What you need to do to find the right health fund for your needs.
Are you looking for the best health insurance* policy? While it may seem a simple task, getting the best private health insurance* in Australia is a matter of perspective.
Why? Because what you think of as the best medical insurance* may not be the right cover for someone else. You might value a policy that provides you with comprehensive extra cover, while someone else may just be looking for cover to help them avoid paying the Medicare Levy Surcharge if you earn over a certain income. Make sure you choose the right health fund for your situation.
Compare your health insurance options online
Complete the form and you'll be contacted by a consultant for an obligation free discussion about your health insurance options.The consultant will work with you to compare a range of health insurance providers which may include:
The best* health insurance policy is the cover that is best* for you, your family and your circumstances. In general, the fund should:
- Have low or no gaps between what is covered by Medicare and what your insurance will pay
- Come from an insurer with a good industry rating, high retention rates and few complaints
- Have only minimum waiting periods
- Cover more procedures with no out-of-pocket expenses
- Include lots of extras, benefits and discounts
- Have lower management expenses as a percentage of premiums
The first question you should ask yourself when choosing private health insurance is "Do I need it?". As an Australian, you already have hospital cover under the Medicare public health system. Whether you need more cover than this will depend on whether you want:
- Treatment at a hospital of your choice
- Your own doctor to treat you
- A private or semi-private room
- Elective surgery when you need it, rather than joining a waiting list
- Cover for ancillaries not covered by Medicare
If you decide you do need private health insurance, choosing the right cover involves determining your needs and the level of cover each policy provides:
- If you are young and single, hospital cover may not be a high priority, so you will need to find a policy with the best* cover for ancillaries such as optical and dental
- If you have dependants, you will need to find a policy that provides the best* family cover, preferably with individual rather than overall capped benefit limits
- If hospital cover is important to you, you will need to find a provider who has agreements with hospitals in your area and a policy that covers a high percentage of costs, so you don’t end up paying a large gap
While hospital cover is there for when you need it, extras cover is an area where you can actually get something back on what you have paid out for things such as dental, optical and chiropractic services.
- The benefit paid on such extras varies considerably with insurers and you need to look carefully at what the benefit limits are on a policy to decide whether it offers good value for money. Basically, if you are paying out a lot more than you are getting back, you may need to look at adjusting your cover or finding another insurer.
- If you use one service more than most, such as requiring regular dental treatments, you should find a policy that pays higher benefits in this area, rather than just paying a fixed premium for a range of services you barely use.
- Also rather than paying a set amount for a service, look for policies that cover a percentage of your bill, the higher the better, as this provides better value, particularly if your healthcare provider charges above-average prices.
- When shopping for the best* extras cover, also look for insurers who offer discounts for using their preferred service providers, as this can work out much cheaper and also look for policies that include lifestyle cover, which can give you access to a range of health and lifestyle-related discounts.
Switching health insurance providers is easier than most people realise. Given that the cost of health cover is on the rise in Australia, there’s never been a better time to shop around and switch if necessary. If your current policy no longer meets your needs, if you’ve found a better deal or if your personal circumstances have changed, switching insurers makes good sense. And you won’t be penalised for doing so. Providing your current policy is paid and up-to-date at the time of switching, your existing benefits will travel with you to the new provider. These include:
- Your Lifetime Health Cover status. Your level of age loading will remain unchanged.
- Your government rebate. Providing your level of cover isn’t changing, you will receive the same government rebate as you received previously.
- Your waiting period exemption. If you have already served your waiting period, your new insurer cannot make you serve a further waiting period.
The process of switching is fairly straightforward. Once you have found the insurer and policy you want to switch to, you simply notify your current insurer of your intention to switch. They will then send a Transfer Certificate to you or your new insurer, which will confirm your level of cover and current waiting period and age loading status.
Your medical insurance needs change as you get older, which means that what was the best medical insurance policy when you were 20 may not be the best policy when you're 40.
Private health insurance* for singles
If you’re young and single, health cover probably isn’t something that’s at the forefront of your mind. But accidents can happen at any time so it’s important to have some level of cover in place. And thanks to Federal Government initiatives like Lifetime Health Cover and the Medicare Levy Surcharge, there are plenty of financial incentives to take out cover.
The best health insurance* for singles typically offers a basic level of benefits and features. It should cover all the essentials:
- Hospital treatment after an accident
- Emergency ambulance transportation
A basic level of extras cover can also be very beneficial for singles, helping keep the cost of general treatments like dental, optical and physiotherapy down. Most health insurers offer entry-level policies that offer combined basic hospital and extras cover, or you can choose the individual cover that suits your needs.
Private health insurance* for couples
Getting the best health insurance* as a couples depends on where you and your partner are at in life. If you're young, fit and healthy you may only need a basic level of hospital and extras cover. You may just be interested in avoiding the Lifetime Health Cover loading and paying the Medicare Levy Surcharge if you earn over a certain amount ($90,000 for individuals and $180,000 for families).
If you're a family that is planning on starting a family, already have a couple of kids, you will need a higher level of cover that includes a mix of hospital and extras cover.
Considering the changing circumstances and health cover needs of couples, it’s important to review your cover regularly to make sure it’s still suitable for your situation.
Private health insurance* for families
For many Australian families, private health insurance cover is an essential expense. The level of cover you choose will depend on your budget and what you’re looking for in a policy. Some families only want a basic level of affordable cover, some want the ultimate peace of mind from a comprehensive policy, and others want a combination of the two.
Whatever the case may be, the health cover needs of a family can change quickly, so regularly reviewing the level of cover you have in place is a good idea.
Private health insurance* for seniors
Looking after yourself in your senior years is all about taking charge of your health, and the best way to do that is with private health insurance seniors cover. The Federal Government also provides a higher private health insurance rebate for people aged 65-plus, so it’s worth your while to keep health insurance cover in place.
The best* way to get value for money on your health insurance is to shop around. Comparing policies can reveal a variety of money-saving opportunities. Other ways to save include:
- Paying your premium in advance to avoid the administration fees associated with monthly payments
- Paying by direct debit, which will earn you a discount with some insurers
- Paying a higher excess to lower your premium
- Joining a restricted membership fund if you are eligible, as the premiums are usually lower and benefits to members higher
- Taking out health cover through your super fund, as many negotiate discounts with health insurers.
The answer really depends on your personal circumstances and it comes down to weighing up public and private health insurance:
- If you are young and healthy, you may not consider private hospital cover worth it, but may benefit from extras cover for things not covered by Medicare. If you are older or have health issues, you may certainly consider it worth it, particularly if you are spending time in hospital.
- If you earn less than $140,000 pa, you may consider it worth it, as you will receive a portion of it back in the form of a government rebate. If you earn more than $140,000 pa, you may be less inclined to take out private health, as your rebate will be much less.
- If you are a high income earner with no private hospital cover, you will be subject to the Medicare Levy Surcharge, so you may wish to take out basic hospital cover simply to avoid this.
- And if you haven’t taken out private health cover by the time you turn 31, the Lifetime Health Cover loading will see you paying 2% more for every year you fail to do so. For this reason alone, taking out private health cover from an early age would seem to be more than worth it.
Private Vs Public
|If you live in New South Wales or Australian Capital Territory, you may want to get ambulance cover as the only people that are provided with free ambulance cover are low income earners and pensioners. Emergency ambulance services are provided free by the State Governments of Queensland and Tasmania.|
Medicare does not cover:
Medical Services and General Treatment
|Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist if you visit a doctor outside a hospital. If your doctor bulk bills then you wont pay a cent.|
|Your private health fund may cover:||Medicare provides benefits for:|
|Thanks to the Pharmaceutical Benefits Scheme (PBS), you only pay for a portion of the cost of prescription medications.The amount varies depending on the medication up to a standard maximum.|
In Australia, around 50% of all extras claims are for dental. People tend to prioritise dental cover because treatment is expensive and not covered by Medicare. Dental cover comes in two types;
- Major dental – covers complex fillings, extractions, crowns, bridges and major procedures.
- General dental – covers minor dental services like regular checkups and teeth cleaning.
- Whether there is a gap between what is covered and what your dentist charges
- Whether the insurer has a preferred dentist scheme to reduce costs
- What waiting times are involved, as they can differ with each policy
If you’re a young single with good teeth, you may be able to get away with general dental cover, but if you are older or have a large family, you would probably be better off with major dental cover for when those inevitable wisdom teeth, braces and dentures come along.
Have a look at this table of commonly claimed for procedures to find out how much each health insurer will cover you for.
|Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genetalia||$221.35||$335.85||$311.85||$366.10||$315.80||$303.15||$296.90||$265.65||$265.65|
|Breast, benign lesion surgical biopsy of excision||$260.05||$355.20||$367.25||$356.40||$380.55||$355.30||$348.80||$312.10||$312.10|
|Carpal Tunnel Release||$276.80||$459.05||$426.80||$440.20||$453.75||$404.90||$417.55||$332.20||$332.20|
|Complicated Delivery (of baby)||$1,629.35||$2,649.15||$2,307.90||$1,855.90||$2,406.65||$2,198.50||$2,280.10||$1,955.20||$1,955.25|
|Coronary Artery Bypass||$2,200.00||$3,665.20||$3,404.40||$3,783.30||$3,294.85||$3,265.15||$3,064.80||$2,640.00||$2,640.00|
|Femoral on Inguinal Hernia||$464.50||$640.60||$657.50||$909.70||$662.70||$636.05||$623.05||$557.40||$557.40|
|Overnight investigation for sleep apnoea||$588.00||$747.65||$707.85||$682.20||$703.45||$694.25||$709.40||$705.60||$705.60|
|Tonsils or Tonsils and Adenoid||$295.70||$522.05||$493.85||$513.90||$481.30||$472.35||$442.65||$354.85||354.85|
|Uncomplicated Delivery (of baby)||$693.95||$2,150.35||$1,979.05||$1,484.50||$2,057.05||$1,886.95||$1,550.60||$832.74||$832.74|
In a nutshell, the answer to this question is yes. Everyone who takes out private health insurance is entitled to a government rebate, the size of which is determined by your income. The rebate is designed to encourage more people to take out private health cover and to make it more affordable for those who do. To be eligible, you must:
- Be eligible for Medicare
- Earn less than the Tier 3 threshold ($140,000 pa for singles or $280,000 pa for families)
- Be a member of a registered private health fund
The rebate can be claimed in the form of a premium discount from your insurer, a rebate on your tax return or in a direct payment from Medicare. And even if you don’t pay any tax or only have a small taxable income, if you have private medical insurance, you are still entitled to a rebate. The only group for whom the rebate is less of an incentive is high income earners (those earning more than Tier 3), as the amount they receive is reduced substantially, the more they earn.
The Medicare Levy Surcharge (MLS) is a tax on Australian high income earners who do not have private hospital cover. Its purpose is to encourage those who can afford it most to take out private cover to reduce the demand on the Medicare system. High income earners will only be exempt from the surcharge if they have hospital cover, as extras cover alone is not enough. The hospital cover must not have an excess of more than $500 for singles and $1,000 for couples or families. The rebate levels applicable from 1 April 2016 to 31 March 2017 are:
< Age 65
< Age 65
Medicare Levy Surcharge (MLS)
In keeping with the theme of finding the best health insurance* for your needs, here are some tips you may find useful in your search:
- Review your existing cover at least once a year, as a better deal may have come along in the meantime or your circumstances may have changed
- Don’t be afraid to switch, as legislation now ensures your benefits and current status will travel with you
- Mix and match your hospital and extras cover, as two different insurers may have the best* offers on each
- Select a higher excess if you can afford it and you feel you are unlikely to need hospital treatment in the near future, as this will reduce the cost of your premium
- If insuring your family, look for a policy with individual benefit limits rather than overall capped limits on extras
- Avoid hospital cover that has both an excess and a co-payment, otherwise you could end up paying a lump sum on admission and a further amount for every day you are in hospital
- Make sure your policy includes full ambulance cover, not just emergency ambulance cover
- To avoid paying a gap, make sure your preferred doctor and hospital both have agreements with your health fund
* The offers compared on this page are chosen from a range of products finder.com.au has access to track details from and is not representative of all the products available in the market. Products are displayed in no particular order or ranking. The use of terms 'Best' and 'Top' are not product ratings and are subject to our disclaimer. You should consider seeking independent financial advice and consider your personal financial circumstances when comparing products.