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What does private health insurance cover that Medicare doesn't?
Private health insurance gives you access to similar hospital treatments to what's covered by Medicare – but you get other benefits like your choice of doctor, private rooms, and wait times are significantly shorter. The amount you pay for health insurance depends on the tier of hospital cover you have.
If you're treated as a private patient in a hospital (either private or public), Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fee for services that are listed on the MBS.
Your health insurance typically covers the other 25%, plus accommodation costs and theatre fees, depending on your level of cover and provided you have served relevant waiting periods. You will often be out of pocket for costs like the excess, and the gap between the MBS fee and the total cost of your procedure.
A public hospital will allocate a doctor for you. You don't get to choose.
You can choose which doctor you see.
Private room
You'll likely end up in a shared room in a public hospital.
Insurance gives you access to a private room if there's one available.
Waiting lists
Waiting lists for elective treatments can range from a few weeks to a few years.
Private insurance usually involves a shorter wait. For some procedures, you may even be able to pick your date.
Treatment types
Medicare doesn't cover most dental, hearing aids or other out-of-hospital treatments.
Extras can give you cashback on out-of-hospital services such as optical, dental, psychology and hearing aids.
Ambulance costs
In most cases, Medicare won't pay for your ambulance except in Queensland and Tasmania.
Most health funds include cover for an emergency ambulance, even on Basic policies.
Pros and cons of health insurance
Pros
Peace of mind for unexpected health issues or accidents
Reduced wait times and choice of doctor
Save on tax by avoiding the medicare levy surcharge (MLS)
Cons
New customers wait up to 12 months for some procedures
You'll typically still pay towards your hospital treatment
May not be worthwhile if you're under 30 or earn less than 101k
Our expert says
"Private hospital insurance covers all the same treatments as Medicare. The difference lies in the standard of care. It's kind of like choosing between a dependable budget car or something flashier. Both will get you from A to B but one is a faster and nicer place to be."
"I've always been a big proponent of private health cover – and geez I was glad I had it when I was diagnosed with breast cancer in 2021. With any unexpected serious illness, the type of treatment – and crucially the speed of it – could make all the difference."
Nicole Pedersen-McKinnon
Freelance finance journalist
Our expert says
"Health insurance is heavily regulated in Australia, which makes it easier to compare health insurance policies like-for-like. That said, funds still have different products and prices, so it's still important to make sure you're getting the right cover for you and your family."
Hospital Cover: Hospital cover helps pay for a range of hospital treatments in a private hospital. This can include joint reconstructions, hernia operations and childbirth.
Extras Cover: Extras cover helps towards out-of-hospital healthcare. This includes trips to the dentist, eye care by an optometrist, physiotherapists, natural therapies and more. As of March 2025, 55.1% of Australians have extras cover.
Health insurance rebate: The private health insurance rebate makes health insurance cheaper for most people. Your exact rebate is determined by your age and income.
Private health and tax: Whether you're a high earner or turning 30, there are a few things you need to know about private health insurance at tax time.
Switching health funds: Switching health funds is quick and easy. You can transfer your waiting periods, while potentially saving money with new sign-up deals.
I've saved $800 by switching
"Changing health insurance had been on my to-do list for ages, but I found it very confusing. Eventually I compared and took advantage of sign-up offers –by switching health insurers, I've saved around $800 so far."
We ask hundreds of Australians what they're paying for health insurance every month. Here's what their bill looked like in November 2025.
Extras only: $51
Basic: $106
Bronze: $137
Silver: $176
Gold: $226
Price based on 500+ responses for single hospital or extras insurance.
Frequently asked questions about health insurance
Private health insurance can help you cover the cost of medical care in a private hospital (hospital cover) and help pay for out-of-hospital medical costs that aren't covered under Medicare (extras cover). Most private health insurance policies also cover the cost of emergency ambulance transport, which isn't covered by Medicare in most states.
When you take out a private health policy, you have the option of going to a public or private hospital. If you go to a private hospital, or if you're treated as a private patient in a public hospital, your health fund will help cover the cost of care. The main advantages of using the private system are that you can choose your own doctor, get access to improved facilities like a private room, and have access to shorter waiting lists for important surgery.
Hospital cover is available in the following tiers; basic, bronze, silver and gold. Each covers a different list of treatments with gold being the most comprehensive hospital policy avaialable.
In the public system, prices are set according to the Medicare Benefits Schedule (MBS) and Medicare pays 100% of the cost. You won't be left out of pocket, but you won't get your choice of hospital, doctor or appointment time either. In the private system, prices are usually higher than those listed in the Medicare Benefits Schedule and Medicare will only pay 75% of what it would have, had you gone public. Your private health insurance covers at least the remaining 25%. If your private doctor charges more than a doctor in the public system, which is usually the case, you'll have to cover the extra expense. Remember, with hospital insurance, you'll also have to serve waiting periods. For example, if you have a pre-existing medical condition, you'll have to hold your policy for at least a year before your cover would chip in towards the cost of treatment.
Extras insurance helps towards non-hospital-related healthcare, such as dental work, new glasses and physiotherapy appointments. Usually, an extras policy will pay a percentage of your bill – this could be anywhere from 50% to 90%. In other cases, they will cover the whole bill, up to a certain amount. Extras policies also have waiting periods. For example, you often need to hold a policy for a year before you can claim for orthodontics.
Waiting periods apply to both extras and hospital policies - you'll need to serve these before claiming a benefit. Some extras policies let you skip some waiting periods.
Extras benefit limits place a cap on the amount you can claim. They typically reset every 12 months. A higher limit may mean a more expensive policy, but not always.
Health insurance is community rated, which means you don't have to pay more for pre-existing conditions and the price you pay isn't impacted by your age.
However, here are a few things that can impact your quote:
Your excess or co-payment. When you take out insurance, you can agree to take some responsibility for the health cover costs in return for lower premiums – this is your excess. You only pay it if you go to hospital. The higher your excess, the lower your premiums will be.
Your location. If you live in a regional area of Australia, your insurance might cost you more due to poorer access to health facilities as well as potential travel and accommodation expenses.
Which fund you choose. Some funds and policies are better value than others, charging less for similar cover. If you take the time to compare health insurance, you can find the cheapest health cover for your needs.
People from countries that Australia has a Reciprocal Health Care Agreement (RHCA) with can access some treatment from Medicare. If you don't have an RHCA, you'll need Overseas Visitor Health Cover. As of 2021, Australia has an RHCA with Belgium, Finland, Italy, Malta, the Netherlands, Norway, New Zealand, Ireland, Slovenia, Sweden and the UK. Traveling to Australia without coverage could result in huge medical bills if you are sick or injured.
Thanks to the most recent PHI reforms, which have introduced Basic, Bronze, Silver and Gold tier policies, finding cover for a specific service is easier than ever. Every tier is required to provide cover for specific services so you can check out what is included in each and select the one that covers the treatment you require. Some services often performed out of hospital are only covered when performed in a hospital, like the cost of MRI scans. Our guides for specific treatments have more details:
If you cancel your health insurance, you won't be entitled to the services you would have otherwise had access to. This means you would have to rely on the medical services provided by Medicare. Note that cancelling your health insurance may also have tax implications, depending on your circumstances.
When you switch health funds you generally won't have to re-serve waiting periods if you had similar or equivalent cover with another provider. However, if you're upgrading or didn't previously have cover for a service that your new policy includes, you will probably have to serve a waiting period.
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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Could you kindly break down the cost for me per person.
For myself I need a very basic Health insurance plan 33 year old male.
For my Wife something that will cover pregnancy, scans etc should that be our luck to fall pregnant.
And then something for a minor , 3 year old that would cover xrays scans, doctor visits etc.
Finder
SarahJuly 2, 2024Finder
Hi Julian,
The premium is calculated based on all of you as a family. Usually, it doesn’t cost any extra to add a child to a policy. Things like GP visits are generally covered by Medicare and most doctors bulk bill for under 16s, meaning these visits have no cost.
As for you and your wife, as you have different needs, you could look at taking our two seperate policies: yours basic, hers more fully featured to cover pregnancy etc. However it is often cheaper to get a couples policy.
Note that extra are optional, you may want to go without extras cover to reduce the cost of your premiums.
Hope this helps!
HtaMay 21, 2024
Hi, could I please ask which insurance covers HPV treatments, including wart treatment, pap smear and other HPV related treatments if needed?
Finder
SarahMay 24, 2024Finder
Hi Hta,
All of these treatments would be managed through a GP, which is linked to Medicare. You would need to go to your GP or a sexual health clinic for treatment, and you would be eligible for Medicare rebates if you’re entitled to Medicare Benefits.
Health insurance could provide some cover if you ever need day surgery related to HPV, but you would still likely be out of pocket (hospital excess, gap payments and doctor’s fees) even with insurance. So if that was your primary reason for taking out health insurance, the financial benefit might not be enough incentive, considering the high cost of premiums.
Of course this is a personal decision, and you have to consider things like your income and the medicare surcharge (more info here if you’re not aware).
Finder
TimMarch 6, 2024Finder
Hi Jason, thanks for your question.
Health insurance premiums will be going up by 3.03% on average in 2024. The government has to approve these increases each year – this year took a little longer for that to happen. The price rise should happen on April 1 2024.
Be sure to check the news article I linked – it’s got the breakdown of how much each health fund is increasing premiums. 3.03% is just an average across all funds – your fund will probably be slight more or less than that.
Have a good one!
Tim
JohnSeptember 4, 2021
Hi,
Are there any such plans that cover foreign hospital treatments for people seeking treatment for cancer? I have pre-existing medical conditions and looking for health cover for overseas treatment. Please advice.
Finder
JamesSeptember 12, 2021Finder
Hi John,
Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance that specifically covers overseas medical expenses may help.
Make sure you read each policy’s Product Disclosure Statement (PDS) with care so that you know what cover is available.
Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.
Regards,
James
Finder
JamesSeptember 10, 2021Finder
Hi John,
Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance (https://www.finder.com.au/travel-insurance) that specifically covers overseas medical expenses may help. Make sure you read each policy’s Product Disclosure Statement (PDS) with care, so that you know what cover is available.
Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.
Regards,
James
RobertAugust 28, 2021
I would like a real time answer to my request for cover .
Finder
JamesAugust 30, 2021Finder
Hi Robert,
Can which cover you are referring to, please? I’ll wait for your response. If possible, please return to our website and click on the chat button found on the lower right corner of our to chat with us in real-time.
Moreover, please feel free as well to get in touch with the specific insurer you have chosen. They should be able to provide you with more details of the cover you’re interested in.
Get affordable cover for ambulance transport if you are not already covered under Medicare. Compare quotes from Australian funds to decide which level of protection is best for you.
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Could you kindly break down the cost for me per person.
For myself I need a very basic Health insurance plan 33 year old male.
For my Wife something that will cover pregnancy, scans etc should that be our luck to fall pregnant.
And then something for a minor , 3 year old that would cover xrays scans, doctor visits etc.
Hi Julian,
The premium is calculated based on all of you as a family. Usually, it doesn’t cost any extra to add a child to a policy. Things like GP visits are generally covered by Medicare and most doctors bulk bill for under 16s, meaning these visits have no cost.
As for you and your wife, as you have different needs, you could look at taking our two seperate policies: yours basic, hers more fully featured to cover pregnancy etc. However it is often cheaper to get a couples policy.
Note that extra are optional, you may want to go without extras cover to reduce the cost of your premiums.
Hope this helps!
Hi, could I please ask which insurance covers HPV treatments, including wart treatment, pap smear and other HPV related treatments if needed?
Hi Hta,
All of these treatments would be managed through a GP, which is linked to Medicare. You would need to go to your GP or a sexual health clinic for treatment, and you would be eligible for Medicare rebates if you’re entitled to Medicare Benefits.
Health insurance could provide some cover if you ever need day surgery related to HPV, but you would still likely be out of pocket (hospital excess, gap payments and doctor’s fees) even with insurance. So if that was your primary reason for taking out health insurance, the financial benefit might not be enough incentive, considering the high cost of premiums.
Of course this is a personal decision, and you have to consider things like your income and the medicare surcharge (more info here if you’re not aware).
Hi Jason, thanks for your question.
Health insurance premiums will be going up by 3.03% on average in 2024. The government has to approve these increases each year – this year took a little longer for that to happen. The price rise should happen on April 1 2024.
Be sure to check the news article I linked – it’s got the breakdown of how much each health fund is increasing premiums. 3.03% is just an average across all funds – your fund will probably be slight more or less than that.
Have a good one!
Tim
Hi,
Are there any such plans that cover foreign hospital treatments for people seeking treatment for cancer? I have pre-existing medical conditions and looking for health cover for overseas treatment. Please advice.
Hi John,
Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance that specifically covers overseas medical expenses may help.
Make sure you read each policy’s Product Disclosure Statement (PDS) with care so that you know what cover is available.
Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.
Regards,
James
Hi John,
Unfortunately, most domestic health insurance policies don’t offer cover for treatment needed outside of Australia. However, travel insurance (https://www.finder.com.au/travel-insurance) that specifically covers overseas medical expenses may help. Make sure you read each policy’s Product Disclosure Statement (PDS) with care, so that you know what cover is available.
Also, check to see if there are any reciprocal healthcare agreements in place between Australia and each country you’re intending to visit.
Regards,
James
I would like a real time answer to my request for cover .
Hi Robert,
Can which cover you are referring to, please? I’ll wait for your response. If possible, please return to our website and click on the chat button found on the lower right corner of our to chat with us in real-time.
Moreover, please feel free as well to get in touch with the specific insurer you have chosen. They should be able to provide you with more details of the cover you’re interested in.
Regards,
James