Health insurance tiers
There are 4 health insurance tiers – basic, bronze, silver and gold. Here’s what they mean for you.
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In Australia, private hospital insurance is categorised using a 4-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. You're covered for more private hospital treatments, but you'll also pay more money.
Gold hospital cover
Gold-tier hospital insurance covers all 38 treatments outline by the Australian government. This includes joint replacements, pregnancy, insulin pumps and other treatments, as well as all services covered by silver-tier policies.
Typical cost: From around $160 a month for a single policy.
Silver hospital cover
Silver-tier hospital insurance covers at least 26 treatments outlined by the Australian government. This includes treatments such as dental, lung and chest and podiatric surgeries, as well as all services covered by bronze-tier policies.
Typical cost: From around $115 a month for a single policy.
Bronze hospital cover
Bronze-tier hospital insurance covers at least 18 treatments outlined by the Australian government. This includes joint reconstructions, ear, nose and throat as well as gynaecology treatments, plus all services covered by basic-tier policies.
Typical cost: From around $80 a month for a single policy.
Basic hospital cover
Basic-tier hospital insurance isn't required to fully cover any treatments outlined by the Australian government, but it needs to have restricted cover for rehabilitation, hospital psychiatric services and palliative care. Basic cover is primarily used to avoid the Medicare levy surcharge (MLS) and lifetime health cover (LHC) loading.
Typical cost: From around $75 a month for a single policy.
What's included in each hospital cover tier?
A policy must meet some minimum requirements to fall into a specific tier. 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. The table below lays out the minimum requirements for each tier. "R" means insurers are allowed to offer cover for this clinical category on a restricted basis or with limited benefits.
|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|
Compare hospital cover from 30+ funds
What is a "plus" policy?
A "plus" policy falls in between categories in that it has exceeded the minimum requirements of a tier but hasn't quite met the requirements of the tier above it. An example of a "silver plus" policy would be one that covers every silver treatment, but also covers pregnancy. The same goes for the other tiers.
Are all "plus" policies the same?
No, most "plus" policies are different from one another. 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, 2 plus policies could have different extras.
For example, a 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 the extras in a plus policy. They may be exactly what you're looking for, or something you know you'll never need.
Who can benefit from each tier?
While the tier system wasn't made to match a particular policy to a particular type of person, some groups of people will likely benefit more from one tier than another. We've outlined some of those associations below.
Basic-tier hospital policies don't cover much. In fact, they are only required to offer restricted cover for 3 treatments. However, there are some other benefits to a basic hospital policy, including some tax implications. Here are a few groups of people who may benefit from basic coverage:
- 30 year-olds: A basic hospital policy is all you need to avoid the LHC loading that will kick in after you turn 31. If you don't have hospital cover after your 31st birthday, the LHC will add 2% per year onto the cost of any future private health insurance policy you choose to take out.
- High income earners: If you earn of $90k per year, you'll be subject to the MLS, an additional tax on your income. You can avoid the MLS completely by holding even a basic-tier hospital policy. Sometimes, the cost of the policy can be less than the amount the MLs would cost you.
- Young people with basic needs: A lot of "basic plus" policies cover more than just the basics, generally for slightly more than a bare-bones basic policy. If you're in good health and aren't planning on having children in the private system, then a basic plus policy might suit you.
Bronze hospital insurance is more comprehensive than basic cover, but is still quite affordable. Bronze hospital policies cover a range of common treatment types, including joint reconstructions, bone, joint and muscle issues and hernia and appendix treatment. Here are a few groups of people who may benefit from bronze coverage:
- Young people: If you're young with relatively simple health needs but don't plan on having children in the private system, then a bronze policy may be the right fit for you. It covers a range of important treatments, but nothing too complex.
- Young families: Bronze policies also cover a range of treatments useful for young children and teenagers. These include bone, joint and muscle, tonsils, adenoids and grommets and ear, nose and throat treatments. If you don't plan on having more kids, a bronze policy can be a good level of cover for your entire family.
- Women: Provided you don't want to have children in the private system any time soon, bronze cover is great for women. It covers a range of relevant treatments, including cancer, medically necessary breast surgery, gynaecology, as well as pregnancy termination and miscarriage.
Silver coverage is comprehensive, covering more complex treatments than bronze-tier policies. These include lung and chest, back, neck and spine and dental surgery, although dental surgery is often found on "bronze plus" policies. Here are a few groups of people who may benefit from silver coverage:
- Child-free families: Silver coverage doesn't include pregnancy coverage, so people who aren't looking to start a family may be well-suited to a silver policy.
- Middle-aged Australians: Silver policies cover a range of treatments that are more relevant to Australians aged around 30 to 50 years old. If the silver-tier treatment list matches your needs as you grow older, it might be a good option for you.
- People with specific medical needs: If there are silver treatments that match your specific medical needs, such as diabetes or pain management, then a silver policy is a good fit for you.
Gold hospital polices are the most comprehensive policies available in Australia, with coverage for all 38 clinical categories. Here are a few groups of people who may benefit from gold coverage:
- People planning on having children: The gold tier is the only one to include mandatory coverage for pregnancy and childbirth in the private system, as well as for assisted reproductive services, like in vitro fertilisation (IVF). If you're looking to have children in the private system, a gold policy might be worth considering. Note that there is a 12-month waiting period for these services.
- Older Australians: Gold policies cover a range of treatments such as cataracts and joint replacements, which may be useful for older Australians.
- People with complex medical needs: There are a few complex procedures that are only available on gold-tier hospital policies, including weight loss surgery, insulin pumps and sleep studies. If there are gold-tier treatments that you think might be useful for your specific needs, consider a gold policy.
Best health insurance in each tier: Finder Awards 2021
Below you'll find the finalists from the 2021 Finder Awards. Each policy was chosen based on criteria such as the excess or co-payment amount, number of associated (agreement) hospitals, treatments covered in public or private hospitals, waiting periods and annual benefit limits.
Gold health insurance
Silver health insurance
Bronze health insurance
Good value cheap health insurance
Just looking for a cheap hospital policy that covers basic treatments and helps you avoid the MLS and LHC? These are a few good value basic plus policies from Finder partners that might fit the bill for you.
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