Seniors health insurance

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What does seniors health insurance cover?

Hospital

Hospital cover gives access to treatment in a private hospital as a private patient. You can choose your doctor, get your own hospital room (where one is available) and have more flexibility over scheduling procedures. You can choose from 4 levels of hospital cover in Australia: basic, bronze, silver and gold. All must cover specific treatments.

• Typical hospital services covered

  • Accommodation as a private patient in a private or public hospital
  • Operating theatre fees
  • Intensive care costs
  • The cost of MRIs, X-rays, CAT scans and pathology for in-patients
  • Eye surgery
  • An extensive range 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
  • Emergency ambulance services
  • Palliative care

Extras

Extras insurance helps pay for out-of-hospital treatments which Medicare doesn't usually cover. This can include dental, physiotherapy, chiro and optical. Many policies also cover ambulance fees which the public system does not pay for, unless you live in Queensland or Tasmania.

• Typical extras services covered

  • Ambulance (usually covered by hospital as well)
  • Optical
  • Dental
  • Chiropractic
  • Physiotherapy
  • Hearing aids

  • Non-Pharmaceutical Benefits Scheme (PBS) pharmaceuticals
  • Blood pressure monitors
  • Occupational therapy
  • Podiatry
  • Psychology
  • Preventative tests (such as bowel screening and bone density testing

What's the best health insurance for seniors?

Our list of top health funds can make finding the best seniors health insurance policy a little easier. Here are some of our top health insurance picks based on best insurer, most popular and waiting periods. For a more detailed breakdown, you can head to our best health insurance page.

Top Pick for

Best insurer

Bupa

Top Pick for

Most popular

Medibank

Top Pick for

Waiting periods

ahm lifestyle Extras

• Why we chose these funds

  Bupa

  We chose Bupa because it won Finder's Best Health Insurance Provider Award in 2020 and Finder's Best Gold Award in 2020.

  Medibank

  We chose Medibank because it was the most visited Finder partner on our site between March 2020 and March 2021 and had the highest percentage of members of all Aussie funds, according to the Commonwealth Ombudsman's State of the Health Funds Report.

  ahm lifestyle extras

  We chose ahm lifestyle extras because it lets you claim heaps of benefits from day 1, general dental, optical and physiotherapy are all included and we couldn't find another policy this generous for common treatments.

What seniors health insurance policy do you need?

Thanks to 2019 government reforms, all health cover in Australia must cover specific treatments. There's usually no specific seniors health insurance policy offered by insurers, but there are certain levels of cover that are more appropriate for seniors than others.



Gold

Gold-tier hospital insurance typically costs around $160 per month for a single policy and covers all 38 treatments outlined by the Australian government. This includes joint replacements, insulin pumps and cataracts so are good for seniors with some health issues or those who want total peace of mind.



Silver

Silver-tier hospital insurance covers a minimum of 26 treatments but does not include joint replacements, insulin pumps and cataracts cover, so costs a little less than gold – often around $115 per month. You'll still be covered for services such as implantation of hearing devices, podiatric surgery and heart and vascular though.



Bronze

This is a more basic policy that may be more suited to seniors who want to take advantage of shorter waiting times and some basic cover such as joint reconstructions, kidney and bladder and chemotherapy. Policies start from around $80 per month.



Basic

Most seniors probably aren't suited to basic cover as it is only required to provide restricted cover for rehabilitation, hospital psychiatric services and palliative care. It's good if you simply want to avoid an expensive ambulance bill or still work – you don't need to pay the Medicare levy surcharge (MLS) and lifetime health cover (LHC) loading if you get a policy. Policies cost around $75 per month.


Plus policies
Since all health funds are required to offer the same treatments for each tier, keep an eye out for silver plus, bronze plus and basic plus policies. These cover at least one service more than the standard tiered policies and are often tailored to seniors who want top cover that doesn't also include pregnancy services.

• Show table of all treatments

  Every senior has different health concerns, though there are a few common illnesses among those aged 65 and over. For instance, coronary heart disease is the number 1 leading cause of death for men aged 65 and over – for women, it's lung cancer. Find out which level of health insurance covers the treatment you need below:

  "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

Do seniors need health insurance?

Public vs private waiting times for procedures

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FAQs about seniors health insurance

• Will I have to serve waiting periods?

  Yes. You will usually have to serve a 2-month waiting period for most treatments or 12 months for pre-existing conditions. The good news is you won't have to re-serve any waiting periods for items if you held a previous policy that also covered that treatment. 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.

• Why should I consider seniors health insurance?

  Private health insurance can provide access to more services and treatments, including private hospital rooms, elective surgeries and some treatments not covered by Medicare. It also provides more choices of doctors and hospitals and can help avoid waiting lists for non-urgent procedures.

  In general, it is recommended that seniors evaluate their needs, budget and existing coverage through Medicare before deciding to purchase private health insurance and compare various plans and policies offered by different insurance providers before making a final decision.

• 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 criteria

  Benefits

  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.

• How much does health insurance cost for seniors?

  Health insurance is community rated, which means whether you're 18 or 88, you're going to pay the same amount for the same level of cover. 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.

• What if I have a pre-existing condition?

  All health insurers are required to cover pre-existing conditions. However, you'll generally need to serve a 12-month waiting period starting when you take out a policy before you can submit a claim.

• What isn't covered by seniors health insurance?

  As with any health insurance policy, there are a number of common exclusions. Typically, this includes treatments such as laser eye surgery and specialist appointments outside of the hospital. Another common exclusion is non-medically necessary surgery. Examples include surgical face-lifts or tattoo removal.

• 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 ($144,001 or more for singles and $288,001 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).

  Singles	≤$93,000	$93,001–$108,000	$108,001–$144,000	≥$144,001
  Families	≤$186,000	$186,001–$216,000	$216,001–$288,000	≥$288,001
  	Base tier	Tier 1	Tier 2	Tier 3
  Up to 65	24.608%	16.405%	8.202%	0%
  Age 65–69	28.710%	20.507%	12.303%	0%
  Age 70+	32.812%	24.608%	16.405%	0%

  Thresholds above are based on new tiers brought in by the government from 1 July 2023. Source: Private Healthcare Australia.

• Do seniors need to pay the LHC loading?

  In most cases, yes. There are some exceptions where seniors won't have to pay the LHC – for example, if you were born on or before 1 July 1934.

• How much is the LHC loading going to cost me?

  If you've never had health insurance before, you will likely have a LHC of 70% applied to your premium, unless you were born before 1 July 1934. This is the maximum LHC loading that can be applied. You'll also need to hold cover for 10 continuous years before the fee is removed. For example, 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.

This article was reviewed on 30 June by James Martin. James is the insurance editor at Finder and he's written on a range of insurance and finance topics for over 7 years.