Health insurance tiers

There are four 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 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 - $90About $80 - $110About $100 - $160About $150 - $190
What's covered?3 restricted categories18 categories + 3 restricted26 categories + 3 restrictedAll 38 categories covered
Any hot tips?ahms starter (basic) Base Hospital $500 Excess with Co-Payment
(Bronze plus)
CUA Health Limited Standard Hospital $500 Excess
(Silver plus)
HCF Hospital Gold $500 excess
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*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$77.80$92.60$115.95$189.10 Go to Site
NIB$83.14$94.96$121.49$201.83 More info
Suncorp$83.14$98.04$124.17$211.24More info
Qantas$83.14$94.96$118.52$193.56Go to Site
Medibank$81.15$88.90$123.75$176.65Go to Site
HCFn/a$93.45$116.15$185.80Go to Site
HBF$77.92$88.74 $125.41 $169.48 Go to Site
GMHBA$77.50$91.30 $121.40$174.20 More info
CBHS$78.05$103.27 $133.59 $139.83 More info
CUA$87.55$111.16$123.43$226.10More info
Frank$76.25$92.25 $117.85 n/aMore info
TUH$78.70$101.35$161.15 $202.70More info
Bupa$81.12$93.45$114.56$196.21More info
RT Healthn/a$89.51 $161.20$176.81More info
Peoplecare$86.70$107.00$135.80$179.20 More info
Westfund$95.75$97.75$116.98$184More info
Teacher's Health$90.20 n/a$111.75$155.70More info
Unihealth$90.20 n/a$111.75$155.70More 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.

Clinical categoryBasicBronzeSilverGold
Hospital psychiatric servicesRRR
Palliative careRRR
Brain and nervous system
Eye (not cataracts)
Ear, nose and throat
Tonsils, adenoids and grommets
Bone, joint and muscle
Joint reconstructions
Kidney and bladder
Male reproductive system
Digestive system
Hernia and appendix
Gastrointestinal endoscopy
Miscarriage and termination of pregnancy
Chemotherapy, radiotherapy and immunotherapy for cancer
Pain management
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)
Dental surgery
Podiatric surgery (provided by a registered podiatric surgeon)
Implantation of hearing devices
Joint replacements
Dialysis for chronic kidney failure
Pregnancy and birth
Assisted reproductive services
Weight loss surgery
Insulin pumps
Pain management with a device
Sleep studies

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.
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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.

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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.
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*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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