Hospital cover tiers Basic Bronze Silver Gold specify minimum treatments with coverage and costs rising.
Plus policies offer more than tier minimums but extra inclusions vary significantly between funds.
Basic cover can help high income earners avoid the Medicare Levy Surcharge, starting from around $75 monthly.
In Australia, private hospital insurance is categorised using a 4-tier system. Every single hospital policy will either be classed as basic, bronze, silver or gold. The policies become more comprehensive as they go up through the tiers. You're covered for more private hospital treatments, but you'll also pay more money.
What are the hospital health insurance tiers?
Each of the different health insurance tiers has to cover a standardised set of treatments. Here's a quick summary of each tier.
Gold hospital cover
Gold-tier hospital insurance covers all 38 treatments outlined by the Australian government. This includes treatments like joint replacements, pregnancy and insulin pumps, as well as all services covered by Silver-tier policies.
Average premium: $317.7
a month for a single policy.*
Lowest premium: $207.57
a month for a single policy.*
Silver hospital cover
Silver-tier hospital insurance covers at least 26 treatments outlined by the Australian government. This includes treatments like dental surgery, lung and chest, and podiatric surgery, as well as all services covered by Bronze-tier policies.
Average cost: $168.83
a month for a single policy.*
Lowest premium: $115.04
a month for a single policy.*
Bronze hospital cover
Bronze-tier hospital insurance covers at least 18 treatments outlined by the Australian government. This includes treatments like joint reconstructions, gynaecology, and ear, nose and throat, as well as all services covered by Basic-tier policies.
Average cost: $106.8
a month for a single policy.*
Lowest premium: $91.82
a month for a single policy.*
Basic hospital cover
Basic-tier hospital insurance isn't required to fully cover any treatments outlined by the Australian government, but it does need to have restricted cover for rehabilitation, hospital psychiatric services and palliative care. Generally, Basic cover is primarily used to avoid the Medicare Levy Surcharge and Lifetime Health Cover loading.
Average cost: $88.45
a month for a single policy.*
Lowest premium: $77.36
a month for a single policy.*
*Average prices updated April 2026, in line with Finder's database of health insurance policies. Prices are based on a single individual with less than $101,000 income and living in Sydney with a $750 excess.
Finder survey: Do Australians of different ages feel like their hospital cover offers good value for money?
Response
75+ yrs
65-74 yrs
55-64 yrs
45-54 yrs
35-44 yrs
25-34 yrs
18-24 yrs
Yes
47.73%
33.14%
32.3%
26.63%
40.54%
40.53%
27.06%
No
15.91%
16.28%
19.88%
22.49%
20%
13.16%
20%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
What's included in each hospital cover tier?
A policy must meet some minimum requirements to fall into a specific tier. If it doesn't meet those requirements, it'll be categorised in a lower tier. Those requirements are the same across the entire industry so every insurer is working from the same system.
That means every silver policy will cover the same clinical categories regardless of which insurer you go with. The same goes for basic, bronze and gold. The table below lays out the minimum requirements for each tier. "R" means insurers are allowed to offer cover for this clinical category on a restricted basis or with limited benefits.
Clinical category
Basic
Bronze
Silver
Gold
Rehabilitation
R
R
R
Hospital psychiatric services
R
R
R
Palliative care
R
R
R
Brain and nervous system
Eye (not cataracts)
Ear, nose and throat
Tonsils, adenoids and grommets
Bone, joint and muscle
Joint reconstructions
Kidney and bladder
Male reproductive system
Digestive system
Hernia and appendix
Gastrointestinal endoscopy
Gynaecology
Miscarriage and termination of pregnancy
Chemotherapy, radiotherapy and immunotherapy for cancer
Pain management
Skin
Breast surgery (medically necessary)
Diabetes management (excluding insulin pumps)
Heart and vascular system
Lung and chest
Blood
Back, neck and spine
Plastic and reconstructive surgery (medically necessary)
Dental surgery
Podiatric surgery (provided by a registered podiatric surgeon)
Implantation of hearing devices
Cataracts
Joint replacements
Dialysis for chronic kidney failure
Pregnancy and birth
Assisted reproductive services
Weight loss surgery
Insulin pumps
Pain management with a device
Sleep studies
What is a "plus" policy?
A "plus" policy falls in between categories in that it has exceeded the minimum requirements of a tier but hasn't quite met the requirements of the tier above it. An example of a "silver plus" policy would be one that covers every silver treatment, but also covers pregnancy. The same goes for the other tiers.
Are all "plus" policies the same?
No, most "plus" policies are different from one another. A "plus" tier means that a policy has met the minimum requirements of the core tier, but has offered some extra benefits too. While those minimum requirements will be the same, 2 plus policies could have different extras.
For example, a silver plus policy will have all the same core benefits available in a silver policy, plus cover for sleep studies and insulin pumps. On the other hand, a different silver plus policy will have all the same core benefits, plus cover for cataracts and joint replacements.
Always check the extras in a plus policy. They may be exactly what you're looking for, or something you know you'll never need.
Who can benefit from each tier?
While the tier system wasn't made to match a particular policy to a particular type of person, some groups of people will likely benefit more from one tier than another. We've outlined some of those associations below.
Basic-tier hospital policies don't cover much. In fact, they are only required to offer restricted cover for 3 treatments. However, there are some other benefits to a basic hospital policy, including some tax implications. Here are a few groups of people who may benefit from basic coverage:
30 year-olds: A basic hospital policy is all you need to avoid the LHC loading that will kick in after you turn 31. If you don't have hospital cover after your 31st birthday, the LHC will add 2% per year onto the cost of any future private health insurance policy you choose to take out.
High income earners: If you earn of $90k per year, you'll be subject to the MLS, an additional tax on your income. You can avoid the MLS completely by holding even a basic-tier hospital policy. Sometimes, the cost of the policy can be less than the amount the MLs would cost you.
Young people with basic needs: A lot of "basic plus" policies cover more than just the basics, generally for slightly more than a bare-bones basic policy. If you're in good health and aren't planning on having children in the private system, then a basic plus policy might suit you.
Bronze hospital insurance is more comprehensive than basic cover, but is still quite affordable. Bronze hospital policies cover a range of common treatment types, including joint reconstructions, bone, joint and muscle issues and hernia and appendix treatment. Here are a few groups of people who may benefit from bronze coverage:
Young people: If you're young with relatively simple health needs but don't plan on having children in the private system, then a bronze policy may be the right fit for you. It covers a range of important treatments, but nothing too complex.
Young families: Bronze policies also cover a range of treatments useful for young children and teenagers. These include bone, joint and muscle, tonsils, adenoids and grommets and ear, nose and throat treatments. If you don't plan on having more kids, a bronze policy can be a good level of cover for your entire family.
Women: Provided you don't want to have children in the private system any time soon, bronze cover is great for women. It covers a range of relevant treatments, including cancer, medically necessary breast surgery, gynaecology, as well as pregnancy termination and miscarriage.
Silver coverage is comprehensive, covering more complex treatments than bronze-tier policies. These include lung and chest, back, neck and spine and dental surgery, although dental surgery is often found on "bronze plus" policies. Here are a few groups of people who may benefit from silver coverage:
Child-free families: Silver coverage doesn't include pregnancy coverage, so people who aren't looking to start a family may be well-suited to a silver policy.
Middle-aged Australians: Silver policies cover a range of treatments that are more relevant to Australians aged around 30 to 50 years old. If the silver-tier treatment list matches your needs as you grow older, it might be a good option for you.
People with specific medical needs: If there are silver treatments that match your specific medical needs, such as diabetes or pain management, then a silver policy is a good fit for you.
Gold hospital polices are the most comprehensive policies available in Australia, with coverage for all 38 clinical categories. Here are a few groups of people who may benefit from gold coverage:
People planning on having children: The gold tier is the only one to include mandatory coverage for pregnancy and childbirth in the private system, as well as for assisted reproductive services, like in vitro fertilisation (IVF). If you're looking to have children in the private system, a gold policy might be worth considering. Note that there is a 12-month waiting period for these services.
Older Australians: Gold policies cover a range of treatments such as cataracts and joint replacements, which may be useful for older Australians.
People with complex medical needs: There are a few complex procedures that are only available on gold-tier hospital policies, including weight loss surgery, insulin pumps and sleep studies. If there are gold-tier treatments that you think might be useful for your specific needs, consider a gold policy.
The Australian government introduced health insurance tiers in 2019 to make hospital policies clearer and easier to compare. Before tiers, it was difficult for consumers to understand what their policy covered. The new system ensures every insurer classifies their hospital policies into basic bronze silver or gold with a standard set of minimum inclusions for each tier.
Restricted cover means your health fund will only pay limited benefits for a service, even if you are treated as a private patient in a private or public hospital. This often results in significant out-of-pocket costs for you. For example, Basic policies offer restricted cover for rehabilitation hospital psychiatric services and palliative care.
Yes you can upgrade or downgrade your hospital cover tier at any time. If you upgrade to a higher tier you may need to serve new waiting periods for the additional services now covered. If you downgrade your tier your existing waiting periods will generally carry over for the services that remain covered.
When you upgrade to a higher health insurance tier you generally do not need to re-serve waiting periods for services you were already covered for in your previous tier. However you will need to serve new waiting periods for any additional services or higher benefits introduced by the new tier. For example if you move from Bronze to Silver you will need to serve waiting periods for new Silver-only inclusions like lung and chest back neck and spine.
Yes the health insurance tier system is mandatory and applies to all private health insurance funds in Australia. This means every insurer must classify their hospital policies as basic bronze silver or gold and adhere to the standardised minimum inclusions for each tier. This makes it easier to compare policies across different providers.
A clinical category refers to a specific group of medical treatments or procedures defined by the Australian government. For example "joint replacements" or "pregnancy and birth" are clinical categories. Each health insurance tier must cover a minimum number of these categories either with full or restricted benefits. The table on this page outlines the clinical categories covered by each tier.
A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146).
If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com.
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Nicola Middlemiss is a journalist with nearly a decade of experience in personal finance and insurance. She has contributed to Domain, Yahoo Finance, Money Magazine and Insurance Business Australia, offering in-depth insights into commercial insurance in the Australian market. Nicola holds a Bachelor’s degree in English from the University of Leeds and a Tier 1 General Insurance (General Advice) certification, which complies with ASIC standards.
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