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Health Insurance for Victoria

Do you live in Victoria? Compare your options and find the right fund.

Private health insurance is a great way for residents of Victoria to protect themselves from a range of medical costs. Cover is broken into two cover types:

  • Hospital cover. When you have private hospital insurance in place, you can choose the doctor and hospital you want. You can avoid long waiting lists at public hospitals and be covered for the cost of hospital accommodation, theatre fees, intensive care, drugs and much more.
  • Extras insurance. If you take out extras cover as well, you can be covered for the cost of a wide range of general treatments such as dental, optical, physiotherapy and chiropractic services, which is why private health cover is an essential consideration for all Australians.

Find out how you can benefit from having private health insurance, who the most popular insurer in Victoria is and more.

Compare your Victorian health insurance options

Who are the largest health funds in Victoria?

In the chart below health funds are ranked individually by their market share in each state, territory, as well as Australia as a whole. Please note that not all available health funds are ranked, only those that have 2% market share or higher in each category.

How does the cost of health insurance in Victoria compare?

Victorian families pay more for their health insurance premiums than people anywhere else in Australia. The average annual premium for a Victorian family with hospital and extras cover is $6,653.41 . If you just want hospital cover in Victoria, the annual premium will set you back $4,820.11, while extras cover alone costs $1,900.91 per year.

Premium costs vary between Australian states and territories because health care costs vary in different areas of the country. Also, claim profiles vary from location to location. As a general rule, Victorians use private hospitals more than other Australians and access more expensive treatment, which in turn drives the cost of premiums up.

How much does it cost for an ambulance in Victoria?

Covering the cost of ambulance transportation in Australia varies between states. For example, while the Queensland Government provides ambulance cover for its residents, residents of Victoria will need to either purchase ambulance cover through Ambulance Victoria or from a private health fund. This cover will ensure that your ambulance transportation costs are covered in the event of an emergency.

Costs for ambulance services in Victoria can cost:

ServiceCost
Emergency attendance fees (no transport):$507
Emergency road transport fees (metropolitan):$1,174
Emergency road transport fees (regional and rural):$1,732
Non-emergency road transport (metropolitan):$317 for stretcher or $104 for clinic car
Non-emergency road transport (rural and regional):$536 for stretcher and N/A for clinic car
Fixed wing air transport: Variable charge $2,082 and Fixed charge $2,816
Rotary air transport:Variable charge $10,475 and Fixed charge $23,842

Membership and coverage

The latest APRA statistics show that as at 31 December 2016, 46.6% of Australians had hospital treatment cover. This was a reduction of 0.2% from the September 2016 quarter but an overall increase since 31 December 2015 of 19,048 people.

In Victoria, the figure was slightly lower than the national average, with 43.9% of people having hospital cover as at 31 December 2016. This was the exact same percentage as Queensland and slightly less than South Australia (45.9%) and Tasmania (44.5%).

At 31 December 2016, 55.4% of Australians had general treatment (extras) cover (13,463,257 people), which was 7,759 more than the September 2016 quarter and 110,093 more people since 31 December 2015.

In Victoria, the figure was lower than the national average, with only 50.6% of people having extras cover as at 31 December 2016. This was similar to Tasmania (51.4%) and significantly less than South Australia, which was well above the national average at 59.5%.

The largest health funds in Victoria are Medibank, with a market share of 33.9% and Bupa with 24.4%. Australian Unity is a distant third with 8.0%.

Out-of-pocket payments

According to the APRA report, as at 31 December 2016, the average out-of-pocket (gap) payment for a hospital episode was $275, which was a 5.8% reduction since 31 December 2015 and the average out-of-pocket payment for extras was $48, which was a 1.4% increase since 31 December 2015.

The average gap payment across all services in Australia was $18.06, but in Victoria, the average gap payment was much lower at $12.55.

Men vs women

In terms of gender, more women had health insurance cover in Australia than men as of 31 December 2016. The report found that 5,835,238 women had hospital cover compared with 5,492,274 men, and 6,324,101 women had extras cover compared with 5,920,939 men.

In Victoria, this was also the case, with 1,394,852 women having hospital cover compared with 1,297,741 men, and 1,367,828 women having extras cover compared with 1,271,108 men.

Hospital vs extras cover

The APRA report also revealed that more people have extras cover than hospital cover in Australia (55.4% extras compared with 46.6% hospital), but that coverage rates are still reasonably healthy for both.

This is also the case in Victoria, where 50.6% of the population have extras cover compared with just 43.9% of people with hospital cover.

Who has cover in Victoria?

Those with private health insurance can be further broken down into age groups as follows:

  • 0-14 years. Hospital 17.9% and 18.8% extras cover
  • 15-64 years. Hospital 65.0% and 66.2% extras cover
  • 65+ years. Hospital 17.0% and 15.0% extras cover

The statistics reveal that the biggest net increase in hospital cover was 5,495 people in the 70 to 74 age group, while the biggest net decrease in extras cover was 15,068 people in the 25 to 29 age group.

This age distribution is consistent across all states including Victoria, with the most significant aspect being an under-representation in younger age categories such as the 25 to 29 age group.

How have coverage levels changed over time?

If you compare the 2016 APRA report with the 2015 report, you will find the following information:

  • The percentage of Australians with hospital cover has decreased slightly from 47.2% as at 31 December 2015 to 46.6% as at 31 December 2016.
  • There is a clear age difference in the claim rates for hospital benefits, with older age groups making more claims than younger age groups. In contrast, extras benefit claim rates are more evenly spread among the age groups.
  • While Victoria’s private health membership is below the national average, states such as WA and ACT have a significantly higher participation rate (54.7% hospital and 68.2% extras in WA and 57.7% hospital and 68.4% extras in ACT).
  • Health Insurance Business premium revenue increased by 5.5% since 31 December 2015 and total fund benefits increased by 5.1%.

Compare your health insurance Victoria options with the aid of an adviser

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2 Responses

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    ChristineApril 12, 2017

    To where do I post a Medicare claim?

    I have tried the various electronic options and they don’t work.

    For mobility reasons
    I can’t get to our nearest Medicare Centre (Windsor)

    Can I post the claim to your Windsor (3181) street address?

    Christine

    • finder Customer Care
      ZubairApril 12, 2017Staff

      Hi Christine,

      Thank you for your question.

      You have contacted finder.com.au, a comparison and information service and not actually Department of Human Services.

      You will need to contact Windsor service center directly to confirm if they have an option of claim via post. Alternatively, there is also an option of claim by using the phone.

      All the best,
      Zubair

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