2025 Health Insurance Statistics
Health insurance statistics are for nerds. Luckily we're nerds. You're also a nerd - that's why you're here. Get your keyboards ready, it's spreadsheet time.
People with hospitals and extras cover
According to APRA figures, as of December 2025:
- 45.6% of Australians (12.6 million people) have private hospital cover
- 55.3% of Australians (15.3 million people) have private extras cover
The chart below shows how hospital and extras cover rates have shifted over time. Coverage declined steadily until 2020, before rebounding in the wake of the COVID-19 pandemic. Since around 2023, however, coverage has begun falling again. This renewed decline may reflect the impact of rising inflation and the cost of living crisis, along with structural factors that make private health insurance less financially attractive — particularly for younger Australians.
Health insurance coverage by gender
APRA keeps track of the number of men and women with hospital and extras cover. Women are consistently more likely to have both hospital and extras cover than men. This makes some sense, as people assigned female at birth tend to have more interaction with the healthcare system, especially with regard to childbirth and menopause.
Health insurance coverage by age
When we look at the age ranges of people with hospital and extras cover, we see that older people are more likely to have a policy. This is a bit of a no brainer - older folk have more health issues, so get a lot more value out of health insurance. We do see a drop off after about age 80 for hospital cover, about 70 for extras. This could be because the cost of living starts to squeeze as older Australian's run down their super, though there could be other factors.
The price of hospital insurance
The price of health insurance varies by a range of factors. The biggest ones include the comprehensiveness of cover, whether cover is just for you or multiple people, as well as the excess and where in Australia you live.
We've controlled for a few of them to figure out the average cost of hospital cover across Australia, split out by hospital tier. The table below displays the averages for a 30 year old single policyholder with a $750 excess hospital policy. The prices are based on the current Finder database, which includes all Australian policies listed with the Commonwealth Government.
2025 health insurance price rises
Health insurance premiums typically rise each year on 25 February. In 2025, the average premium increase is 3.73%, slightly higher than last year's 3.03% rise. However, many health funds have chosen to delay their increases until later in the year, citing it as a way to return savings to members following reduced claims during the COVID-19 pandemic.
Here is a chart of the 2025 price rises for Australia's biggest health funds, sourced from health.gov.au.
Private health insurance price rises since 1997
The cost of private health insurance in going up all the time. Every year the government has to approve the price rises that the insurance funds apply for. These numbers have jumped around a lot, as they reflect the ongoing cost of providing medical insurance to Australians, and are affected by macro economic trends like inflation.
How many Australians are switching health funds?
A survey by Roy Morgan reveals that more Australians are checking out other companies before renewing their household insurance policies. In June 2023, 66.1% of the 29 million policies were renewed without looking into alternatives. This shows a slight drop from 66.5% in June 2022 and a more significant decrease from 67.2% in the fiscal year ending June 2021, marking a 1.1% reduction over two years.
Benefits paid by health insurers
In December 2025, insurers paid a total of $5.36 billion in hospital treatment benefits, with an average of $1,577.36 per person, according to APRA. The largest portion of benefits per person was allocated to hospital accommodation and medical costs, followed by medical services and prostheses benefits.
During the same quarter, the average out-of-pocket payment for a hospital Increased to $471.29. The specialty group with the largest out-of-pocket payment was Orthopaedic, averaging $847.36 per episode.
Health insurance complaints
Australia's Commonwealth Ombudsman publishes detailed reports of complaints received by health insurance funds. It publishes a yearly report in around March each year, covering the complaints received in the previous calendar year. The most recent yearly report was published in March 2024, looking at 2023 data.
We've weighted the complaints received by each health funds against market share. This chart below ranks funds based on this ratio - the lower the number, the better. We've only included funds here with a national market share of at least 0.5%.
Australian health funds market share
The following pie chart shows the market share of Australia's biggest health funds. This data was released by the Commonwealth Ombudsman in April 2024, and represents national market share from 2023.
Note that Medibank and ahm are both classified as 'Medibank' in this data – Medibank owns ahm. Also, note that the 'Other' field only includes funds with at least a 0.10% market share. As such, the percentages do not add up to 100%.
Sources
More resources on Finder
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