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Health insurance for NSW residents

Are you a New South Wales resident? Compare your health insurance options.

Private health insurance in Australia is designed to cover a wide range of medical, hospital and treatment costs not covered Medicare.

There are various types of private health cover available. Here you can compare hospital cover, extras cover and combined hospital and extras cover on offer to NSW residents.

Hospital cover lets you choose your doctor and hospital and covers doctors’ fees, hospital accommodation, theatre costs, intensive care, drugs and more.

Extras cover is designed to help you meet the cost of treatments like optical and dental as well as ambulance costs.

Find cover offered to NSW residents

Who are the largest funds in NSW?

The interactive chart below can show you who the largest health funds are by market share in NSW, as well as all the other states and territories in Australia. The option to see who the most popular funds are nationally is also available.

How does the cost of health insurance in NSW compare?

The cost of private health insurance varies substantially between Australian states and territories, with NSW fitting somewhere in the middle of the cost spectrum. The average annual premium for a NSW family buying hospital cover is $4,514.23, while the same policy in Queensland (the most expensive state) would set a family back $4,690.98.

In terms of extras cover, the average annual premiums for a NSW family would be $1,937.45.

If you purchase a combined hospital and extras cover policy in NSW for a family, the average annual premium amount is $6,416.01. NSW is slightly cheaper than Victoria, which has the most expensive average yearly premiums of $6,653.41.

In order to find cheap cover and that provides the greatest value for money in NSW, compare private health funds and shop around.

What membership and coverage do NSW residents have?

According to the statistics from APRA, as at 31 December 2016, 11,327,512 people, or 46.6% of the Australian population, were covered by hospital treatment cover. This was down 0.2% compared to the September 2016 quarter, but was an overall increase of 19,048 people over the year since December 2015.

In NSW, the number of people with hospital cover was slightly higher than the national average, with 47.6% having cover as at 31 December 2016, although this was nowhere near as dramatic as in Western Australia (54.7%) or ACT (57.7%).

As at 31 December 2016, 13,463,257 people, or 55.4% of the Australian population, had some form of general treatment (extras) cover. This was an increase of 7,759 people compared to the September 2016 quarter and an overall increase of 110,093 people since December 2015.

In NSW, the percentage of those with general treatment cover was again above the national average at 57.4% and again overshadowed by WA (68.2%) and ACT (68.4%).

The largest health funds in NSW are Bupa, with a market share of 25.7%, followed by Medibank, with a market share of 23.5%, and HCF, with a market share of 19.8%.

What are the out-of-pocket payments in NSW?

APRA statistics reveal that, as at 31 December 2016, the average out-of-pocket (gap) payment for a hospital episode was $275, which is a 5.8% reduction year-on-year. The average out-of-pocket payment for general (extras) medical services was $48, an increase of 1.4% since 31 December 2015.

Overall, the average gap payment across all services was $18.06, compared with NSW where it was slightly higher at $23.54.

How is the gender split in NSW?

When broken down into gender, more women than men held both hospital and extras cover in Australia as at 31 December 2016, with 5,835,238 women having hospital cover vs 5,492,274 men and 6,324,101 women having general cover vs 5,920,939 men.

In NSW, this was also the case, with 1,906,034 women having hospital cover vs 1,798,661 men and 2,091,791 women having extras cover vs 1,975,623 men.

Do people choose hospital or extras cover?

The APRA statistics show that more Australians have extras cover (55.4%) than hospital cover (46.6%), but coverage rates remain reasonably healthy for both.

This is also the case in NSW, where those with extras cover make up 57.4% of the total population, while those with hospital cover only account for 47.6%.

What are the demographics

According to the APRA report, those Australians with private health insurance can be broken down into the following age groups:

  • 0-14 years: Hospital (17.9%) and extras (18.8%)
  • 15-64 years: Hospital (65.0%) and extras (66.2%)
  • 65+ years: Hospital (17.0%) and extras (15.0%)

The statistics show that 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 those in the 25 to 29 age group.

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

Picture: Shutterstock

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