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2

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3

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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.

Public vs private health insurance comparison

Not sure if private health insurance is worth it? Here are some key differences between the public and private healthcare systems in Australia:

Public system Private health insurance
DoctorA public hospital will allocate a doctor for you. You don't get to choose.You can choose which doctor you see.
Private roomYou'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 listsWaiting 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 typesMedicare 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 costsIn 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

Learn more about private health insurance

  • 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.
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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."

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Watch & learn more about health insurance

How much does health insurance cost?
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

Sources

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Insurance expert

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. See full bio

Tim's expertise
Tim has written 157 Finder guides across topics including:
  • Personal finance
  • Financial comparison
  • Health insurance
  • General insurance
  • Life insurance

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63 Responses

    Default Gravatar
    makOctober 23, 2015

    i m new migrant, with family and 2 kids, I start job 90k+ from October mid, do you think I will also be charged for 2% medical levy?
    as my working months will be 8.5 months so total amount will be less than 90k+
    should I buy the insurance to avoid medical levy or should I buy next year?

      Richard Laycock's headshotFinder
      RichardOctober 23, 2015Finder

      Hi Mak,

      Thanks for your question.

      If you earn over $90,000 a year, or you and your partner have a combined income of over $180,000 a year, you will need to pay Medical Levy Surcharge (MLS). You can use this guide to know exactly how MLS works, how much it could be costing you, and where you can find a policy that’s cheaper than paying the penalty. If you would like to speak with a broker about the best insurance option for you, please complete the contact form above and an advisor will be in touch or you can compare policies we have reviewed.

      Please make sure to read the eligibility criteria, features and details of the policy, as well as the relevant Product Disclosure Statement of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.

      I hope this was helpful,
      Richard

    Default Gravatar
    KayOctober 2, 2015

    If I pay health fund in advance 12 months can I claim for existing illness

      Richard Laycock's headshotFinder
      RichardOctober 6, 2015Finder

      HI Kay,

      Thanks for your question. The government sets the maximum waiting periods that funds can impose for hospital treatment, which is 12 months for pre-existing conditions. The waiting periods for general treatment (ancillary or extras) cover are set by individual health funds.

      I hope this was helpful,
      Richard

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