Seniors health insurance

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. Which you choose is very much dependant on your specific health needs - bit more on that below.

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. What level of extras plans you pick is a personal choice. Extras area a lot like one of the old coupon books you bought from your kid's school - so long as you use the benefits, they are good value for money.

What kind of hospital policy is right for seniors?

Hospital policies come in four main flavours: basic, bronze, silver and gold. The specific treatments each tier of policy needs to cover is set by law, so it makes it a bit easier to compare apples to apples.

For most seniors, a silver of gold policy is probably going to be the best place to start comparing. This is just because we have more complex health needs as we get older, many of which are only covered by the more comprehensive policies. That's not to say you will need a silver or gold policy though - you gotta make that call for yourself.

• Show full table of treatments

  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

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Step 1/3 - About your cover

What kind of health insurance do you need?

Hospital

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Who needs cover?

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Which state do you live in?

QLD

NSW

ACT

VIC

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SA

WA

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What hospital cover do you need?

Cheap cover that lets you avoid the medicare tax

Standard cover (a varied mix of hospital treatments)

Comprehensive cover for most treatments

Pregnancy and childbirth

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What extras cover do you need?

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Preventative & general dental

Major dental & implants

Optical

Physiotherapy

Podiatry

Non-PBS pharmaceuticals

Chiropractic

Emergency ambulance

Remedial massage

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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.