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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 are generally shorter in the private system, particularly for non-urgent elective procedures. 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 may cover 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 generally involves a shorter wait. For some procedures, you may even be able to pick your date.
Treatment types
Medicare doesn't cover dental, optical, hearing aids, physiotherapy or most other allied health services, though it does cover GP and specialist visits, pathology and imaging.
Extras can give you cashback on out-of-hospital services such as optical, dental, psychology and hearing aids.
Ambulance costs
Medicare doesn't cover ambulance transport anywhere in Australia. Queensland and Tasmania cover it for their own residents through state government schemes. Everywhere else you need ambulance cover, either through a health fund or a state ambulance subscription.
Ambulance cover sits outside the hospital tiers. Most funds include emergency ambulance on hospital policies, but some only offer it through extras.
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 31 or earn less than $105k as a single or $210k for couples or families
Compare, switch and get rewarded — only on Finder
Comparing health insurance on Finder doesn't just help you find a better deal. We also think you should be rewarded for your effort. When you purchase an eligible health insurance policy through Finder as a new customer, you could receive a digital Visa gift card as a reward for switching. The value varies depending on the insurer and policy, so it's worth checking what's on offer when you compare.
You can check out the current health insurance rewards we currently have by visiting the Finder Rewards page.
Basic, Bronze, Silver, Gold cover: which is right for you?
Basic is the entry-level tier. It covers three categories: rehabilitation, hospital psychiatric services and palliative care, but only as restricted cover, which means benefits are limited to the public hospital shared-room rate. It's mainly used to avoid the Medicare Levy Surcharge (MLS) or start building your Lifetime Health Cover (LHC) base rate.
Bronze steps things up with cover for a broader range of treatments, including joint reconstructions and hernia repairs. It's a popular choice for younger, generally healthy people who want meaningful cover without paying for things they're unlikely to need.
Silver covers everything in Bronze, plus a wider range of procedures, including back, neck and spine, heart and vascular surgery, lung and chest and dental surgery.
Gold is the highest tier and covers every clinical category set by the Australian government. That includes pregnancy and birth, joint replacements, cataracts, dialysis, weight loss surgery and insulin pumps.
Which tier is right for you?
The right tier really comes down to your age health, and what you actually want to use your cover for.
A healthy 28-year-old might find Basic or Bronze is all they need. It's enough to avoid the surcharge and holding hospital cover before their Lifetime Health Cover base day means they'll never pay a loading. If you're planning a family, Silver or Gold with pregnancy cover is worth the investment. And if you're older or managing a chronic condition, Gold's comprehensive coverage may save you more in the long run than it costs.
One thing to keep in mind: Policies within the same tier aren't all identical. Insurers can offer more than the minimum required inclusions, so it's worth reading the fine print and comparing before you commit.
Extras cover explained
Extras cover is the part of private health insurance that helps with everyday healthcare costs outside of hospital, including things like going to the dentist, getting new glasses or seeing a physio.
What's typically included under extras cover?
Most extras policies cover some combination of the following:
Dental
Optical
Physiotherapy
Chiropractic and osteopathy
Psychology
Remedial massage
Podiatry
Speech therapy and occupational therapy
The specific services covered, and how much you get back, will vary between policies and insurers. A basic extras policy might only cover dental and optical, while a comprehensive one could include 20 or more services.
Is your health insurance actually keeping up with you?
Life changes, which means your health cover should too. Whether you've recently coupled up, had a baby, changed jobs or just hit a new decade, it's worth reviewing your policy at least once a year. Many Australians are either over-insured (paying for cover they'll never use) or under-insured (finding out too late that a treatment isn't covered). A quick annual check could save you hundreds.
Annual limits and waiting periods
Every extras policy comes with two key limitations worth understanding before you claim. Annual limits cap how much you can claim per service, per year. For example, you might have a $500 annual limit on physio or a $300 limit on optical. Once you've hit your limit for that service, you're paying out of pocket for the rest of the year. Some policies also have an overall annual limit across all extras combined.
Waiting periods are the time you have to wait after taking out a policy before you can make a claim. Unlike hospital cover, extras waiting periods aren't set by legislation. Each insurer chooses its own. General dental and optical are typically two months, while major dental and orthodontics commonly run 12 months or more. Make sure you check the specific waits on any policy before you switch for a particular treatment.
How to compare and choose a health insurance policy in 7 steps
With dozens of health funds and hundreds of policies on the market, knowing where to start makes all the difference. Here's how to find the right option for your health needs:
Work out what you actually need: Before you look at a single policy, think about how you use healthcare. Do you go to the dentist twice a year? See a physio regularly? Planning a family in the next few years? Your usage history is the best guide to what cover is worth paying for.
Decide between hospital, extras or both: You can take out hospital cover only, extras only, or a combined policy. Hospital cover protects you from big unexpected costs, while extras helps with routine, everyday healthcare.
Set a budget: Health insurance premiums vary a lot, so decide what you're comfortable spending per month, then look for the best cover within that range.
Compare policies at the same tier: If you're shopping for hospital cover, compare like for like. For instance, can look very different. One might add Gold-only categories, such as cataracts or joint replacements on top of the Silver minimum (often sold as 'Silver Plus') while another covers the 26 Silver categories and nothing more.
Read up on the extras limits: For extras cover, the benefit limits matter as much as the list of included services. A policy that covers physio but only pays back $200 a year may not go far if you're a regular visitor.
Look at out-of-pocket costs: Some hospital policies use a "gap cover" arrangement with certain doctors, meaning you pay little or nothing beyond your excess. Check whether your preferred hospitals and specialists are covered, and what your potential out-of-pocket costs could look like.
Check the fine print on exclusions: Every policy has treatments it won't cover. These are listed in the policy's product disclosure statement (PDS). It's worth skimming, especially if you have a specific condition or procedure in mind.
Our expert says
"A lot of people assume the cheapest policy offers the best value, but that's rarely true. The right cover is the one that actually matches how you use healthcare. Take 10 minutes to think about what you've spent on health costs in the last year before you start comparing. That alone will tell you more than any policy name or tier label."
"Gold hospital cover reaches every clinical category the public system does. Below that, each tier excludes more. The real difference is the standard and speed of care: it's like choosing between a dependable budget car and something flashier. Both 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."
The Federal Budget changes announced in May 2026 mean the government's private health insurance rebate for seniors will be cut, though not removed altogether.
Previously, people aged 65 to 69 received a ~28% rebate, and those 70 and over received a ~32% rebate. Under the new change, everyone 65 and older drops to the standard 24% rate.
This change is effective April 1, 2027. The government expects to save around $3 billion over 4 years because of this adjustment.
For older Australians looking to offset the price increase, it's a great time to compare policies and look at switching. Remember that your waiting periods move with you when you move to the same tier/level of cover, so you could pay less without losing any coverage.
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.
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 straightforward. Waiting periods you've already served transfer across on equivalent cover. But if you upgrade to a higher tier or add a service you didn't have, you'll serve a new wait on the extra cover.
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 March 2026.
Extras only: $53
Basic: $90
Bronze: $144
Silver: $184
Gold: $285
Price based on 400+ 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 any state.
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 available.
As a public patient in a public hospital you're treated at no cost, under the funding agreement between the federal and state governments, but you don't choose your hospital, doctor or appointment time. As a private patient, Medicare pays 75% of the MBS fee for your doctor's services and your hospital cover pays at least the remaining 25%. If your doctor charges more than the MBS fee, which is common, you pay the difference. Remember, with hospital insurance, you'll also have to serve waiting periods. Insurers can apply a waiting period of up to 12 months for pre-existing conditions. That means anything you had signs or symptoms of in the six months before you joined or upgraded, as assessed by a doctor your insurer appoints. Psychiatric care, rehabilitation and palliative care are capped at two months even when the condition is pre-existing.
Extras insurance helps towards non-hospital-related healthcare, such as dental work, new glasses and physiotherapy appointments. Most extras policies pay a set percentage of your bill, commonly between 50% and 100%, up to an annual limit. Some funds have no-gap arrangements with selected providers where you pay nothing for routine services like a check-up and clean. 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, and you'll need to serve these before claiming a benefit. Waiting periods can't be skipped, but insurers often waive selected extras waits as a sign-up offer.
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, so insurers can't charge you more because of your health status, claims history or a pre-existing condition. Age does affect what you pay, through factors such as the age-based discount for 18–29 year olds, the Lifetime Health Cover loading if you join after your base day and the age tiers in the government rebate.
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 state. Premiums are set state by state, so the same policy costs a different amount in NSW than it does in WA. Within your state, insurers can't charge you more for living regionally.
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. Australia has Reciprocal Health Care Agreements with Belgium, Finland, Ireland, Italy, Malta, the Netherlands, New Zealand, Norway, Slovenia, Sweden and the UK. Cover under the Italian and Maltese agreements is limited to six months. An RHCA only covers medically necessary treatment, and many visa classes require Overseas Visitor Health Cover regardless. 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.
Health insurance premiums aren't tax-deductible, but private health cover still affects your tax in two ways. The Medicare Levy Surcharge is an extra tax of 1% to 1.5% that applies to higher income earners who don't hold appropriate hospital cover.
Medicare Levy Surcharge income thresholds – from 1 July 2026
From 1 July 2026, the MLS income thresholds are:
MLS rate
Single income
Couples income
0%
$0 - $105,000
$0 - $210,000
1%
$105,001 - $123,000
$210,001 - $246,000
1.25%
$123,001 - $164,000
$246,001 - $328,000
1.50%
$164,001+
$328,001+
Note that the family income threshold is increased by $1,500 for each MLS dependent child after the first child. There are pretty specific rules around what counts as a dependent child for MLS purposes. Check the ATO definitions here if this might apply to you.
Hospital cover exempts you from the MLS as long as the excess is no more than $750 on a single policy, or $1,500 on a couple, family or single-parent policy. A higher excess than that won't exempt you. Extras cover does not exempt you from the MLS.
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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Finder guides across topics including:
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Get rewarded $$ for switching with Finder Rewards
Find a better deal, save on your bills and get a free gift card. Sign up to be the first to hear about new Finder Rewards.
I am considering changing to a new provider, but am unsure if (post budget) there is any Government contributions toward the fees. I am 80 and wife 74.
Finder
SarahMay 22, 2026Finder
Hi Roger,
The Federal Budget changes will see the government’s private health insurance rebate for seniors cut, not removed altogether. This will bring it in line with the rate for people under 65. The change means your government rebate will drop from the current 32.158% to 24.118% (a reduction of roughly 8%). This is due to come into effect as of April 1, 2027, so you have some time up your sleeve and may be able to get great value from switching. Right now, we have two Finder Rewards live with health insurers that you might want to review. Hope this helps!
JuneMarch 31, 2026
I already have silver hospital and extras cover with another fund, does this impact if I change over to another provider?
Finder
SarahApril 1, 2026Finder
Hi June,
If you transfer your health insurance, any waiting periods you’ve already served will be transferred across (provided you take out the same level, eg Silver cover). One thing to keep in mind is that it’s best to submit any outstanding claims before you switch. Hope this helps!
ClaireDecember 28, 2025
The $300 gift card offer for joining Medibank can be combined with other offers from Medibank’s own website?
Finder
AngusDecember 29, 2025Finder
Hi Claire, Yes, you can combine with other offers providing you apply via the link on Finder and use the same email address for your Medibank policy as for your Finder account.
ALICEDecember 19, 2025
Is the $300 gift card offer in joining Medibank still available now. Today is a 19 Dec at 11.40 am
Finder
CeydaDecember 19, 2025Finder
Hi Alice, yes, the Medibank $300 gift card offer is still available. This promotion ends at 11:59pm 5th January, 2026.
peterDecember 2, 2025
what is the best couple cover i am 68 and wife is 40
Finder
SarahDecember 8, 2025Finder
Hi Peter,
It depends on your income (because this determines your rebate), what level of cover you want (top or basic?), what type of cover you want (hospital, extras or both?) and what access you have to public hospitals in your area, among other things! This guide gives you a bit more information about how to choose what type of cover you might want. Hope this helps!
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.
Finder is a comparison service. We do not compare every product or every provider in the market.
We make money through commercial arrangements with some of the providers on this site. Products marked 'Sponsored', 'Promoted', 'Featured' or 'Advertisement' appear as a result of a commercial arrangement.
Our editorial content, product reviews and any 'Top Pick' designations are prepared independently of these commercial arrangements.
The default order of products in our tables can be influenced by commercial arrangements. You can re-sort or filter using the controls above each table.
Some content on this site may be generated or supported by AI tools. You should verify details directly with the provider.
Finder is one of Australia's leading comparison websites. We are committed to our readers and stand by our editorial principles.
Our comparison service does not include every product or every provider in the market. Some product issuers offer their products under multiple brands or through associated companies. Where we can, we identify the underlying issuer so you can compare like with like, but you should always check with the provider directly to confirm which brand you are dealing with.
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Our editorial opinions, product reviews and any 'Top Pick' designations are prepared independently of these commercial arrangements. A 'Top Pick' is an editorial choice made by our writers and editors based on the criteria described on each comparison page. A 'Top Pick' is not a personal recommendation and does not mean the product is appropriate for your circumstances.
If you would like to know whether we have a commercial arrangement with a specific product issuer, please contact us.
When products are grouped in a table or list, the default order can be influenced by commercial arrangements we have with product issuers. In some categories, sponsored or featured products appear in the top positions of the table by default, and are always labelled as such.
Other factors that influence default order include price, fees and features, and (where relevant) our editorial view of the product.
You can re-sort every comparison table using the controls above the table. You can filter by product features that matter to you. The order you see after re-sorting or filtering is not influenced by commercial arrangements.
Some content on this site is generated or supported by artificial intelligence tools, including our AI-powered assistant FinderBot. AI-generated content may contain errors. Please verify important information directly with the product issuer before making a financial decision. For more information about FinderBot, see the FinderBot Terms of Use and FinderBot Privacy Collection Notice.
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.
I am considering changing to a new provider, but am unsure if (post budget) there is any Government contributions toward the fees. I am 80 and wife 74.
Hi Roger,
The Federal Budget changes will see the government’s private health insurance rebate for seniors cut, not removed altogether. This will bring it in line with the rate for people under 65. The change means your government rebate will drop from the current 32.158% to 24.118% (a reduction of roughly 8%). This is due to come into effect as of April 1, 2027, so you have some time up your sleeve and may be able to get great value from switching. Right now, we have two Finder Rewards live with health insurers that you might want to review. Hope this helps!
I already have silver hospital and extras cover with another fund, does this impact if I change over to another provider?
Hi June,
If you transfer your health insurance, any waiting periods you’ve already served will be transferred across (provided you take out the same level, eg Silver cover). One thing to keep in mind is that it’s best to submit any outstanding claims before you switch. Hope this helps!
The $300 gift card offer for joining Medibank can be combined with other offers from Medibank’s own website?
Hi Claire, Yes, you can combine with other offers providing you apply via the link on Finder and use the same email address for your Medibank policy as for your Finder account.
Is the $300 gift card offer in joining Medibank still available now. Today is a 19 Dec at 11.40 am
Hi Alice, yes, the Medibank $300 gift card offer is still available. This promotion ends at 11:59pm 5th January, 2026.
what is the best couple cover i am 68 and wife is 40
Hi Peter,
It depends on your income (because this determines your rebate), what level of cover you want (top or basic?), what type of cover you want (hospital, extras or both?) and what access you have to public hospitals in your area, among other things! This guide gives you a bit more information about how to choose what type of cover you might want. Hope this helps!