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Looking for the best* health insurance?

After a policy that might actually be useful? Here are some practical ways to find the best health insurance.

Identifying the best health insurance policy goes beyond just looking at cost; it's a matter of perspective since what you think of as the best may not be the best for someone else. For example, you might value a top-level policy that provides maximum cover, while another person may want a basic policy to cover the essentials and to avoid government penalties.

While this article cannot give you personalised advice, it can provide a broad outline of key health insurance features that you should look out for. We will provide a private vs public comparison to help you assess if you need cover and provide strategies that can aid you in making an informed decision on what the best private health insurance is for you.

Compare policies from 30+ Australian health funds


Six features of the best health insurance

After the best health insurance in Australia?

Here are six features to keep an eye out for. Keep in mind that these are general features, and that the best* policy for you is the one that meets your specific needs:

  • Access gap cover for hospital treatments
  • A high percentage or dollar amount back on extras
  • Very few exclusions, restrictions or sub-limits
  • Low waiting periods on extras
  • Membership rewards and perks
  • Issued by a reputable health fund

What do you get with health insurance that you can't get under Medicare?

  • Treatment at a hospital of your choice.
  • Freedom to choose your own doctor.
  • A private or semi-private room.
  • Elective surgery when you need it, rather than joining a waiting list.
  • Cover for out-of-hospital services (extras).

Is extras cover required?

Extras cover allows you to claim for commonly used health services such as dental, optical and physical therapies, most of which are excluded by Medicare. Benefits are paid either as a set amount or as a percentage of the bill.

This is a popular form of health insurance as it's reasonably affordable and can pay towards the cost of health services beyond the standard general treatments. Some of these include gym memberships, herbal medicines, prescriptions medicines, psychology sessions and emergency ambulance transport.

  • Prioritise services. Benefit amounts for extras cover differ between funds, so if you plan to use one service more than most it can be wise to shop around to find a policy that offers the highest amount for it.
  • Benefit amounts. For set amounts, look at how much is paid compared to the typical cost of treatment. For percentage benefits, consider the proportion covered when deciding if it's worth the cost of the policy.
  • Preferred service providers. Some health funds have a network of affiliated providers who offer increased discounts to its members. These can include dentists, opticians and chiropractors.

Health insurance vs Medicare

Hospital

Be aware that health funds may require you to visit a hospital in its affiliate network in order to be covered as a private patient. You can check that the hospital you choose to be treated at is covered by your fund prior to admittance.

Private or public?What is or isn't covered?
Private health insurance
  • Choice of public OR private hospital
  • Choice of your own doctor
  • Choice of hospital
  • Choice as to when you are admitted to hospital
  • 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs
  • Medical services that are cosmetic, not clinically necessary or incurred overseas
Medicare
  • Treated at no charge
  • Treatment in a public hospital by a doctor appointed by the hospital
  • Treated as a public patient
  • Private patient hospital costs
  • No choice of doctor or hospital
  • Medical services which are cosmetic, not clinically necessary or incurred overseas

Extras

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 won't pay a cent.

Private or public?What can you get benefits for?
Private health insurance
  • Acupuncture
  • Chiropractic services
  • Eye therapy
  • Most physiotherapy
  • Speech therapy
  • Most dental examinations and treatment
  • Glasses and contact lenses
  • Occupational therapy
  • Hearing aids and other appliances
  • Podiatry or psychology services
Medicare
  • Consultation fees for doctors
  • Most out-of-hospital surgery
  • Tests and examination
  • Initial eye tests
  • Specific items under the Cleft Lip and Palate Scheme
  • Specific items under the Enhanced Primary Care Plan (EPC)
  • Some surgical procedures performed by approved dentists
  • Other therapeutic procedures performed by doctors

Ambulance

Emergency ambulance services are provided free by the state governments of Queensland and Tasmania, but in other states only certain people, such as veterans and pensioners, are eligible for free services. You can find ambulance cover in both hospital and extras policies.

Private or public?What's covered?
Private health insurance
  • Emergency ambulance transport fees
  • Non-emergency ambulance transport (depending on the policy)
  • Benefits apply anywhere in Australia
Medicare
  • Not covered

Pharmaceuticals

Under the Pharmaceutical Benefits Scheme (PBS), you only pay a portion of the cost of prescription medications. The amount varies depending on the medication up to a standard maximum. However, not all medications are included on the PBS, which is where health insurance comes in.

Private or public?How are pharmaceuticals covered?
Private health insurance
  • Non-PBS prescription medicines can be covered but a co-payment may still apply
Medicare
  • Benefits are paid only towards those listed on the PBS
Couple strolling in the countryside

Ways to get value for money

  • Pay your premium in advance to avoid the administration fees associated with monthly payments.
  • Opting to pay annually via direct debit can get you a discount with some health funds.
  • Pay an excess or co-payment to lower your premium in exchange for paying a lump or daily sum if you go to hospital.
  • Join a restricted membership fund if you are eligible, as the premiums are usually lower and benefits to members higher.
  • Mix and match your hospital and extras cover, as two different funds may have the best* offers on each.
  • If insuring your family, check how long your children can stay covered under your policy.
  • To avoid paying a gap, make sure your preferred doctor and hospital both have agreements with your health fund.

Useful info for first-time buyers

Remember, it's important to compare your options and other financial avenues before applying.

Can you switch health funds for a better deal?

Changing health funds 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, especially if your current policy no longer meets your needs or if you’ve found a better deal.

Even better, you generally 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 fund. These include the following benefits:

  • Your Lifetime Health Cover status. Your level of age loading will remain unchanged.
  • Your government rebate. Your rebate will stay the same providing your level of cover isn’t changing.
  • Your waiting period exemption. Waiting periods that you have already served can't be reapplied.

The process of switching is fairly straightforward. Once you have found the fund and policy you want to switch to, simply notify your current fund of your intention to switch. They will then send a Transfer Certificate to you or your new fund which will confirm your level of cover, current waiting periods and age loading status.

How does age affect your health cover?

Your health insurance needs change as you get older, which means that the best* policy for you at 20 may not be the best* when you're 40. This is why it can pay to review your existing cover at least once a year, as you may find you're either paying for services you don't need or you need to increase your cover.

  • Singles. Health insurance for singles typically offers a basic level of benefits and features at an affordable cost.
  • Couples. Instead of taking out lots of health insurance, people in relationships can get covered under one policy.
  • Families. This policy type allows you to cover dependants whose age excludes them from taking out health insurance.
  • Seniors. Shifting from a family policy to a couples or singles policy and dropping cover for services such as pregnancy can lower the cost of health insurance or allow you to pick up cover for treatments you may require as you get older.
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*Disclaimer: 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.
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2 Responses

  1. Default Gravatar
    MichaelFebruary 15, 2017

    Which private health insurance companies offer the best reimbursement of the cost of hearing aids?

    • Staff
      ZubairFebruary 16, 2017Staff

      Hi Michael,

      Thank you for your question.

      If you would like to review the cover limits of Australian funds for hearing aids please head over to our health insurance for hearing aids article.

      Cheers,
      Zubair

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