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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 | |
|---|---|---|
| Doctor | 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
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 and covers a small set of hospital treatments (like rehabilitation and palliative care). 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, like joint replacements and spinal surgery. It sits in the middle of the market and suits people who want solid all-round protection.
- Gold is the highest tier and covers every clinical category set by the Australian government. That includes pregnancy, cardiac services and weight loss surgery. It's the most comprehensive and most expensive option available.
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, as it’s enough to dodge the surcharge and build up their Lifetime Health Cover loading without overpaying. 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.
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. Most general dental and optical claims have a 2-month wait, while major dental and orthodontics can require up to 12 months. Pre-existing conditions may attract longer waiting periods too.
How to compare and choose a health 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, two Silver policies can look very different. One might include psychiatric care or heart and vascular surgery as extras, while another keeps strictly to the minimum Silver inclusions.
- Check 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.
- Read 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.
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.
"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."
Watch & learn more about health insurance
Health insurance guides and resources
- Extras only: $53
- Basic: $90
- Bronze: $144
- Silver: $184
- Gold: $285
Frequently asked questions about health insurance
Sources
Ask a question






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!