Health insurance WA | Cover for Western Australia Residents

While Medicare covers many important medical expenses for all Australians, it only offers limited cover that is far from comprehensive. That’s why the Australian Government recommends that all Australians take out private health insurance, and it has introduced a number of initiatives to encourage people to take out cover.

Private health insurance is split into three types:

• Hospital. Hospital covers such expenses as hospital accommodation and theatre fees. It also gives you the option of choosing your doctor and hospital.
• Extras. Extras covers the cost of a range of general treatments not covered by Medicare, including optical, dental and physiotherapy.
• Ambulance. Ambulance covers the cost of emergency ambulance transportation.

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Who are the largest funds in WA?

The pie chart below displays who the health fund market share leaders are in Western Australia, along with top performers in the other states and territories. You can also see who the top six health funds are nationally.

How does the cost of health insurance in WA compare?

Extras premiums in Western Australia are more expensive than in any other Australian state or territory, with the average annual premium for family extras cover costing $1,898.60. Hospital cover for a family attracts an average annual premium of $4,112.85.

If you want to purchase a package policy that combines both hospital and extras cover, the average annual premium for a family is $6,145.54. This is cheaper than in Victoria or Queensland, where annual premiums respectively cost $6,653.41 and $6,378.54.

In order to find a policy that offers the cover you need and also provides value for money, compare a range of health funds and shop around for the right deal.

How much does an ambulance cost in Western Australia?

The way you pay for ambulance costs in Western Australia varies depending on where you are when you require ambulance transportation. In the Perth metropolitan area, you’ll need to take out ambulance cover from a private health fund to cover your emergency ambulance costs. In regional areas of the state, ambulance services are offered by the St John Ambulance Service of Australia. Costs for an ambulance in the metro areas are as follows:

Aged pensioners in Western Australia can take advantage of ambulance services free of charge, while senior citizens aged 65 years and over only have to pay half the cost of normal ambulance expenses.

Membership and coverage

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

In Western Australia, the figure was significantly higher than the national average, with 54.7% of the population having hospital cover as at 31 December 2016. The only higher percentage was in the ACT, where 57.7% of people had hospital cover.

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

In Western Australia, the figure was again well above the national average, with 68.2% of people having extras treatment cover as at 31 December 2016. This was again second only to ACT, which had the highest percentage at 68.4%.

The largest health fund in Western Australia is HBF, with a majority market share of 54.9%. Its closest competitors are Medibank with 20.1% and Bupa with 11.2%.

Out-of-pocket payments

The statistics show that, as of 31 December 2016, the average out-of-pocket (gap) payment for a hospital episode was $275, a 5.8% decrease since 31 December 2015, and the average out-of-pocket payment for extras services was $48, a 1.4% increase since 31 December 2015.

The average gap payment across all services was $18.06, compared with Western Australia where it was $18.29.

Men vs women

With regards to gender, the APRA reports show that more women had health cover in Australia than men as at 31 December 2016. There were 5,835,238 women with hospital cover compared with 5,492,274 men, and 6,324,101 women with extras treatment cover compared with 5,920,939 men.

In Western Australia this was also true, with 728,512 women having hospital cover compared with 711,246 men, and 889,684 women having extras cover compared with 854,523 men.

Hospital vs extras treatment cover

The APRA statistics also showed that more Australians have extras cover than hospital cover (55.4% extras versus 46.6% hospital) but that coverage rates are still fairly healthy for both.

This is also the case in Western Australia, where 68.2% of people have extras cover and only 54.7% of people have hospital cover.

Who's got cover in WA?

The insured can be 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 APRA statistics show that the biggest net increase in hospital cover was 5,495 in the 70-to-74 age group and the biggest net decrease in extras cover was 15,068 in the 25-to-29 age group.

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

Changes over time

Comparing the 2016 and 2015 APRA reports reveals several interesting statistics:

• The proportion of Australians with hospital cover has gone down slightly from 47.2% as at 31 December 2015 to 46.6% as at 31 December 2016.
• There is an obvious age difference in claim rates for hospital benefits, with older age groups making more claims than younger age groups. Extras benefit claim rates on the other hand are more evenly spread across the age groups.
• Western Australia has a significantly higher participation rate than most other states and territories (54.7% hospital and 68.2% extras), and the ACT has the highest participation rate in Australia (57.7% hospital and 68.4% extras).
• Health Insurance Business (HIB) premium revenue went up by 5.5% since 31 December 2015 and total fund benefits went up by 5.1%.

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