Compare Health Insurance Plans in Australia

Last Updated: 15 April 2025

What is Private Health Insurance in Australia?

Private health insurance is an optional cover you can purchase from registered health insurers. It works alongside Medicare (Australia’s public healthcare system) to give you more choice and potentially cover costs that Medicare doesn’t fully pay for.

Key Differences: Medicare vs. Private Health Insurance

Health Service	Public Health Care (Medicare)	Private Health Insurance
In-hospital services	Treatment as a public patient in a public hospital. Medicare covers costs. You usually can’t choose your doctor or hospital. Long waits for elective surgery are common.	Treatment as a private patient in a public or private hospital. You can often choose your doctor/specialist. Shorter waiting times for elective surgery. Your insurer and Medicare cover most costs (depending on your policy and excess). Potential for a private room (if available).
Doctor/Specialist Visits (Out of Hospital)	Medicare covers some or all costs (bulk billing or patient gap).	By law, private health insurance cannot cover the gap for out-of-hospital medical services covered by Medicare.
Other Out-of-Hospital Services (Extras)	Medicare may partly cover some services (e.g., some allied health under chronic disease plans). Limited dental or optical cover.	Extras policies can cover a portion of costs for services like dental, optical, physiotherapy, chiropractic, etc. (depending on your cover).
Prescription Medicines	Covered by the Pharmaceutical Benefits Scheme (PBS) with a co-payment.	Some top-level policies may offer benefits for non-PBS pharmaceuticals.
Ambulance	Coverage varies significantly by state/territory. Some states provide cover, others require subscription or payment.	Ambulance cover can be included in hospital/extras policies or purchased separately to cover costs where state schemes don’t apply.

Why Consider Private Health Insurance? The Benefits Explained

While optional, private health insurance offers several potential advantages:

• Greater Choice & Control: Choose your own doctor or specialist for hospital treatments and potentially select the hospital (public or private).
• Shorter Waiting Times: Avoid potentially long public hospital waiting lists for elective surgeries (like knee replacements or cataract surgery).
• Private Hospital Access: Get treated in a private hospital, which may offer benefits like a private room (subject to availability).
• Cover for Extras: Get help paying for out-of-hospital services not typically covered by Medicare, such as general dental check-ups, prescription glasses, physiotherapy, and more.
• Potential Tax Savings: If you earn above a certain income threshold, having eligible private hospital cover can help you avoid the Medicare Levy Surcharge (MLS) – an extra tax.
• Avoid Lifetime Health Cover (LHC) Loading: Taking out hospital cover before July 1 following your 31st birthday means you avoid the LHC loading, which adds 2% to your hospital premium for every year you delay (up to a maximum of 70%).
• Government Rebate: Depending on your income and age, you might be eligible for the Australian Government Rebate on Private Health Insurance, which reduces your premium cost.

Understanding the Types of Health Insurance Cover

Australian private health insurance generally falls into three main categories:

1. Hospital Cover

Hospital cover helps pay towards the cost of treatment when you’re admitted to hospital as a private patient. This can include accommodation, theatre fees, and doctors’ charges (up to the Medicare Benefits Schedule fee, with potential gaps).

Hospital Cover Tiers (Mandated Minimum Coverage):

Since April 2019, hospital policies are categorised into tiers – Basic, Bronze, Silver, and Gold – each covering a minimum set of clinical categories. Insurers can also offer ‘Plus’ policies (e.g., Bronze Plus, Silver Plus) which cover more than the minimum for that tier.

• Basic (+): Covers rehabilitation, hospital psychiatric services, and palliative care (restricted cover often applies). Primarily useful for avoiding the MLS or LHC loading. Average Premium Example: ~$107/month (Source: iSelect/PrivateHealth.gov.au – June 2024)
• Bronze (+): Includes everything in Basic, plus ~18 additional categories like brain and nervous system, joint reconstructions, digestive system, gynaecology. Average Premium Example: ~$136/month (Source: iSelect/PrivateHealth.gov.au – June 2024)
• Silver (+): Covers everything in Bronze, plus ~8 more categories like heart and vascular system, lung and chest, dental surgery, podiatric surgery. Silver Plus policies are popular as they often add cover for key services like joint replacements, cataracts, or insulin pumps. Average Premium Example: ~$187/month (Source: iSelect/PrivateHealth.gov.au – June 2024)
• Gold: Comprehensive cover including all 38 clinical categories, such as joint replacements, cataracts, pregnancy and birth, assisted reproductive services, weight loss surgery. Average Premium Example: ~$220/month (Source: iSelect/PrivateHealth.gov.au – June 2024)

(Note: Average premiums are indicative only and vary based on insurer, location, age, excess, rebate, and LHC loading. Use our tool for personalised quotes.)

2. Extras Cover (General Treatment)

Extras cover helps with the costs of healthcare services received outside of hospital, which Medicare generally doesn’t cover. Benefits are usually paid as a percentage of the fee or a set dollar amount, up to annual limits.

Common Extras Services:

• Dental: General (check-ups, cleans, fillings), Major (crowns, bridges, dentures), Orthodontics (braces).
• Optical: Prescription glasses, contact lenses.
• Physiotherapy: Treatment for injuries, muscle pain, rehabilitation.
• Chiropractic & Osteopathy: Spinal manipulation and musculoskeletal treatment.
• Other Therapies: May include podiatry, psychology, speech therapy, occupational therapy, dietetics, remedial massage, acupuncture, etc..

Extras policies vary greatly in the services covered and benefit limits. Consider your likely needs – do you wear glasses? Visit the dentist regularly? Need physio for sports? Choose cover that matches your requirements.

3. Ambulance Cover

Covers the cost of emergency (and sometimes non-emergency) ambulance transport and treatment by paramedics. Coverage arrangements differ by state:

• QLD & TAS: State governments provide free ambulance cover for residents.
• Other States/Territories: You generally need to pay per trip or purchase a subscription/insurance.

Ambulance cover is often included in hospital or extras policies, but can also be bought separately. Check your state’s rules and your policy details carefully.

4. Combined Cover (Hospital + Extras)

Many people choose a combined policy that packages both hospital and extras cover together, often from the same insurer, for convenience.

Factors Affecting Your Health Insurance Cost

The premium you pay depends on several factors:

• Type and Level of Cover: Gold hospital cover costs more than Basic; comprehensive extras cost more than basic extras.
• Who is Covered: Singles policies are cheaper than couples or family policies.
• Your Age (LHC Loading): If you first take out hospital cover after age 30, you’ll pay a 2% Lifetime Health Cover (LHC) loading for each year you delayed, up to 70%. This loading applies for 10 years of continuous cover.
• Your Income (Rebate & MLS):
  • Rebate: Higher income earners receive a lower (or no) government rebate, increasing their effective premium. The rebate also depends on age.
  • MLS: Higher income earners without appropriate hospital cover pay the Medicare Levy Surcharge (1% to 1.5% of taxable income). Taking out even Basic hospital cover avoids this surcharge.
• Your Location: Premiums can vary slightly between states and territories.
• Excess/Co-payment: Choosing a higher excess (the amount you pay upfront if admitted to hospital) generally lowers your premium, but means higher out-of-pocket costs if you need hospital treatment. Co-payments are similar but may apply per day or per admission.
• The Insurer: Different funds charge different premiums for similar levels of cover. This is why comparing is crucial!

Finding Affordable Health Insurance:

“Affordable” doesn’t just mean the lowest price; it means finding the best value for your needs. A cheap policy might exclude treatments you require, leading to large out-of-pocket costs later. Consider:

• Matching cover to your likely needs (don’t pay for pregnancy cover if you don’t plan a family).
• Choosing an appropriate excess level based on your health and budget.
• Claiming your correct government rebate tier.
• Comparing policies from multiple funds.

Find more information on the ATO website about rebates and the MLS.

Compare Health Insurance: Find the Right Fit for You

With premiums rising annually (average increase of 3.03% in 2024), comparing health insurance is more important than ever to ensure you’re not paying too much for cover you don’t need, or missing out on benefits you do.

Why Compare With Us?

• Simple & Fast: Answer a few quick questions, and we’ll show you relevant policies in minutes.
• Side-by-Side Comparison: Easily compare features, benefits, and estimated costs from a range of trusted Australian health funds.
• Tailored to You: Filter options based on your life stage (single, couple, family, senior), desired cover type, and budget.
• Save Time & Money: We do the research legwork, potentially saving you hours and finding deals that could lower your premiums.
• Expert Help Available: Need guidance? Our Australian-based specialists can help you understand your options (call [Phone Number] or schedule a call).
• Free Service: Our comparison service is free for you to use. We receive a commission from the health fund if you purchase a policy through us, but this doesn’t affect the price you pay.
• Safe & Secure: We take your data privacy seriously. Read our Privacy Policy.

How Our Comparison Tool Works

1. Tell Us About You: Enter basic details like your age, location, who needs cover (single, couple, family), and your income tier (for rebate estimate).
2. Select Your Needs: Indicate the type of cover you’re interested in (Hospital, Extras, Combined) and any specific requirements (e.g., pregnancy, dental).
3. Compare Your Options: We’ll instantly show you policies from our panel of health funds that match your criteria. Compare key features, waiting periods, excesses, and estimated monthly premiums side-by-side.
4. Choose & Enquire/Apply: Found a policy you like? You can often get a detailed quote or even start the application process directly.

Comparing for Different Life Stages

Your health needs change throughout life. Consider cover relevant to your situation:

• Singles (Under 31): Focus on avoiding LHC loading, potential MLS avoidance, and extras you’ll use (e.g., dental, optical, physio). Basic or Bronze Plus hospital might suffice.
• Singles & Couples (31+): Hospital cover becomes more important to avoid LHC loading. Consider Silver tiers if planning for future needs like joint reconstructions or heart issues.
• Planning a Family: Look for Gold hospital cover well in advance (typically 12-month waiting period for pregnancy/birth). Consider extras for obstetrics, dental, and child-related therapies.
• Families: Cover for accidents, kids’ dental/orthodontics, and common procedures. Silver Plus or Gold hospital tiers offer broader protection.
• Empty Nesters/Seniors: Needs may shift towards cover for joint replacements, cataracts, heart conditions, hearing aids, and other age-related health needs. Silver Plus or Gold hospital cover is often considered. Check extras for things like podiatry, hearing aids, and major dental.

Understanding the Fine Print: Key Policy Details

Before choosing a policy, it’s vital to understand the details found in the Private Health Information Statement (PHIS) or Product Disclosure Statement (PDS):

• Waiting Periods: Most benefits have waiting periods before you can claim, especially when first joining or upgrading cover. Common waiting periods are 2 months for most hospital/extras, 12 months for pre-existing conditions (hospital) and major dental/orthodontics/pregnancy (hospital).
• Exclusions: Services or treatments the policy specifically does not cover. Check these carefully!
• Restrictions: Services where the policy only pays limited benefits (e.g., cover as a private patient in a public hospital only).
• Excess: The fixed amount you agree to pay towards your hospital admission cost before the insurer pays benefits. Usually applies per person per year.
• Co-payments: A daily fee you might pay for each day you are in hospital, often capped per admission or per year.
• Benefit Limits: For extras cover, insurers set limits on how much you can claim per service per year (e.g., $500 annual limit for general dental).
• The Gap: The difference between what doctors charge for hospital treatment and what Medicare plus your insurer pays. Some funds have ‘gap cover arrangements’ with certain doctors to reduce or eliminate this gap. Check your fund’s participating providers.
• Provider Networks: Some funds have agreements with specific hospitals or extras providers (e.g., dentists, optometrists) where you might receive higher benefits or reduced out-of-pocket costs.

Switching Health Funds: It’s Easier Than You Think

Unhappy with your current cover or found a better deal? Switching health funds is straightforward thanks to portability rules:

• No Need to Re-serve Waiting Periods: If you switch to an equivalent or lower level of hospital cover, you won’t have to re-serve waiting periods you’ve already completed. If upgrading, you’ll only serve waiting periods for the new benefits.
• We Can Help: Often, your new fund can handle the cancellation of your old policy for you.
• Continuous Cover: Ensure your new policy starts the day after your old one ends to maintain continuous cover and avoid LHC implications.

Comparing regularly ensures your policy still offers good value and meets your current needs, as older policies might not keep pace with rising healthcare costs or newer treatment options.

Frequently Asked Questions (FAQs)

Do I really need private health insurance?

It’s optional, but offers benefits like choice, faster access to elective surgery, and extras cover. It can also help avoid tax penalties (MLS, LHC).

What’s the difference between Hospital and Extras cover?

Hospital cover helps with in-hospital costs as a private patient. Extras cover helps with out-of-hospital services like dental and physio.

How much does it cost?

Premiums vary based on cover level, age, income, location, excess, and insurer. Use our tool for personalised estimates.

Can I switch funds if I have a pre-existing condition?

Yes. You won’t have to re-serve waiting periods for benefits you were already covered for. A 12-month waiting period applies to hospital treatment for pre-existing conditions you weren’t previously covered for when first taking out cover or upgrading.

How often should I compare my policy?

It’s wise to review your cover annually, especially before premium increases (usually April 1st), or when your life circumstances change (e.g., income change, starting a family, kids leaving home).

What are waiting periods?

These are periods you must wait after joining or upgrading cover before you can claim benefits for certain treatments. Common waits are 2 months for most services and 12 months for pre-existing conditions or pregnancy.

What is the Lifetime Health Cover (LHC) loading?

It’s a government loading added to your hospital premium if you don’t take out hospital cover by July 1 following your 31st birthday. It adds 2% per year you delay, up to 70%.

What does ‘the gap’ mean?

The gap is the difference between what your doctor charges for hospital treatment and what Medicare plus your health fund pays. Some funds have arrangements with doctors to reduce or eliminate this gap.

Ready to Find Your Perfect Health Insurance Match?

Don’t navigate the complex health insurance market alone. Take control of your health cover and potentially save money by comparing policies tailored to your needs. It takes just minutes to see your options.