How does Australian health insurance cover hospital stays?
- Public hospitals are open to everyone and are largely covered by Medicare, while private hospitals are largely not covered by Medicare and often require private health insurance.
- Private hospitals will usually offer private rooms to their patients, while public hospitals tend to provide shared rooms. You also get more freedom of choice and shorter waiting times at private hospitals. Being a private patient at a public hospital also gets you some of these benefits.
- Basic hospital cover is less expensive but provides fewer benefits, while comprehensive is more expensive but has more benefits.
- Some private health funds have a hospital network. This is a list of both public and private hospitals that they are partnered with. In some cases you get more benefits at network hospitals, or will only be able to claim insurance benefits at private hospitals which are part of the network.
Contents of this guide
Compare Australian health insurance hospital cover
Funds in the finder.com.au panel
|Provider||Hospitals covered||Learn more|
|HIF||Both public and private, within HIF hospital network only||Get a quote|
|Health.com.au||Public only with basic, private available with comprehensive||Get a quote|
|AHM||Public only with basic, private available with comprehensive||Get a quote|
|Australian Unity||Network private hospitals, all public hospitals||Get a quote|
|GMHBA||Public only with basic, private available with comprehensive||Get a quote|
|HCF||Network private hospitals, all public hospitals||Get a quote|
|nib||Network private hospitals, all public hospitals||Get a quote|
|Transport Health||Public only with basic, private with comprehensive||Get a quote|
Complete list of providers
|Health fund||Hospitals covered*|
|Cessnock District Health Fund|
|Health Care Insurance|
Note: Also covers overnight accommodation but depends on the level of hospital cover.
|Latrobe Health Services|
|Mildura Health Fund|
|Phoenix Health Fund|
|Queensland Country Health Fund|
|St. Lukes Health|
|CBHS health fund|
|Doctors Health Fund|
|Reserve Bank Health Society|
|Teachers Health Fund|
*Information collected on July 2017 and correct at that date
Hospital insurance for public vs private patients
When checking into a hospital, you will need to nominate yourself as either a public or a private patient. You cannot be a public patient in a private hospital, but can be a private patient in a public hospital.
For cost-effective hospital insurance, you may want to compare basic public hospital policies.
If you are looking for a comprehensive level of cover at some of the top hospitals in Australia, then you can compare top hospital cover policies.
Like most other insurance policies, hospital cover generally includes an excess which is a flat cost you must pay when claiming hospital benefits on health insurance. This is typically several hundred dollars. Some hospital insurance plans do not have any excess.
What happens if I need to go to hospital and I don't have health insurance?
If you are going to a hospital without health insurance, then you will only be able to choose a private hospital or choose to be a private patient at a public hospital, if you pay potentially large fees out of pocket. In a non-emergency situation, some private hospitals may turn you away without health insurance.
- All permanent Australian residents are covered by Medicare. This means you can access public hospital treatment as public patients free of charge, but cannot generally choose your doctor or which hospital you go to.
- All permanent Australian residents are able to attend public hospitals as private patients with Medicare covering 75% of the medical treatment costs, but not accommodation and other additional expenses.
What about overnight and same-day hospital stays?
The two different types of hospital stay are overnight and same-day. The former is for medical procedures or health issues that require you to stay in the hospital for longer periods of time. Same-day refers to checking in and being discharged from the hospital in a single day.
Overnight stays might incur extensive hospital accommodation costs over time, while same-day stays typically cost less. Depending on whether you have hospital insurance cover and your policy, certain benefits might only be available for either same-day or overnight hospital stays. For example, some policies might not cover private rooms for same-day stays unless medically necessary or at a private or network hospital.
What about long-term patients?
If you are staying in hospital for more than 35 days in a row, you become classified as a long stay or nursing home type patient, unless your doctor specifically says otherwise. This means your hospital accommodation will start costing more. Private health funds are legally not allowed to insure against these long-term stay costs.
If I have health insurance, do I get a shared or private hospital room?
Some hospital health insurance policies will only cover the full cost of a shared room, but not a private one. Depending on the policy this might only apply at public hospitals, or only at non-network hospitals, or in all circumstances. If you do end up being admitted to a private room, whether or not you deliberately chose one, then the hospital is required to inform you if you will be required to pay for the cost if your health insurance won’t cover it, or pay the gap if it is only partially covered.
What other costs are there if I go to a hospital?
While at hospital, you will incur some expenses other than overnight or same-day stays. Some are covered by Medicare (up to 75-100% depending on the hospital and the costs), while others will require you to pay out of pocket or through private health insurance.
The costs covered by Medicare include:
- Medical treatments. These are medically necessary procedures, and will typically be the reason you’re in the hospital in the first place. Medicare effectively covers medically required procedures for Australian permanent residents.
The costs typically not covered include:
- General treatments. These are the things usually covered under the “extras” part of health insurance policies. It includes procedures like dental work, chiropractic treatment, podiatry, therapies of many kinds and prostheses like hearing aids.
- Additional extras. Optional extras like a TV in your room, getting a private room and other luxuries and non-essentials.
How does ambulance cover work in Australia?
Ambulance costs are another important factor to consider alongside same-day and overnight hospital stay costs as they are often integral to a hospital trip. Ambulance costs can be incurred both while initially travelling to hospital and when being transferred between hospitals. Read on for more information on how ambulance costs work with health insurance.
Depending on what state you live in, the government pays for different ambulance costs for different groups. In all cases, you must have a valid card, such as a seniors health card or pensioner concession card to be eligible for free ambulance transport.
|State||Ambulance cover - is it free?|
|Australia wide||Free for Department of Veterans Affairs Gold Card holders|
|ACT||Free for healthcare concession card holders and pensioners|
|NSW||Free for pensioners, seniors and healthcare concession card holders|
|NT||Free for pensioners and seniors|
|QLD||Free for all Queensland residents|
|SA||Requires a subscription through the SA state ambulance service|
|TAS||Free for all Tasmanian residents|
|VIC||Free for pensioners and healthcare concession card holders|
|WA||Free for seniors|