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In Australia, private hospital insurance is categorised using a four-tier system. Every single hospital policy will either be classed as basic, bronze, silver or gold.
The policies become more comprehensive as they go up through the tiers, so you're covered for more private hospital treatments, but you'll also pay more money.
Figuring out which tier policy you need is the first step to finding health insurance which is right for you. Otherwise, you might end up paying for benefits you don't want.
This page will help you do that. It'll explain what's included in each tier and how much you can expect to pay for certain policies. Looking for a quick overview?
Snapshot of Health insurance tiers
|How much should I expect to pay a month?||About $60 - $90||About $80 - $110||About $100 - $160||About $150 - $190|
|What's covered?||3 restricted categories||18 categories + 3 restricted||26 categories + 3 restricted||All 38 categories covered|
|Any hot tips?||ahms starter (basic)||Health.com.au Base Hospital $500 Excess with Co-Payment|
|CUA Health Limited Standard Hospital $500 Excess|
|HCF Hospital Gold $500 excess|
|Go to Site||Go to Site|
*Hot tips were chosen by looking at Finder partners to see which policies offered the most value in treatments compared to price. Quotes were based on a single person with $500 excess.
Get a quote for health insurance
Use our search engine below to compare quotes from over 30 Australian health funds. Once you get your results, you can filter to see specific tiers.
How do the health insurance tiers work?
Every hospital insurance policy falls into one of four tiers - basic, bronze, silver or gold. As you ascend through the tiers, the policies become more comprehensive and you'll find that more medical conditions are covered. Of course, the policies will become more expensive too.
For a policy to fall into a specific tier, it must meet some minimum requirements. If it doesn't meet those requirements, it'll be categorised in a lower tier. Those requirements are the same across the entire industry so every insurer is working from the same system.
That means every silver policy will cover the same clinical categories, regardless of which insurer you go with. The same goes for basic, bronze, and gold. There may be some small differences in the details, but they'll be relatively similar within each tier.
In some cases, a policy will fall in between categories. This means it has exceeded the minimum requirements of one tier but hasn't quite met the requirements of the tier above. When this happens, it may be called a 'plus' policy. For example, bronze plus or silver plus.
Are 'plus' tiers all the same?
No. A 'plus' tier means that a policy has met the minimum requirements of the core tier, but has offered some extra benefits too. While those minimum requirements will be the same, two plus policies could have different extras.
For example, one silver plus policy will have all the same core benefits available in a silver policy, plus cover for sleep studies and insulin pumps. On the other hand, a different silver plus policy will have all the same core benefits, plus cover for cataracts and joint replacements.
Always check what the extras are in a plus policy. They may be exactly what you're looking for, or something you know you'll never need.
Compare prices of different health funds
The table below shows quotes from Finder partners across each tier. Some include extra treatments, so there may be a notable difference in prices.
|AHM||$74.40||$89.35||$110.95||$178.15||Go to Site|
|Qantas||$79.26||$89.78||$112.65||$179.58||Go to Site|
|Medibank||$76.15||$83.40||$116.10||$164.30||Go to Site|
|HCF||n/a||$92.45||$111.65||$172.90||Go to Site|
|RT Health||n/a||$86.41||$153.57||$168.51||More info|
|Teacher's Health||$89.40||n/a||$107.95||$146.00||More info|
Quotes are based on a single living in Sydney earning less than $90,000 with a $500 hospital excess.
How to compare different hospital tiers
There are 38 clinical categories and each tier of hospital insurance covers a different amount of these clinical categories. For example, gold policies are required to cover all 38, but basic policies are only required to offer restricted cover across 3.
Remember though, you might not need cover for all 38 categories. That's why it's important to look at what's covered, so you're not paying for something you don't want.
The table below lists all 38 clinical categories, and which tiers have to cover them.
|Hospital psychiatric services||R||R||R|
|Brain and nervous system|
|Eye (not cataracts)|
|Ear, nose and throat|
|Tonsils, adenoids and grommets|
|Bone, joint and muscle|
|Kidney and bladder|
|Male reproductive system|
|Hernia and appendix|
|Miscarriage and termination of pregnancy|
|Chemotherapy, radiotherapy and immunotherapy for cancer|
|Breast surgery (medically necessary)|
|Diabetes management (excluding insulin pumps)|
|Heart and vascular system|
|Lung and chest|
|Back, neck and spine|
|Plastic and reconstructive surgery (medically necessary)|
|Podiatric surgery (provided by a registered podiatric surgeon)|
|Implantation of hearing devices|
|Dialysis for chronic kidney failure|
|Pregnancy and birth|
|Assisted reproductive services|
|Weight loss surgery|
|Pain management with a device|
Basic health insurance
Basic policies only have to offer restricted cover across three categories - rehabilitation, hospital psychiatric services, and palliative care. Usually, people take out a basic policy to avoid the Medicare levy surcharge or Lifetime Health Cover loading.
Finder's Pick for Basic Health Insurance: ahm Health Insurance Starter basic
ahm's starter basic policy is one of the cheapest in the market. If you're just looking for health insurance because you want to avoid the Medicare Levy Surcharge, this is a great option.
ahm Starter Basic.
Bronze health insurance
Bronze health insurance must offer cover in 18 specific clinical categories as well as the restricted cover that's available in basic health insurance.
You'll be covered for many common hospital treatments such as chemotherapy, joint reconstructions and hernias - among others.
Finder's Pick for Bronze Health Insurance: Health.com.au Bronze Plus Base Hospital $500 Excess with Co-payment
Offering slightly more than the usual bronze tier policies, Health.com.au's Base Hospital policy provides cover over 23 categories, plus 3 restricted categories. The low excess also makes the policy more affordable in the long-run.
Health.com.au Bronze Plus Base Hospital $500 Excess with Co-payment.
Silver health insurance
Silver health insurance has to cover the same three restricted categories at basic and bronze, as well 26 other clinical categories.
Some of the benefits that are required of a silver policy, but not bronze, including treatment for the heart and vascular system, lungs and chest, and the back, neck and spine.
Product not active
Gold health insurance
The best of the best, gold tier health insurance has to cover all 38 clinical categories, without restrictions. That means you'll have access to everything offered by the other tiers, as well as top-level benefits like fertility treatment, weight loss surgery, and pregnancy and childbirth.
Finder's Pick for Gold Health Insurance: HCF Hospital Gold $500 excess
With a premium of around $155 a month, HCF's Hospital Gold policy is one of the more affordable gold-tier policies and offers full coverage. A great option for anyone who wants premium cover for a decent price.
HCF Hospital Gold $500 excess.
*Picks were chosen by looking at Finder partners to see which policies offered the most value in treatments compared to price. Quotes were based on a single person with $500 excess.
Which health insurance tier is right for me?
We can't tell you which health insurance tier is right for you. The best way to go about deciding is to think about what you want from your policy then check which tiers cover it.
- Are you looking to avoid the MLS? A basic policy with an excess of no more than $750 will exempt you from the Medicare levy surcharge. If you don't care about cover, this could be the one for you.
- Are you worried about cancer? About half of Aussies are diagnosed with cancer by the age of 85. If this is one of your main concerns, and you'd like your treatment to be private, a bronze policy will cover you.
- Are you planning a family? If your family is still growing and you want private healthcare throughout your pregnancy, you'll need a gold tier policy.
- Are you worried about heart conditions? Over a million Aussies are living with a heart or vascular health condition. If this is one of your bigger worries, a silver policy is guaranteed to cover you.
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