What you need to know
- Hosptial cover helps pay for treatment in a private hospital.
- Private hospital cover can help you avoid long public waiting lists for surgery.
- The cheapest hospital cover can be found from around $18 a week.
Here is a wide range of hospital policies from Finder partners. All prices are based on a $750 excess for a single earning less than $90,000 living in Sydney.
Hospital only health insurance lets you be treated at private or public hospital as a private patient – usually with your choice of doctor. Hospital cover also pays a share of your medical costs when you're admitted to the hospital, such as accommodation and theatre fees. Hospital cover can give you more flexibility as a patient, including access to shorter surgery waiting lists. It comes in 4 tiers: basic, bronze, silver and gold.
Each health insurance tier covers a standardised set of treatments. Here's a quick summary of each tier.
Gold-tier hospital insurance covers all 38 treatments outline by the Australian government. This includes treatments such as joint replacements, pregnancy and insulin pumps, as well as all services covered by silver-tier policies.
Typical cost: From around $160 a month for a single policy.
Silver-tier hospital insurance covers at least 26 treatments outlined by the Australian government. This includes treatments such as dental surgery, lung and chest and podiatric surgery, as well as all services covered by bronze-tier policies.
Typical cost: From around $115 a month for a single policy.
Bronze-tier hospital insurance covers at least 18 treatments outlined by the Australian government. This includes joint reconstructions, ear, nose and throat and gynaecology treatments, as well as all services covered by basic-tier policies.
Typical cost: From around $80 a month for a single policy.
Basic-tier hospital insurance isn't required to fully cover any treatments outlined by the Australian government, but it needs to have restricted cover for rehabilitation, hospital psychiatric services and palliative care. Basic cover is primarily used to avoid the Medicare Levy Surcharge and Lifetime Health Cover loading.
Typical cost: From around $75 a month for a single policy.
There are 2 different government schemes that may cost you money if you do not have hospital cover.
If you earn over $90,000 and don't have hospital cover, you'll be taxed between 1% and 1.5% of your wage due to the MLS. Get a cheap policy and you can avoid the tax.
For a lot of people, the cost of a hospital policy can actually be less than what they'd be taxed if they didn't have it. So even if you don't plan on using private health insurance, it can make financial sense to get a policy anyway.
LHC loading kicks in on 1 July immediately following your 31st birthday. For every year you don't have health insurance from that date, you'll be charged an extra 2% when you eventually do decide to get a policy.
That means if you wait until you're 41, your premiums will be 20% higher than they would have been if you took out a policy before the deadline. Get life insurance before the deadline and you won't be hit with the penalty.
If you receive an in-hospital service as a private patient, Medicare typically covers 75% of the Medicare Benefits Schedule (MBS) fee. Your private health cover will pay the remaining 25%.
However, a doctor or specialist won't always stick to the MBS fee set by the government as a fair fee for a service or treatment. In this case, you'd have to pay an out-of-pocket fee known as "the gap".
Some insurers have deals with healthcare providers that mean all or some of the gap is covered by your health fund.
Hospital cover only helps with items that are on the MBS. If the treatment you want isn't on the MBS, you won't get help from private hospital cover.
The main hospital covers and their waiting periods include:
|Service covered||Typical waiting period|
|Emergency ambulance cover||1 day|
|Accidental injury benefit||1 day|
|Acute mental health treatment||2 months – a one-time waiver may apply|
|Palliative care (for life-limiting illnesses)||2 months|
|Pregnancy and birth||12 months|
|Pre-existing conditions||12 months|
Waiting periods vary depending on your policy. The services listed here do not represent a complete list of services covered under all hospital policies. Depending on your fund and policy, you may find many other cover options to match your needs.
No matter what level of health insurance you get, there are certain things that won't be covered. They include the following:
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