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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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How to combine two existing top (premium) health cover policies from adult single to a couples when both are with separate insurers? Wish to compare which of these two insurers would best cover the two of us as a couple whilst neither one loses benefits or has a waiting period. We both have been with our respective health providers for over ten years continuously.
Finder
JeniJune 21, 2018Finder
Hi Nikko,
Thank you for getting in touch.
If you’re currently on separate policies, the first step would be to see if you can save any cash by combining your policies – we’ve added a bit of info on that here https://www.finder.com.au/health-insurance/couples – it doesn’t always work out cheaper and it’s probably worth a closer look.
With your waiting periods, they are different for hospital cover and general treatment (extras) cover. All of your hospital waiting periods that you’ve already served travel with you to the new policy – so if you do decide to combine your policies, you should be covered.
Keep in mind, you’ll still have to serve waiting periods for any new benefits that you didn’t have before (such as pregnancy cover and also extras).
If you already have a preferred health fund from your two options – it may be worth giving them a call as they can move you onto one package.
I hope this helps. Please feel free to reach out to us if you have any other enquiries.
Thank you and have a wonderful day!
Cheers,
Jeni
SusanMay 25, 2018
As a couple over 50 we would like private hospital cover with general dental, optical, physio and chiro.. what is the best option?
NikkiMay 25, 2018
Hi Susan,
Thanks for getting in touch with Finder.
While we don’t provide a specific product recommendation, you can enter the necessary details on our health insurance search form then click the “Search Policies” button. This should allow you to compare quotes from different insurers.
When you are ready, you may then click on the “Go to site” button and you will be redirected to the insurer’s website where you can proceed with the application or get in touch with their representatives for further inquiries you may have.
Hope this was helpful.
Cheers,
Nikki
KevinMay 24, 2018
Hi there. My wife is already pregnant and the pregnancy insurance waiting period is 12 months!! So how does PHI work to cover her when she is giving birth? What is the solution around this?
Finder
JhezelynMay 25, 2018Finder
Hello Kevin,
Thank you for your comment.
To be qualified for the private health insurance you’re advised to take out the policy in advance before attempting to conceive. Most Australian private health funds have a 12 month waiting period for obstetric services.
I am afraid that no PHI will consider your wife’s condition as she is already pregnant, however, you can still contact the insurer directly and see what options they can offer you. I hope this helps.
Regards,
Jhezelyn
JoApril 19, 2018
How does Defence Health compare to other health funds in terms of value for money – cost of premium to rebate received. The mo they premium certainly appears a lot higher than other funds but do the rebates reflect that?
Finder
JeniApril 22, 2018Finder
Hi Jo,
Thank you for getting in touch with Finder.
According to ou review, Defence Health offers a range of health insurance options to more than 300,000 Australians with Defence connections. With hospital and extras cover to suit everyone from the young and healthy to those who need comprehensive protection, it provides affordable cover and peace of mind.
I hope this helps.
Have a great day!
Cheers,
Jeni
MarcoMarch 19, 2018
Hi, are quoted premiums before or after any Govt rebates?
NikkiMarch 26, 2018
Hi Marco!
Thanks for your question and for visiting finder.
Quoted premiums are before government rebates. Rebate rates are subject to change based on the cost of living and the average health insurance premium amount. It would be helpful to check with your health insurance provider on their ongoing rates as well.
If you’re looking for private health insurance in Victoria, compare the most popular health funds in your state and how much it costs to take out cover.
Finder makes money from featured partners, but editorial opinions are our own.
Finder is one of Australia's leading comparison websites. We are committed to our readers and stand by our editorial principles.
We try to take an open and transparent approach and provide a broad-based comparison service. However, you should be aware that while we are an independently owned service, our comparison service does not include all providers or all products available in the market.
Some product issuers may provide products or offer services through multiple brands, associated companies or different labeling arrangements. This can make it difficult for consumers to compare alternatives or identify the companies behind the products. However, we aim to provide information to enable consumers to understand these issues.
We make money by featuring products on our site. Compensation received from the providers featured on our site can influence which products we write about as well as where and how products appear on our page, but the order or placement of these products does not influence our assessment or opinions of them, nor is it an endorsement or recommendation for them.
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Where our site links to particular products or displays 'Go to site' buttons, we may receive a commission, referral fee or payment when you click on those buttons or apply for a product.
When products are grouped in a table or list, the order in which they are initially sorted may be influenced by a range of factors including price, fees and discounts; commercial partnerships; product features; and brand popularity. We provide tools so you can sort and filter these lists to highlight features that matter to you.
Please read our website terms of use and privacy policy for more information about our services and our approach to privacy.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
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How to combine two existing top (premium) health cover policies from adult single to a couples when both are with separate insurers? Wish to compare which of these two insurers would best cover the two of us as a couple whilst neither one loses benefits or has a waiting period. We both have been with our respective health providers for over ten years continuously.
Hi Nikko,
Thank you for getting in touch.
If you’re currently on separate policies, the first step would be to see if you can save any cash by combining your policies – we’ve added a bit of info on that here https://www.finder.com.au/health-insurance/couples – it doesn’t always work out cheaper and it’s probably worth a closer look.
With your waiting periods, they are different for hospital cover and general treatment (extras) cover. All of your hospital waiting periods that you’ve already served travel with you to the new policy – so if you do decide to combine your policies, you should be covered.
Keep in mind, you’ll still have to serve waiting periods for any new benefits that you didn’t have before (such as pregnancy cover and also extras).
If you already have a preferred health fund from your two options – it may be worth giving them a call as they can move you onto one package.
I hope this helps. Please feel free to reach out to us if you have any other enquiries.
Thank you and have a wonderful day!
Cheers,
Jeni
As a couple over 50 we would like private hospital cover with general dental, optical, physio and chiro.. what is the best option?
Hi Susan,
Thanks for getting in touch with Finder.
While we don’t provide a specific product recommendation, you can enter the necessary details on our health insurance search form then click the “Search Policies” button. This should allow you to compare quotes from different insurers.
When you are ready, you may then click on the “Go to site” button and you will be redirected to the insurer’s website where you can proceed with the application or get in touch with their representatives for further inquiries you may have.
Hope this was helpful.
Cheers,
Nikki
Hi there. My wife is already pregnant and the pregnancy insurance waiting period is 12 months!! So how does PHI work to cover her when she is giving birth? What is the solution around this?
Hello Kevin,
Thank you for your comment.
To be qualified for the private health insurance you’re advised to take out the policy in advance before attempting to conceive. Most Australian private health funds have a 12 month waiting period for obstetric services.
This is explained on these pages:
– https://www.finder.com.au/health-insurance/pregnancy-health-insurance
– https://www.finder.com.au/no-waiting-period-health-insurance
I am afraid that no PHI will consider your wife’s condition as she is already pregnant, however, you can still contact the insurer directly and see what options they can offer you. I hope this helps.
Regards,
Jhezelyn
How does Defence Health compare to other health funds in terms of value for money – cost of premium to rebate received. The mo they premium certainly appears a lot higher than other funds but do the rebates reflect that?
Hi Jo,
Thank you for getting in touch with Finder.
According to ou review, Defence Health offers a range of health insurance options to more than 300,000 Australians with Defence connections. With hospital and extras cover to suit everyone from the young and healthy to those who need comprehensive protection, it provides affordable cover and peace of mind.
I hope this helps.
Have a great day!
Cheers,
Jeni
Hi, are quoted premiums before or after any Govt rebates?
Hi Marco!
Thanks for your question and for visiting finder.
Quoted premiums are before government rebates. Rebate rates are subject to change based on the cost of living and the average health insurance premium amount. It would be helpful to check with your health insurance provider on their ongoing rates as well.
Hope this helps!
Thanks and best regards,
Nikki