Seniors health insurance

Don’t get left on a public hospital waiting list; get seniors health insurance and skip the queues.

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As you get older and a little wiser, seniors health insurance is peace of mind worth paying for. There aren't policies specifically designed for pensioners but our comparison tool lets you compare health insurance policies side by side. It makes it much easier to see which ones offer the benefits you need, for a price you can afford.

Compare seniors health insurance in Australia

Our comparison tool lets you select what's most important to you. Once you've clicked "Search Policies", you can refine your search by selecting the benefits that are most important to you, such as heart surgery, joint replacement or pre-existing conditions.

Are you switching health funds or getting a policy for the first time?

Before going any further, it’s important to know whether you’re getting cover for the first time or looking to change health funds. Which situation best describes you?

What should you consider before you switch?

If you’ve already got cover and you’re looking to switch funds, you’ll need to ask yourself why you’re switching. Are you trying to save money or have your needs changed?

  • Are you trying to save money? If you’re trying to save money, make sure it’s not to the detriment of your cover. If you’ve had a policy for a while, your benefit levels may be higher than those offered on newer products. Before you switch to any policy, make sure you’ve compared those limits so you don't end up locking yourself into a worse product. What you’re saving yourself in the short term by switching to a cheaper policy could end up costing you more in the long run.
  • Have your needs changed? As you get older, your health insurance needs change. You may have been on a top hospital policy, with pregnancy, which you no longer need. Conversely, you may have had a basic policy, which does not serve your growing needs.

What about waiting periods?

The good news is you won’t have to re-serve any waiting periods for items that your previous policy covered. However, if the policy you’re switching to has higher benefit limits or cover for treatments not covered by your original policy, you will have to serve those waiting periods.

Do seniors need health insurance or is Medicare good enough?

We’re lucky to live in a country where everyone has access to hospital cover with little to no out-of-pocket costs thanks to Medicare. Before taking out a health insurance policy, you should weigh up the pros and cons of having private cover, as you might be better off just sticking with the public system. Some items to consider when weighing up public vs private hospital as a senior include the following:

MedicarePrivate hospital
Premiums
  • Free (other than the levy)
  • Costs $75/month+ extra if you earn over $90,000
  • Starts at $69 per month (and cancels out your Medicare levy surcharge)
Doctor and hospital
  • Medicare chooses
  • You can choose your own hospital and doctor
Accommodation
  • Public hospital and room
  • You may get a private room in a hospital or stay in a private hospital
Waiting times
  • You could wait months for non-urgent treatment
  • You can skip the queue and have more choice over your appointment time
Hospital and medical costs
  • Free
  • Medicare pays 75% and the remaining 25% plus any additional fees are paid by you and your insurer
Specialised services
  • Treatments such as weight loss surgery and IVF can be covered but are hard to access
  • Top policies will cover this type of treatment (often there is a 12-month waiting period)
Emergencies
  • Ambulances are not free unless you live in Queensland or Tasmania

Medicare doesn’t cover everything

While Medicare definitely has its pros in regard to hospital cover, it has more cons than pros when it comes to extras cover. Extras cover is there to cover you for treatments that fall outside of the auspices of hospital cover such as optical, dental and physio.

Public vs private waiting times for procedures

Source: Australian Institute of Health and Welfare (AIHW) Private health insurance use in Australian hospitals 2006–07 to 2016–17

How does the Commonwealth Seniors Health Card work?

Once you turn 65, the Australian government officially considers you a senior and you may be eligible for a Commonwealth Seniors Health Card (CSHC). This is a concession card for older Australians that allows you to access cheaper pharmaceuticals and government-funded medical services. The eligibility requirements and benefits you can claim with this card are outlined below:

Eligibility criteriaBenefits
To qualify for the CSHC, you must meet the following criteria:

  • Be of pension age (65) or older
  • Be an Australian resident currently living in Australia
  • Don't qualify for a Department of Veterans' Affairs pension
  • Don't qualify for any other Department of Human Services payments
  • Meet an income test
CSHC holders can access the following:

  • Bulk-billed visits to your GP (depending on your doctor).
  • Increased Medicare Safety Net benefits.
  • Cheaper prescription medication through the PBS.
  • Other benefits that vary depending on where you live. These may include discounted utilities bills and property rates, cheaper health care costs (including ambulance, dental and eye care) and discounted public transport.

What should you look for in a policy if you’re over 65?

It’s not as easy as finding a health fund and clicking on the seniors health insurance button, because none of them has a policy called “seniors health insurance” or “health insurance for seniors”.

Health insurance falls into two categories: hospital or extras.

Health insurance typeMain featuresWhat else is covered
Hospital cover
  • Access to a private or shared room in a private hospital
  • Choose the doctor who treats you and the hospital you attend
  • Ability to avoid lengthy public hospital waiting lists for procedures
Read more
Extras cover
  • Claim for out-of-hospital services that are largely excluded from Medicare
  • A huge number of benefits available ranging from dentistry to exercise classes
  • Can be combined with hospital cover for dual protection
Read more

A typical seniors health insurance policy with hospital cover may include

Deciding whether you want a hospital, an extras or a combined policy will come down to your personal circumstances. However, hospital has the big-ticket items that are relevant to seniors. These include cover for the following:

  • Accommodation as a private patient in a private or public hospital
  • Operating theatre fees
  • Intensive care costs
  • In-patient X-rays, MRIs, CAT scans and pathology
  • Eye surgery
  • An extensive assortment of other surgeries and procedures (such as hip and knee replacements, back surgery, colonoscopies, dental surgery, hernia repair, renal dialysis and more)
  • Cardiothoracic surgery (heart, lungs and chest)
  • Cancer and stroke treatment
  • In-patient pharmaceuticals
  • Rehabilitation services
  • Prostheses
  • Organ transplant
  • In-patient psychiatric treatment
  • Gap cover for when you visit your GP
  • Palliative care

Notice anything missing from this list that would normally be covered by a top hospital policy? Yep, you guessed it: pregnancy. When an insurer or comparison site refers to a seniors policy, what they’re really saying is: “Here is our top hospital policy minus cover for pregnancy, obstetrics, IVF, etc".

Different tiers of hospital cover

Since 2019, hospital insurance has been broken into four tiers: Basic, Bronze, Silver and Gold. As a general rule, if you’re a senior, you’re going to want to look for a top hospital policy as it provides you with the greatest access to the widest range of procedures and treatments.

A seniors hospital insurance policy that has extras may include the following

Some benefits you might find include:

  • Ambulance. Health insurance will cover your emergency ambulance bills.
  • Optical. Includes glasses and contact lenses. Extras will pay a set amount towards your glasses, normally $150 or $200. Medicare will pay for your eye test.
  • Dental. Including check-up, clean and scale, crowns and bridges, root canal therapy, dentures, implants, teeth extraction etc. Extras will pay a percentage of your treatment costs, from 50% up to 100%.
  • Chiropractic. Extras will pay a percentage of your treatment costs, from 50% up to 75%. Your policy will come with a limit which is the total amount claimable.
  • Physiotherapy. Extras will pay a percentage of your treatment costs, from 50% up to 75%. Your policy will come with a limit which is the total amount claimable.
  • Hearing aids. Policies will typically pay a set cost, rather than cashback rebates. There can be a waiting period from 12–36 months.
  • Non-Pharmaceutical Benefits Scheme (PBS) pharmaceuticals. Cover for non-PBS medications is included on some high-level extras cover. There will be a limit on the amount you can claim per item, for example $50.
  • Blood pressure monitors. The amount you receive is either a cost limit or a percentage of total cost. Monitors can be listed in either a hospital or extras policy.
  • Occupational therapy. Because occupational therapy is such a broad category, certain components are covered by Medicare while others are only covered by private health funds, but you will need a referral from a doctor.
  • Podiatry. Treatments include arthritis complications affecting the legs and feet, skin and nail problems, corns, calluses, ingrown toenails, bunions and orthotics. You'll get a yearly limit on treatment.
  • Psychology. Extras will pay a percentage of your sessions. Your policy will come with a limit which is the total amount claimable. Medicare may also be able to help.
  • Preventative tests. Such as bowel screening and bone density testing.

What does the best seniors policy look like?

While you won’t find a “seniors” policy on the market, there are a number of key features you should look for when buying health insurance in later life. First things first, you’re generally going to want top cover. Next, you’re going to want to look for policies that provide a high level of cover for relevant treatments such as heart surgery, major eye surgery and joint replacement.

If you’re looking to have cover for out-of-hospital treatments, you’re going to want to look for an extras policy that provides a good level of cover for dental (both general and major), along with optical, physio, health aids (such as hearing aids and blood glucose monitors) and ambulance.

How much does it cost for seniors?

Health insurance is community rated, which means no matter whether you’re 18 or 88, you’re going to pay the same amount for the same level of cover. How much your health insurance will cost will come down to the following:

  • Whether you choose extras only, hospital only or a combination cover
  • The level of cover – top hospital costs more than basic hospital
  • The brand
  • Where you live
  • How much you’ll be hit by the LHC if you’re getting cover for the first time

On average, a single hospital + extras policy can cost from $67.15 per month to $277.41 per month for a female living in NSW.

Are seniors eligible for a health insurance rebate?

Yes and if you’re over the age of 65, your private health insurance rebate increases, provided you're not classified as a high-income earner ($140,001 or more for singles and $280,001 and over for families, single parents and couples).

You can claim the rebate either as a premium reduction through your health fund or as a tax offset when you lodge your tax return with the Australian Taxation Office (ATO).

How much is the Lifetime Health Cover (LHC) loading going to cost you?

If you’re getting health insurance for the first time as a senior, you’re going to be impacted by the Lifetime Health Cover (LHC), which is a loading of 2% on top of your premiums for every year over the age of 31 you didn’t have private health insurance. This can make buying health insurance as an adult prohibitively expensive for seniors.

How much more will health insurance cost if the LHC applies to you?

Let’s assume you’re 70 years old and have never held cover. The maximum loading of 70% will apply to your policy for the first 10 years you hold it. If the normal annual premium for your seniors health insurance policy was $1,800, you’d need to pay an extra $1,260 per year, not counting any rebates you might be eligible for. While an additional $100 or so each month is nothing to sneeze at, getting insured can still be worth it if you make the most of your policy.

When don’t you have to pay the LHC?

There are a few exceptions where seniors won’t have to pay the LHC, the most relevant exemption is whether you were born on or before 1 July 1934. If you were, then you don’t need to worry about the LHC.


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24 Responses

    Default Gravatar
    HusneMarch 28, 2019

    Wanted private health insurance with Basic Hospital and some extras like optical, dental and joint replacements etc.

      Avatarfinder Customer Care
      JeniMarch 30, 2019Staff

      Hi Husne,

      Thank you for getting in touch with Finder.

      Upon checking, you’re currently at the right page. Kindly choose the answer that suits you and please enter your postcode then click on the orange Search policy button to start comparing your options. Once you have decided which to go with, please click on the green go to site button of your chosen quote to be redirected to the provider’s official page. If you need further assistance on getting private health insurance, you may call our team on 1300 594 882 from Monday to Thursday, 8am – 7:30pm and Friday, 8:30am – 5pm.

      I hope this helps.

      Thank you and have a wonderful day!

      Cheers,
      Jeni

    Default Gravatar
    Kathleen,February 25, 2019

    Can you clarify the difference between ‘earn’ (gross income?) and taxable income re :
    Premiums
    Free (other than the levy)
    Costs $75/month+ extra if you earn over $90,000

      Default Gravatar
      NikkiFebruary 26, 2019

      Hi Kathleen,

      Thanks for getting in touch! Your premiums will be free if your gross (or taxable income) is over $90,000. Hope this clarifies!

      Best,
      Nikki

    Avatarfinder Customer Care
    MayMarch 28, 2018Staff

    Hi Bill,

    Thanks for your inquiry.

    Yes, cardiovascular disease is considered to be a pre-existing condition so the waiting period applied is 12 months. If you like to compare the insurance prices and cover, please use our panel above and click on the orange ‘Search policies’ button. Please discuss directly with the insurer about your options and waiting period once you’ve chosen a brand.

    Cheers,
    May

    Default Gravatar
    terryMarch 19, 2018

    My mother in law is 98 years old, she has had private health insurance for over 20 years i believe, maybe much more. Last year she fell and broke a hip, was taken by ambulance to a public hospital. We requested a private room but were told there were none available. We could have moved her to a private hospital, but were advised with age pain etc it would not be advisable to do so. Is there a cover for these types of situations where there seems to be very little if any successful claims that can be made, other than palliative care at sometime in the future?

      Default Gravatar
      LiezlMarch 22, 2018

      Hi Terry,

      Thanks for reaching out to us at Finder!

      Depending on which policy your mother-in-law has, she might benefit from the wide range of general treatments included in hospital and extras covers such as physiotherapy, osteopathy, chiropractic services or other natural or alternative therapy.

      Kindly note that the extent to which particular services are covered will depend largely on the insurer and policy. If you’re unsure of the inclusion and limits, it’s a good idea to contact her insurer directly.

      I hope this information helps.

      Best regards,
      Liezl

    Default Gravatar
    RosemaryMarch 27, 2017

    am aged 86 and am insured with Australian Unity for hospital cover
    Is this a good choice or should I be looking at another health fund.
    I keep in good health

      Avatarfinder Customer Care
      ZubairMarch 28, 2017Staff

      Hi Rosemary,

      Thank you for your question.

      finder.com.au is a comparison and information service and we are not permitted to provide our users with personalized financial advice or product recommendations.

      It would be a good idea to first check the current benefits that you have with your existing insurer. From there, you can then check the list of insurance brands featured on our website and make a quick comparison. From there, you should get a better idea of whether you should make the switch or not.

      Cheers,
      Zubair

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