Man giving book which written Health Insurance

ACT Health Insurance

Do you reside in the ACT? Compare policies and get the right one for you.

Being protected by private health insurance can cover you in the event of sickness or injury for numerous medical services and treatments which are excluded by Medicare. It also provides additional benefits such as paying for the expenses of private accommodation in hospital and allowing you to choose the doctor who treats you. Several types of private health insurance exist, with most providers allowing you to combine them to suit your specific requirements:

  • Hospital cover. Insures you for treatments, services and ancillary costs that you will incur in the event you are admitted to a medical facility.
  • Extras cover. Insures you for non-hospital related services such as optical and dental.
  • Ambulance cover. Pays for the expense of emergency ambulance transport.

Learn about the policies available in the Australian Capital Territory

Who are the most popular health insurance providers in the ACT?

This interactive chart shows the health funds that are most popular with residents of the Australian Capital Territory, as well as the top contenders in every other state, territory and Australia as a whole. The results of this chart are based on market share percentage.

How cost effective is ACT health insurance?

Health insurance premiums vary depending on what state or territory you are in, although not to an overly substantial degree. Premium rates correspond to the level of benefit payments being made, so if your state or territory has a high rate of health insurance claims, the premium cost will reflect that.

However, increases in premiums are not something that health funds can implement unilaterally, as rises are overseen and approved not only at Federal Government level by the Minister for Health, but also by the Private Health Insurance Administration Council (PHIAC), an independent financial regulator. Currently, the average health insurance policy costs in the ACT:

  • Hospital only: $4,514.23 for families and $2,087.23 for singles
  • Extras only: $1,937.45 for families and $875.95 for singles

How much does an ambulance cost in the ACT?

In the ACT, like most states in Australia, if you don't have private health insurance you will have to pay for emergency ambulance transport out-of-pocket. The costs for emergency transport in the ACT are as follows:

ServiceCost
Emergency ambulance service (treatment and transport)$918 (+$12/km for every km travelled outside the ACT)
Emergency ambulance service (treatment not including transport)$637
Non-emergency ambulance service (treatment and transport) by an Ambulance Paramedic or an Intensive Care Paramedic$656 (+$12/km for every km travelled outside the ACT)
Non-emergency ambulance service (treatment and transport) by Patient Transport Service resource$237 (+$5/km for every km travelled outside the ACT)

Free ambulance transport is available to those who hold a valid:

  • ACT Centrelink Pensioner Concession card
  • ACT Centrelink Health Care card
  • Department of Veterans Affairs Entitlement card

Membership and coverage

The latest statistics from APRA show that, as of 31 December 2016, 46.6% of the Australian population had hospital cover. This was a reduction of 0.2% compared to the September 2016 quarter, but an overall increase of 19,048 people since 31 December 2015.

In ACT, the number of people with hospital cover was well above the national average, with 57.7% having cover as at 31 December 2016. This was the highest percentage of cover anywhere in Australia and the only other state to come close was Western Australia with 54.7%.

As at 31 December 2016, 55.4% of Australians had general treatment (extras) cover. This was an increase of 7,759 people on the September 2016 quarter and an overall increase of 110,093 people since 31 December 2015.

In ACT, the percentage of those with extras treatment cover was again well above the national average at 68.4% and again closely followed by Western Australia at 68.2%.

The largest health funds in ACT are Medibank, with a market share of 29.8%; Bupa, with 22.5%; NIB, with 15.4%; and HCF, with 14.1%.

Out-of-pocket payments

The APRA reports showed that the average out-of-pocket (gap) payment for a hospital episode was $275 as at 31 December 2016, which represents a 5.8% reduction since 31 December 2015. The average out-of-pocket payment for extras services was $48, which represents an increase of 1.4% since 31 December 2015.

Overall, the average gap payment across all services was $18.06. The average gap payment in ACT was considerably higher at $55.58.

Men vs women

From a gender point of view, more women than men had private health insurance in Australia as of 31 December 2016, with 5,835,238 women holding hospital cover compared to 5,492,274 men, and 6,324,101 women holding extras cover compared to 5,920,939 men.

In ACT, this was also true, with 119,633 women having hospital cover compared to 110,504 men, and 125,847 women having extras cover compared to 115,679 men.

Hospital vs extras treatment cover

The APRA reports show that more people have extras treatment cover than hospital cover in Australia (55.4% extras compared to 46.6% hospital), but that coverage rates are relatively healthy for both.

This is also the case in ACT, where those with extras treatment cover make up 68.4% of the population, while only 57.7% have hospital cover.

Who has cover in the ACT?

Those Australians with private health insurance can also be broken up into age groups as follows:

  • 0-14 years. Hospital 17.9% and 18.8% extras cover
  • 15-64 years. Hospital 65.0% and 66.2% extras cover
  • 65+ years. Hospital 17.0% and 15.0% extras cover

According to the APRA statistics, the largest net increase in hospital cover was 5,495 for the 70 to 74 age group and the largest net decrease in extras cover was 15,068 for the 25 to 29 age group.

This age distribution is consistent across all states and territories including ACT, with the most significant aspect being an under-representation in younger age categories like the 25 to 29 age group.

How have coverage levels changed over time?

If you compare the 2016 APRA report with that compiled for 2015, several observations can be made:

  • The number of people with hospital cover at 31 December 2015 was 47.2%, which has decreased slightly to 46.6% in 2016.
  • There is a noticeable age difference in the claim rates for hospital and extras benefits, with a higher claim rate in older age groups for hospital benefits and extras benefit claims remaining more evenly spread across the age groups.
  • ACT and Western Australia have significantly higher participation rates than other states and territories (ACT 57.7% hospital and 68.4% extras cover and WA 54.7% hospital and 68.2% extras cover).
  • Health Insurance Business (HIB) premium revenue rose 5.5% for the year as at 31 December 2016 and total fund benefits were up by 5.1%.

Get a quote on health insurance policies in the ACT

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