Private Health Insurance in Australia

Consumers can purchase private health insurance to cover some of the costs of healthcare as a private patient. There are two types of private health insurance cover available – hospital and general.

• Hospital Cover: This helps pay for treatment and accommodation in a private hospital or a shared public hospital room. It can also give you faster access to certain treatments, private rooms, and a choice of doctor.
• Extras Cover (or General Treatment): Covers services like dental, optical, physiotherapy, chiropractic, and other health services that aren’t fully covered by Medicare. The extent of your cover depends on the type of policy you select and may include services such as home nursing, podiatry, physiotherapy, occupational, speech & eye therapy, glasses & contact lenses and prostheses (e.g. hearing aids).
• Combined Cover: A combination of both hospital and extras cover.
• Ambulance cover: This is available separately in certain states as a service offered by independent providers, combined with other policies, or in some cases is covered by the state government.

Most insurance providers offer combined policies that provide a packaged cover for both hospital and general treatment services, or you can buy separate hospital and general treatment policies to ‘mix and match’.

Though Medicare provides universal health insurance that delivers affordable, accessible and high-quality health care for citizens and permanent residents of Australia, individuals choose to take out private health insurance to have more health care options and to cover items which aren’t covered on Medicare.

Private health insurance is not compulsory in Australia, and people who opt to buy private health insurance can mix and match the levels and type of cover to suit their individual circumstances.

Private health insurance in Australia is a valuable option for those seeking faster treatment, additional coverage, or benefits not included in the public system. However, with the public healthcare system (Medicare) already covering a wide range of services, many Australians choose to use private health insurance to complement, rather than replace, the services offered by Medicare.

Levels of Coverage

Private health insurance policies in Australia vary in terms of coverage. You can choose a basic, medium, or top-level policy based on your needs and budget. The more comprehensive your policy, the higher the premium you will pay, but it offers broader coverage.

Choosing Private Health Insurance

When choosing private health insurance, you should consider:

• Cost: Premiums for private health insurance can vary widely depending on the level of cover, your age, and your insurer.
• Benefits: What services are covered, and what the waiting periods are for certain treatments or services.
• Exclusions: Be sure to check if there are exclusions or limits on certain treatments (e.g., pre-existing conditions or certain surgeries).
• Provider network: Some insurers have partnerships with specific hospitals or healthcare providers, which may limit your choices.

Private Health Insurance Rebate

The Australian Government provides a private health insurance rebate to make private health insurance more affordable. The rebate is income-tested and can be claimed as:

• A premium reduction (subsidy that reduces your premiums).
• A tax offset (if you are liable for income tax).

The rebate amount depends on your age and income. People aged 65 and older may receive a higher rebate.

Medicare Levy Surcharge: If you earn above a certain income threshold and do not have private health insurance, you may have to pay the Medicare Levy Surcharge, which is an additional tax to fund Medicare.

Popular Health Insurers in Australia

Some well-known private health insurers in Australia include:

• Medibank
• Bupa
• HCF (Hospitals Contribution Fund)
• Australian Unity
• NIB

The best way to start researching options is to visit Privatehealth.gov.au.