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Hospital cover in Australia

Private hospital cover helps pay for treatment in private hospitals, offering more flexibility and shorter surgery waiting lists. Cheap hospital cover starts from around $19 a week.

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.

Compare hospital cover from multiple funds

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 $93,000 living in Sydney.

Name Product Treatments Price Apply
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
$77.92
per month
starter basic
Basic$750 excess
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
$82.71
per month
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
$82.78
per month
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +8 other treatments covered
$84.51
per month
starter basic
Basic$500 excess
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
$85.76
per month
essentials basic plus
Basic Plus$750 excess
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +5 other treatments covered
$87.04
per month
starter bronze
Bronze$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$88.70
per month
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +8 other treatments covered
$89.53
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$91.11
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +16 other treatments covered
$91.83
per month
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What is hospital only health insurance?

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.

Heart

Hospital only

Hospital cover helps pay for treatment in a private hospital, and may help you save money at tax time.
Ambulance

Extras only

Extras cover will chip in for medical costs outside hospital, such as optical, dental, physio and chiro.
Combined

Combined

Combined policies have both hospital and extras coverage, offering the most comprehensive coverage available.

Pros and cons of hospital health insurance

Pros

  • With 4 tiers to choose from and dozens of health funds, it's possible find cover that's tailored to your individual needs.
  • With a hospital plan, you can swerve long elective surgery waiting lists at public hospitals.
  • Basic hospital policies can cost less than what you'd be hit with if the Medicare levy surcharge, a government levy, applies to you. Getting in early can also help you make premium savings due to the Lifetime Health Cover loading.

Cons

  • Top tier plans offer wide-ranging cover, but they can add more than $200 to your insurance bills each month. More basic plans come with limited perks.
  • Out-of-pocket costs still apply when the cost of your health service is more than the MBS item fee.
  • You can't usually claim for pre-existing medical conditions for the first 12 months of your policy. A pre-existing condition is any ailment you've suffered from within the 6-month period before your insurance starts.

What are the hospital health insurance tiers?

Each health insurance tier covers a standardised set of treatments. Here's a quick summary of each tier.

Gold health cover

Gold hospital cover

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 health cover

Silver hospital cover

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 health cover

Bronze hospital cover

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 health cover

Basic hospital cover

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.

Hospital health insurance and tax (the MLS and LHC)

There are 2 different government schemes that may cost you money if you do not have hospital cover.

Rich person

Medicare Levy Surcharge

If you earn over $93,000 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.

30 year old

Lifetime Health Cover loading

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.

How does hospital cover work?

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.

Waiting periods for hospital cover

The main hospital covers and their waiting periods include:

Service coveredTypical waiting period

Emergency ambulance cover1 day
Accidental injury benefit1 day
Acute mental health treatment2 months – a one-time waiver may apply
Rehabilitation2 months
Palliative care (for life-limiting illnesses)2 months
Pregnancy and birth12 months
Pre-existing conditions12 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.

What isn't covered by private hospital insurance?

No matter what level of health insurance you get, there are certain things that won't be covered. They include the following:

  • Pre-existing medical conditions within the first 12 months
  • Out of pocket costs (that's when your doctor charges more than the MBS item fee)
  • Fees for any specialists you see outside of hospital
  • Any services you receive outside of hospital
  • Any medical treatment that does not have an MBS item number
  • Hospital stays that are longer than 35 days
  • Cosmetic surgery for non-medical reasons

Frequently asked questions

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