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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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What does the question “Do you qualify for a restricted fund?” mean.
Finder
RenchMarch 8, 2018Finder
Hi Steve,
Thanks for your inquiry.
Restricted health funds are funds where membership is restricted to certain people. They are usually operated by industry or employment groups and are not-for-profit, being run solely for the benefit of their members. You can get more information from our guide on how are restricted funds different from a standard health fund.
Best regards,
Rench
ShaunOctober 4, 2017
With premiums that keep increasing, I am now paying around $94 a month ($1128 per year) on something that I have never actually used over the last 6 years!
What is the actual consequence if I walked out of heath insurance (don’t mention hypothetical scenarios such as me getting into an accident)?
How much am I actually penalized on my tax?
GruOctober 5, 2017
Hello Shaun,
Thank you for your question.
If you would decide not to take on private health insurance, please be ready to face out-of-pocket costs if you do get hospitalised or need medical care and services. Out-of-pocket costs will vary greatly depending on the hospital you go to and the doctor or specialist they see.
As per being penalised for not taking out health insurance, yes would. Another reason Australians commonly take out private health insurance is to avoid financial penalties. Australia’s tax system encourages high-income earners to take out private health insurance as well as paying the 2% levy to help fund Medicare and the National Disability Insurance Scheme.
If you do not take out private health insurance, you will pay a 2% tax penalty called the Medicare Levy Surcharge.
Hope this helped.
Cheers,
Gru
AleishaSeptember 5, 2017
I am 76 years old. What do I need to cover with private health insurance that I am not covered for as a pensioner? Thank you.
LiezlSeptember 6, 2017
Hi Aleisha,
Thanks for reaching out.
Medicare does not provide cover for the following:
– most dental examinations and treatment,
– most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services,
– acupuncture (unless part of a doctor’s consultation),
– glasses and contact lenses,
– hearing aids and other appliances
You may, however, arrange private health insurance to cover many of these services. You may compare health insurance for seniors over 70 on this page. There are forms on that page, which you can fill out to compare your health insurance policies or have someone call you to discuss your possible options.
I hope this has helped.
Cheers,
Liezl
AnitaAugust 3, 2017
I want to find a better cover at a better price than what I already have.
LiezlAugust 3, 2017
Hi Anita,
Thanks for reaching out. You can definitely do that by using our policy search engine above. Simply enter your details and type of cover you want. Once you click the “Search Policies” quotations from different brands will be generated. You may then click the “Go to Site” button to get the quote and for more details.
Cheers,
Liezl
DionneJune 29, 2017
Hi, just want to check our current policy with other providers to ensure we are adequately covered and what we currently require.
JonathanJune 29, 2017
Hello Dionne!
Thanks for the question! You are actually on the right page! :)
Scroll a bit below, you would see different health insurance available in finder, such as health funds, EoFY deals, hospital and extra covers, and overseas. You may select which one is applicable for you.
Once redirected to another page, use our form and click “Search Policies” orange button.
If you need further help on this matter, you can talk to an insurance advisor or financial adviser.
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.
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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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What does the question “Do you qualify for a restricted fund?” mean.
Hi Steve,
Thanks for your inquiry.
Restricted health funds are funds where membership is restricted to certain people. They are usually operated by industry or employment groups and are not-for-profit, being run solely for the benefit of their members. You can get more information from our guide on how are restricted funds different from a standard health fund.
Best regards,
Rench
With premiums that keep increasing, I am now paying around $94 a month ($1128 per year) on something that I have never actually used over the last 6 years!
What is the actual consequence if I walked out of heath insurance (don’t mention hypothetical scenarios such as me getting into an accident)?
How much am I actually penalized on my tax?
Hello Shaun,
Thank you for your question.
If you would decide not to take on private health insurance, please be ready to face out-of-pocket costs if you do get hospitalised or need medical care and services. Out-of-pocket costs will vary greatly depending on the hospital you go to and the doctor or specialist they see.
As per being penalised for not taking out health insurance, yes would. Another reason Australians commonly take out private health insurance is to avoid financial penalties. Australia’s tax system encourages high-income earners to take out private health insurance as well as paying the 2% levy to help fund Medicare and the National Disability Insurance Scheme.
If you do not take out private health insurance, you will pay a 2% tax penalty called the Medicare Levy Surcharge.
Hope this helped.
Cheers,
Gru
I am 76 years old. What do I need to cover with private health insurance that I am not covered for as a pensioner? Thank you.
Hi Aleisha,
Thanks for reaching out.
Medicare does not provide cover for the following:
– most dental examinations and treatment,
– most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services,
– acupuncture (unless part of a doctor’s consultation),
– glasses and contact lenses,
– hearing aids and other appliances
You may, however, arrange private health insurance to cover many of these services. You may compare health insurance for seniors over 70 on this page. There are forms on that page, which you can fill out to compare your health insurance policies or have someone call you to discuss your possible options.
I hope this has helped.
Cheers,
Liezl
I want to find a better cover at a better price than what I already have.
Hi Anita,
Thanks for reaching out. You can definitely do that by using our policy search engine above. Simply enter your details and type of cover you want. Once you click the “Search Policies” quotations from different brands will be generated. You may then click the “Go to Site” button to get the quote and for more details.
Cheers,
Liezl
Hi, just want to check our current policy with other providers to ensure we are adequately covered and what we currently require.
Hello Dionne!
Thanks for the question! You are actually on the right page! :)
Scroll a bit below, you would see different health insurance available in finder, such as health funds, EoFY deals, hospital and extra covers, and overseas. You may select which one is applicable for you.
Once redirected to another page, use our form and click “Search Policies” orange button.
If you need further help on this matter, you can talk to an insurance advisor or financial adviser.
Hope this helps.
Cheers,
Jonathan