Private health insurance is available to Australians, but it is not mandatory.
Private health insurance can be worth it if you've turned 31, earn over $97k or want more choice in your healthcare.
The private healthcare system has tax advantages over the public system, like avoiding the Medicare Levy surcharge (MLS).
What is private health insurance?
Private health insurance helps to cover the cost of procedures and treatments not covered by Medicare. This can include specialist appointments, dental care, physiotherapy and ambulance cover.
Do I need private health insurance?
As the majority of healthcare is supported by Medicare, many Australians wonder how much of a difference private health insurance can make in their lives. Or to put it more frankly, if private health insurance is "worth" the price tag. Here are some scenarios where you might want to consider health insurance:
You want extras cover
Medicare doesn't cover out of hospital services such as dental, optical or physiotherapy. Health insurance can if you get extras insurance. Policies start from around $13 a month and a few let you skip waiting periods for things like general dental.
You earn over 97k
The Medicare Levy surcharge (MLS) is a government levy of up to 1.5% on your income if you earn more than $101,000 (or $202,000 for couples) and don't have private health cover. You can avoid the MLS with a basic hospital policy, which cost around $80 a month.
You're turning 31 soon
When you turn 31, a 2% Lifetime Health Cover loading (LHC) is added to your health insurance premium for every year you don't have hospital cover. That fee accumulates as you age and stays in place until you've held hospital insurance for 10 years.
You want to avoid lengthy waiting times
Public waiting lists for elective surgery are typically much longer than private waiting lists. If you don't want to wait, private health insurance might be a good option. Keep in mind though that if it's a pre-existing condition you're receiving treatment for – for example a bad knee – you'll need to have held cover for 12 months before insurance will cover you.
You want your choice of doctor
With private health insurance, you get to choose your own doctor and when you're treated. You can also get your own room in a private hospital, where possible.
What type of health insurance cover do I need?
When you start shopping around on health insurance policies, you'll find there's generally three types:
Hospital only. Hospital only covers expenses in a private hospital. There are 4 levels of insurance: basic, bronze, silver and gold. All must cover specific treatments. According to findings by APRA, 12.5 million Australians (45%) currently hold hospital cover.
Extras only. Extras cover pays for medical costs outside of a hospital e.g. optical, dental, physio, psychology and chiro. Policies are very customisable, allowing you to only pay for treatments you'll actually use.
Combined. A combined policy includes hospital and extras. Bundling these with a single fund can sometimes save you money, but not always.
Pros and cons of private health insurance
Pros
It typically has shorter wait times than in public hospitals.
It can pay for out of hospital care such as dental, optical and physio.
It covers ambulance transportation, unlike Medicare.
You have choice – for example, you choose your own doctor and can get your own private room.
There are some tax benefits if you earn 97k or more a year.
Cons
Basic policies don't cover much and top tier policies are expensive – often around $170 per month.
You may have out of pocket expenses – private doctors aren't obligated to adhere to MBS fees.
Medicare covers the exact same hospital treatments as private hospital insurance.
You need hospital cover if you want to avoid the LHC loading and MLS – extras won't count.
When is private health insurance not worth it?
The government actively encourages people to take out private health cover to alleviate pressure on the public system. However, that doesn't mean it's always the right decision for you. For example, private health insurance might not be worth it if:
You are happy with the public system. The ability to choose your own specialist or hospital, or to have the option of a private room and better food, is a selling point for some – for others, it's an additional expense that's not worth paying for.
It's costing a lot but giving little in return. If you'd be paying $1,200 a year for insurance but only claiming a few hundred on physio or new glasses annually, it doesn't make much financial sense. You may want to just get extras cover for now.
You feel like you're being pressured into unneeded cover. Just because the ads say you need a private fund in case anything goes wrong, remember that the public health system can still provide quality care. It covers the exact same treatments as private health insurance.
You might benefit from private hospital cover. Here's why:
It could save you at tax time: Your income is high enough that you're likely to be charged the Medicare Levy Surcharge (MLS). This is an extra tax of between 1% and 1.5% of your overall income, which will be charged at tax time. To prevent it, you'll need to take out at least a basic hospital insurance policy (though we recommend at least basic plus).
It will stop you paying more later: Ever since you turn 31, you're eligible for the Lifetime Health Cover loading (LHC). For every year after your 31st birthday, not having hospital cover will add a 2% levy to your premiums when you eventually do take out private hospital cover. Avoid this by getting at least a basic hospital cover policy.
You may want private cover for childbirth: If you're planning on having a baby soon, then you might want private hospital cover with childbirth. Private hospital childbirth isn't for everyone, but if it's something you're after, you'll need a gold tier policy at least 12 months before you become pregnant.
You probably don't need private hospital cover right now. Here's why:
You're not looking to have a baby, so you don't need to worry about private childbirth.
Despite all that - if you want cover for a good range of hospital treatments in a private hospital - just in case - you might want to consider a Bronze policy. Bronze policies are pretty affordable and cover 18 different treatment categories.
Extras
You might benefit from having private extras cover. Here's why:
If you're planning on having a baby, extras cover could give you access to valuable out-of-hospital care. Some extras policies include cover for pre-natal and ante-natal services to give you and bub the best chance of success.
Private extras cover helps you pay for a range of out-of-hospital services not covered by Medicare. This can include dental checkups and surgery, prescription glasses and contact lenses, as well as hearing aids and blood glucose monitors. Best of all, if you are sure you use your extras regularly, it can actually save you money!
Ambulance
You should consider ambulance cover. Here's why:
Ambulance callouts aren't covered by Medicare, and only Tasmania and Queensland offer free cover for residents. That means you'll be billed whenever you need an ambulance to a hospital, generally starting at $500 per callout. Luckily, ambulance is often covered with hospital and extras policies - just check the fine print before you buy. Otherwise, you can get standalone ambulance cover from around $60 per year.
As a Tassie resident, you're covered for ambulance services within the state. However, you won't be covered for services on the mainland, which can cost more than $500 per callout. Ambulance is often covered with hospital and extras policies, but not always in Tasmania. If you're not covered, standalone ambulance cover starts around $60 a year.
You probably don't need ambulance cover. Here's why:
As a Queensland resident, you've covered for ambulance services anywhere in Australia, so you probably don't need private ambulance cover. Ambulance is often covered with hospital and extras policies, but not always in Queensland - double check your health insurance if you ever move interstate.
The health insurance calculator is not a complete assessment of your financial position. It is a general guide only. There are many additional factors unique to each individual that you should take into account. Results are only as accurate as the information entered by the user. We recommend speaking to your financial adviser when considering your financial position and health insurance decisions.
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FAQs
You are never obligated to take out health insurance. However, once you turn 31, you'll be hit with a Lifetime Health Cover (LHC) loading of 2% for every year you don't have hospital insurance.
If you earn over 97k or 194k as a couple per year, you'll pay the Medicare Levy Surcharge (MLS). If you are 31 or older, but you never get private health insurance, you will never have to pay the Lifetime Health Cover loading – this only applies if you get insurance after you turn 31.
No, it's entirely your choice. Medicare covers pregnancy but some people opt to go private because you get to choose your obstetrician and get your own room.
Yes, you might. With private health insurance, Medicare typically pays for 75% of the MBS fee; insurance covers the remaining 25%. However, medical specialists aren't obligated to adhere to the MBS fee – it's just a recommendation. If they charge more, you might have out of pocket expenses, unless your fund has a gap cover agreement with the hospital.
Ceyda Erem is Finder’s senior writer for insurance and has almost 10 years of experience writing about personal finance. Formerly a copywriter for several business and finance clients, Ceyda has written hundreds of articles, guides, blogs and more to ensure Australians stay in the loop about how to best manage their money. She has a Bachelor of Arts, Majoring in Writing from Macquarie University.
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