 |
| Police Health Ltd | 0.30% | $5,169 |
| Mildura District Hospital Fund Limited | 0.20% | $2,716 |
| Transport Health Pty Ltd | 0.10% | $3,020 |
| Cessnock District Health Benefits Fund Limited | 0.10% | $3,842 |
| Health Care Insurance Limited | 0.10% | $3,823 |
| Phoenix Health Fund Limited | 0.10% | $4,330 |
| National Health Benefits Australia | 0.10% | $4,987 |
| ACA Health Benefits Fund Limited | 0.10% | $5,612 |
| Reserve Bank Health Society Limited | 0.10% | $7,714 |
Health fund admin fees
| Health fund | Admin fees per policy per year | Portion of admin fees that make up an average policy |
|---|---|---|
| Defence Health | 6.50% | $231 |
| Teachers Federation | 6.70% | $258 |
| CBHS | 7.40% | $294 |
| National Health Benefits | 7.50% | $374 |
| Bupa | 7.90% | $276 |
| HCF Limited | 7.90% | $284 |
| Medibank Private | 8.00% | $265 |
| Mildura District Health | 8.10% | $220 |
| Police Health | 8.30% | $429 |
| ACA Health | 8.50% | $477 |
| Industry | 8.50% | $288 |
| NIB | 8.90% | $269 |
| Phoenix | 9.10% | $394 |
| Health Partners | 9.30% | $320 |
| Latrobe | 9.30% | $318 |
| Navy Health | 9.50% | $354 |
| Queensland Country Health | 9.50% | $422 |
| CUA Health | 9.70% | $331 |
| Peoplecare | 9.90% | $377 |
| Transport Health | 10.00% | $302 |
| HBF | 10.10% | $299 |
| GMHBA | 10.30% | $322 |
| The Doctors' Health Fund | 10.60% | $518 |
| TUH | 10.90% | $475 |
| St Luke's | 11.00% | $419 |
| Australian Unity | 11.20% | $368 |
| Cessnock District Health | 11.40% | $438 |
| Westfund | 11.80% | $431 |
| Reserve Bank Health | 11.90% | $918 |
| Health Care Insurance | 12.40% | $474 |
| HIF | 13.00% | $347 |
| Railway and Transport | 14.30% | $624 |
| Grand United Health | 15.50% | $839 |
Health fund premium rises in 2017
- The average annual policy premium for 2017 is currently around $3,388. Policies range in value depending on level of cover.
- On average, premiums rose by 4.84% on April 1st 2017.
| Health fund | Premium increase | Average policy cost |
|---|---|---|
| Railway and Transport | 5.54% | $4,364 |
| CUA Health | 4.97% | $3,412 |
| Transport Health | 4.93% | $3,020 |
| NIB | 4.48% | $3,022 |
| Cessnock District Health | 6.57% | $3,842 |
| Police Health | 4.63% | $5,169 |
| Health Care Insurance | 6.06% | $3,823 |
| Phoenix | 5.93% | $4,330 |
| GMHBA | 4.94% | $3,126 |
| HCF Limited | 3.65% | $3,595 |
| CBHS | 3.29% | $3,973 |
| Peoplecare | 5.09% | $3,808 |
| Medibank Private | 4.60% | $3,313 |
| National Health Benefits | 5.41% | $4,987 |
| TUH | 7.30% | $4,358 |
| Health Partners | 5.10% | $3,441 |
| Bupa | 4.90% | $3,494 |
| Australian Unity | 4.46% | $3,286 |
| Latrobe | 4.49% | $3,419 |
| Westfund | 4.96% | $3,653 |
| ACA Health | 4.70% | $5,612 |
| Teachers Federation | 4.96% | $3,851 |
| HBF | 5.96% | $2,960 |
| HIF | 7.99% | $2,669 |
| St Luke's | 4.99% | $3,809 |
| Mildura District Health | 5.95% | $2,716 |
| Queensland Country Health | 5.15% | $4,442 |
| Defence Health | 5.51% | $3,554 |
| The Doctors' Health Fund | 3.54% | $4,887 |
| Reserve Bank Health | 5.00% | $7,714 |
| Navy Health | 4.94% | $3,726 |
| Grand United Health | 4.11% | $5,413 |
Complaint by market share
| Health fund | Portion of complaints | Market share |
|---|---|---|
| CUA Health | 1.80% | 0.60% |
| Australian Unity | 5.10% | 3.10% |
| Medibank Private | 40.20% | 27.60% |
| HCF Limited | 10.60% | 10.30% |
| NIB | 7.80% | 8.10% |
| Bupa | 21.70% | 27.00% |
| HIF | 0.60% | 0.90% |
| GMHBA | 1.40% | 2.10% |
| CBHS | 0.90% | 1.40% |
| Latrobe | 0.40% | 0.70% |
| Health Partners | 0.30% | 0.60% |
| Westfund | 0.30% | 0.70% |
| HBF | 3.30% | 8.00% |
| Peoplecare | 0.20% | 0.50% |
| Defence Health | 0.70% | 1.80% |
| TUH | 0.20% | 0.60% |
| Teachers Federation | 1.20% | 6.40% |
Plain text version: Consumers and health insurance
Which statistics are you interested in?
How many Australians have health insurance?
According to the latest statistics from APRA, 47% of Australians currently have hospital cover and 55.7% have extras cover. This is further broken down into age groups as follows:
| Age bracket | Hospital cover | Extras cover |
|---|---|---|
| 0 – 14 years | 17.9% | 18.8% |
| 15 – 64 years | 65.0% | 66.2% |
| 65+ years | 17.0% | 15.0% |
Source: http://www.apra.gov.au/PHI/Publications/Documents/1611-QPHIS-20160930.pdf
Now let's break it down by age and region:
| Location | Hospital cover | Extras cover |
|---|---|---|
| ACT | 58.1% | 68.5% |
| NSW | 47.9% | 57.6% |
| NT | 40.9% | 44.3% |
| Queensland | 45.3% | 50.2% |
| SA | 46.0% | 59.4% |
| Tasmania | 44.8% | 51.6% |
| Victoria | 44.5% | 51.1% |
| WA | 55.0% | 68.4% |
Source: http://www.apra.gov.au/PHI/Publications/Documents/1611-QPHIS-20160930.pdf
This shows us that ACT and WA have the greatest percentage of cover and NT has the least. It also shows that more Australians overall have extras cover than hospital cover.
What type of cover are people getting?
A higher percentage of Australians have extras cover than hospital cover and the only exception to this is in the 65+ age group. Slightly more people in this group have hospital than extras cover (17% vs 15%) and claim more for hospital services than younger demographics. This is not surprising given that older people are more likely to require and use hospital services.
According to APRA’s report, private health funds paid out $1,154 million in ancillary (extras) benefits in the last quarter of 2016. The proportion paid for the most popular ancillary services was as follows:
- Dental. $619 million
- Optical. $176 million
- Physiotherapy. $101 million
- Chiropractic. $71 million
This clearly shows that most people take out extras cover for dental services, which Medicare does not cover. However, unlike hospital cover where the older demographic had a higher claim rate, the percentage of extras cover held and claimed for was fairly evenly spread among the age groups.
Out-of-pocket (gap) payments
The APRA report also showed that the average out-of-pocket (gap) payment for a hospital episode was $284 in the September quarter of 2016, which is a 1.7% reduction compared to the same quarter of 2015.
The average out-of-pocket payment for general (extras) medical services was $129. The average for specialty services, such as plastic surgery, was $341 and $318 for orthopaedics. The average gap also varied by state and territory.
Are Australians ditching their health cover?
The APRA report shows that a healthy proportion of Australians still hold both hospital and extras cover and reductions in numbers on previous years are only very minor (health fund memberships dropped from 47.4% to 47.0% during the year to June 2016).
So given these statistics, are Australians really ditching their private health cover? The surveys certainly indicate dissatisfaction with private health funds. A survey of 2,005 Australians conducted by finder.com.au found that 15% of people surveyed are preparing to cancel their cover and nearly half of those (44.7%) blamed increasing premium costs for their decision.
Another recent poll, commissioned by the Medical Technology Association of Australia (MTAA), revealed that 77.9% of Australians believe private health funds are motivated by money and put profits ahead of patients.
Given that the public health system is struggling to cope with inadequate funding, increased waiting times and fewer beds, the growing dissatisfaction with private health cover is a worrying trend. But if you look at the statistics, around half of all Australians now hold private health cover, and there seems to be little evidence of a major swing away from private health insurance. We will probably have to wait to see what the next round of statistics reveals and continue to shop around in earnest for the best value cover we can find.
What's new in the world of health insurance?
- Consumers inadvertently exposing themselves to increased risk of tooth decay
- Don’t buy your glasses online
- Health round-up: Healthcare ranking, dementia and tobacco
- Private health insurance affordability a significant concern for consumers says ACCC
- Bupa Global data breach hits 547,000 customers
- Health round-up: Sperm, weight gain and coffee
Ask an Expert
