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Australia’s healthcare system is based on Medicare which gives permanent residents access to doctors, specialists and public hospitals for little or no cost. It covers hospital treatment, bulk billed doctor visits and rebates for certain medical services like optical care. For many people this is all they need.
Private health insurance sits alongside Medicare. It adds flexibility, choice and faster treatment for non-emergency procedures. It also gives you access to private hospitals and the doctor you want. Understanding how private health insurance works can help you decide if it’s worth it for you and your family.
Updated on 23 August 2024
Private health insurance covers services that Medicare doesn’t fully pay for. It helps reduce waiting times for elective surgery, lets you choose where you are treated and can even lower your tax if you earn above a certain income.
There are two main types of cover, hospital cover and extras cover. You can buy one or both depending on what you need. Hospital cover helps with costs when you are in hospital. Extras cover helps with services you use outside hospital like dental, optical and physiotherapy.
Many people think you must buy both but that’s not true. You can buy hospital cover with one insurer and extras with another. Some combined policies have both under one premium which can be convenient but isn’t always cheaper. Comparing both options is the best way to see what works for you.
Hospital cover pays for treatment and accommodation in a private hospital. It can also pay for your choice of doctor and certain fees in public hospitals. It gives you the freedom to avoid long public waiting lists and choose when and where you have your procedure.
Hospital cover doesn’t pay for services outside hospital like scans or specialist consultations before or after surgery. Those are usually paid for by Medicare or out of pocket.
People who earn more than $101,000 a year as singles or $202,000 as couples may also save on tax with hospital cover. Without it they pay the Medicare Levy Surcharge. For some that makes hospital cover worth it even if they rarely need hospital treatment.There’s also an incentive to get cover before you turn 31. The Lifetime Health Cover loading adds 2% to your hospital premium for every year you delay after your 31st birthday. Waiting 10 years could mean paying 20% more for the same cover. Joining early prevents that extra cost.
Extras cover pays for services used outside hospital, sometimes called general or ancillary treatments. These include:
Each policy has an annual limit on how much you can claim. For example you might get up to $400 for dental and $200 for optical. After you hit your limit, you pay the rest yourself.
Extras cover doesn’t reduce your tax and doesn’t affect Lifetime Health Cover loading. Some people buy it for peace of mind but never use it. Reviewing how often you use extras each year helps decide whether to keep or cancel it.
Combined cover is hospital and extras in one policy. It can be easier since you only deal with one insurer and one bill. But it’s not always the best value.
Before you choose a combined cover, think about what you actually use. Someone who never goes to the dentist might not need extras while someone who exercises often and sees a physio might find extras worthwhile. Buying hospital and extras from different funds may sometimes be cheaper overall.
All hospital cover in Australia is grouped into four tiers: Basic, Bronze, Silver and Gold. These help you compare policies across insurers.
Each tier must meet government standards but insurers can add extra benefits. That means two Silver policies might not include the same treatments. Comparing the details helps you make sure you’re getting value for what you pay.
The government encourages Australians to take out private hospital insurance with several incentives.
The Medicare Levy Surcharge (MLS) applies to higher income earners without hospital cover. Having hospital insurance removes this charge.
The Lifetime Health Cover (LHC) Loading increases premiums by 2% for each year you delay taking out hospital cover after 31 and up to 70%.
The Private Health Insurance Rebate reduces your premiums based on your age and income. Singles earning under $101,000 or families earning under $202,000 get the full rebate.
These incentives mostly apply to hospital cover, not extras. Extras policies alone don’t protect you from tax surcharges or loadings.
Ambulance transport is not covered by Medicare. Depending on where you live your state may cover you or you might need a separate policy.
Queensland and Tasmania: Ambulance is covered by the state.
Victoria, South Australia, Northern Territory and rural Western Australia: You can buy a state ambulance subscription or add it to private cover.
New South Wales, ACT and metro Western Australia: Ambulance is usually included with private hospital or extras cover.
Always check what your policy includes. Some funds only cover emergency transport or exclude air ambulance. Knowing your coverage before an emergency prevents any surprises later.
All insurers have waiting periods before you can claim certain benefits. For hospital cover, these are usually 2 months for most treatments and 12 months for pre-existing conditions or pregnancy. Extras cover has similar rules, with longer waits for major dental and hearing aids.
When you switch insurers you usually keep your waiting period status for the same level of cover. If you move to a higher tier or lower excess, a new waiting period may apply for the difference.
Switching funds is easy. Your new fund handles the transfer and ensures you have continuous cover. Many people switch to save money or get better benefits and it can often be done within a week.
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Premiums go up every April 1st and that’s the perfect time to review your policy. Many Australians stay with the same fund for years without checking what else is available. Comparing policies means you’re not paying more than you should.
Every policy has a Private Health Information Statement (PHIS) that explains what’s included. These are available at privatehealth.gov.au. You can use them to compare inclusions, exclusions and limits before switching.
When reviewing your policy, focus on what you actually need. Health needs change over time and your insurance should keep up with it. You might not need pregnancy cover anymore or you might want more cover for heart or joint treatments.
There are a few things to consider before changing funds.
Benefit limits are the highest amount you can claim for each service. These may be set as dollar figures or percentages.
Lifetime limits apply to some treatments like orthodontics. Once you reach them, you can’t make another claim for that service.
Extras cover lets you see what services you use most and how much you can claim each year per person and per family. Policies differ, and some cap how much you can claim across several services.
Some funds give small discounts for paying yearly or through direct debit.
Members who stay longer might get loyalty bonuses such as higher limits or rewards though these are usually lost when changing funds.
Checking these details means you don’t lose valuable benefits or miss out on savings.
Not everyone needs top tier cover. Some people keep hospital cover just to avoid the Medicare Levy Surcharge or LHC loading. A cheaper Basic or Bronze policy will still protect you from those charges and keep your LHC status. You can upgrade later according to your needs.
Extras cover is optional. Worth keeping if you use dental, optical or physio services often. If not, cancelling extras will save you money without affecting tax or loading.
Health insurance should make sense for your situation, not cost you money you never claim back.
A good policy is about more than price. It’s about value and usability.
When comparing, look for:
Policies with gap agreements help avoid surprise bills. These agreements set a standard rate between the insurer and the hospital or specialist.
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One of our experts will be in touch shortly.
In the interim if you would like to speak with us, please call us on 1300 786 045
Back to HomeThere are times when sticking with what you have is the right move. You may have benefits or loyalty bonuses that new members don’t get. You may also like the customer service or claims process of your current fund.Â
If your cover matches your needs, claims are sorted out with ease and your preferred doctors or hospitals are included. Staying with what you have can be a good choice.
CheapBills helps Australians compare health insurance policies across a wide range of funds. We work with:
Our team will help you understand what you’re paying for and where you can save. Switching is easy, you keep your waiting period status for equivalent cover and your new insurer manages the transfer.
Health insurance should work for you. Knowing what’s in your policy, understanding your rebate and reviewing your cover each year keeps costs down.
The public system is good but private cover gives you choice and flexibility. The right policy depends on your life stage, health needs and budget. Comparing regularly helps you stay covered without paying for what you don’t use.
CheapBills makes that easy. We help you find a policy that fits, keeps you covered and saves you money in the long run.
Senior Content Creator
Filza writes about energy, internet, insurance and moving tips at Cheap Bills. She breaks down what you need to know when comparing providers, switching plans or setting up services at a new place. See full bio
Find answers to common questions about Health InsuranceÂ
Private health insurance covers services that Medicare does not fully pay for. It gives access to private hospitals, shorter waiting times, and more choice over doctors. It can also help reduce tax costs for higher income earners.
You do not need both. Hospital cover helps with in-hospital treatment, while extras cover pays for services like dental and physio. Many people choose one based on usage rather than paying for both without claiming.
Hospital cover is split into Basic, Bronze, Silver, and Gold tiers. Each level includes more treatments. Basic covers limited services, while Gold includes all clinical categories, including pregnancy and more complex procedures.
The Medicare Levy Surcharge applies to higher income earners without private hospital cover. Taking out eligible hospital insurance removes this extra tax, which can make even basic policies worth considering for some households.
Yes, most policies include waiting periods. Standard waits are two months for general treatment and twelve months for pre-existing conditions or pregnancy. These rules apply across insurers and affect when you can start claiming benefits.
Switching is usually simple. Your new insurer handles the transfer and keeps your waiting periods for equivalent cover. Most changes happen within a few days, with no gap in cover when switching to a similar policy level.
Ambulance cover depends on your state and policy. Some states include it automatically, while others require a separate subscription or private cover. Not all policies include full ambulance services, so checking details matters before relying on it.

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