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*By switching from Silver + to Silver hospital cover & reducing extras coverage to better suit their needs on 31/03/2025 in NSW. Reduction may change with future rate rises.

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Our customers are paying less

Richard lowered their annual premium by

0

By switching his Silver+ hospital cover & reducing extras coverage to better suit their needs on 31/03/2025 in QLD. Reduction may change with future rate rises.

Sandra lowered their annual premium by

0

By switching from Silver + to Silver hospital cover & reducing extras coverage to better suit their needs on 31/03/2025 in NSW. Reduction may change with future rate rises.

Shane and Alex increased their hospital cover & lowered their annual premium by

0

By switching from Bronze+ to family Silver hospital cover & reducing extras coverage to better suit their needs on 1/04/2025 in QLD. Reduction may change with future rate rises.

Mark lowered their annual premium by

0

By switching from Silver+ to Silver hospital cover & reducing extras coverage to better suit their needs on 12/05/2025 in VIC. Reduction may change with future rate rises

What are the different types of health insurance?

We’ve compiled this table to show the different types of health insurance and what services each one covers. This information should be used as a guide only and you should always check policy documents for specific details.

Hospital Cover

Provides cover for medical conditions that require inpatient hospital treatments, such as medically necessary elective surgeries.

  • Avoid public hospital waiting times when you are treated in a private hospital
  • Available in four tiers: Basic, Bronze, Silver, Gold
  • Be treated as a private patient in public or private hospitals
  • Choice of specialist/doctor (subject to availability)
  • Stay in a private room (subject to availability)
  • Can help you avoid paying the MLS if you earn over the income thresholds
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Extras Cover

Extras cover, also called ancillary or general cover, pays benefits towards some eligible services not covered by Medicare, including dental, physiotherapy and prescription glasses.

  • Receive cover for eligible out of hospital treatments
  • Can cover some non-PBS pharmaceuticals
  • Policy options for singles, couples and families
  • Won’t help you avoid the MLS (if applicable)
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Hospital and Extras Cover (Combined Cover)

Combined cover includes both private hospital and extras cover under a single policy with one health fund.

  • Provides cover for both inpatient hospital treatment and eligible out of hospital services
  • One policy means one premium payment for both hospital and extras
  • One contact point for all your health insurance needs
  • Having hospital cover helps you avoid MLS (if applicable)
  • Extras helps pay for eligible services Medicare doesn’t cover
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A guide to health insurance

Updated September 2025
Written by Joshua Wildie
Reviewed by Kenneth Young
Expert reviewed by Steven Spicer

Dr Ginni Mansberg explains the benefits of having private health insurance

Ginni Mansberg
Health insurance expert
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Expert tips for comparing health insurance online

Our health insurance expert, Steven Spicer, has some helpful tips for finding the right health insurance policy for you.

Steven Spicer
Executive General Manager – Health, Life & Energy

Flexibility is key

Flexibility is one of the key benefits of private health insurance. For example, any waiting periods that you have already served will be recognised by your new fund if you switch to the same or lower level of cover.

Buy for your current needs

When selecting your coverage, it’s a good idea to consider what you might need to include on your policy right now or in the near future. The great thing about health insurance is you can upgrade at any time, just keep in mind that you may need to serve a waiting period for any upgrades. In hospital cover, most waiting periods are only 2 months, excluding pregnancy and birth and most pre-existing conditions which will incur a 12-month waiting period

Get the right level of cover

Deciding on the right level of cover can be vital. It could mean the difference between being covered or leaving yourself out of pocket. Some choose to take out hospital cover alone, while others consider extras only, or a combination of the two.

What is private health insurance?

Private health insurance provides cover towards some healthcare costs not covered by Medicare, up to the limits of your policy. There are two types of private health insurance: hospital cover and extras cover.

Private hospital insurance pays a benefit towards medically necessary treatment as an in-patient in hospital. Extras cover pays a contribution towards many out-of-hospital medical treatments like physiotherapy or dental care. For the benefits of both types of cover, you can take out a combined cover policy.

Why should I take out private health insurance?

How does private health insurance work?

Levels of cover

What does private health insurance cover that Medicare doesn’t?

The public and private healthcare systems complement each other. When you have hospital cover and are treated in a private hospital, both Medicare and your health fund can contribute to the cost. When you have extras cover, your health fund helps you pay for out-of-hospital services that aren’t covered by Medicare, such as dental, optical and physio.

If you’re admitted to a private hospital as a private patient, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee for your procedure. Your private health insurance pays the other 25%, as well as contributing towards accommodation costs and theatre fees. There may be a ‘gap’ between the MBS fee and the total cost of your procedure. You may have to pay this gap, or your health fund may cover some or all of it.

Extras cover

Pregnancy

Dental

Optical

Other medical and allied health services

What is private health insurance comparison?

Private health care comparison is the process of comparing different providers and policies and evaluating which is the best fit for your health needs, lifestyle and budget. Some key factors to keep in mind when comparing include:

  • The type of cover you’ll need (e.g. hospital, extras or combined)
  • Level of cover you need
  • Waiting periods you may need to serve
  • Benefits
  • Policy exclusions

Comparing policies allows you to see what options are on the market and can help you find a policy that better suits your needs.

Which is the best health insurance for me?

Private health insurers in Australia

Premiums, charges and tax breaks

How much does health insurance cost?

How to get cheaper health insurance

Is private health insurance tax deductible?

What is a health insurance excess?

What does ‘no gap’ mean in health insurance?

Private health insurance waiting periods

If it’s the first time you’re taking out health insurance or you’re upgrading your policy, you’ll typically need to serve a waiting period before you can make a claim. The length of this waiting period will depend on the clinical category or inclusion.

The good news is that if you’re switching to a policy with the same or lower coverage, you won’t have to re-serve any waiting periods you’ve already completed. If you’re upgrading your policy, you’ll only have to serve waiting periods for additional inclusions you didn’t have in your previous policy.

Waiting periods for hospital cover

Waiting periods for extras cover

Ambulance cover

Medicare doesn’t pay for ambulance services. You can get cover for ambulances  from some private health insurers, and people in Queensland and Tasmania have ambulance services covered by their state governments, you are covered throughout Australia.

Some ambulance services offer memberships to cover the costs of transport and treatment. Many health funds offer ambulance cover that you can buy on its own, or there may be some ambulance cover included on your health insurance policy.

Even if you’re covered in your own state, this may not apply when you travel interstate. To avoid out-of-pocket ambulance costs while travelling interstate, residents in all states or territories (except for Queensland) may need private health insurance with nationwide ambulance cover or a domestic travel insurance policy.

The table below outlines how ambulance services are covered across Australia.

NSW

The NSW state government subsidises 49% of the cost of ambulance services for people who don’t have ambulance cover. Otherwise, ambulance cover is widely available through registered Australian health funds in NSW.

NSW residents with a Health Care Card, Pensioner Concession Card, Commonwealth Seniors Health Care Card and who otherwise meet NSW’s exemption criteria can access ambulance services at no cost

VIC

Residents of VIC can take out ambulance cover through a registered Australian health fund or a subscription from the state ambulance service.

VIC residents who hold a Pensioner Concession Card or Healthcare Card are entitled to free ambulance cover.

QLD

The QLD state government covers ambulance services for their residents in both QLD and around Australia.

If you receive a bill for ambulance services in another state or territory, you can forward it, along with proof of QLD residency, to the Queensland Ambulance Service.

WA

Residents of WA can take out ambulance cover through a registered Australian health fund or a subscription from the state ambulance service. WA residents who are aged Pensioner concession holders may be entitled to free ambulance transport services.

Western Australians over 65, and in receipt of an Australian Government pension, are entitled to free ambulance services.

Western Australians over 65, who do not receive an Australian Government pension, are entitled to a 50% discount off the cost of ambulance service.

SA

Residents of SA can take out ambulance cover through a registered Australian health fund or a subscription from the state ambulance service.

TAS

Ambulance services in TAS are free for residents, except for motor vehicle or workplace accidents, which are covered by state insurance. Unlike QLD, Tasmanians can only receive free ambulance cover in their state. Therefore, Tasmanians should consider taking out nationwide ambulance cover or buy travel insurance before travelling interstate.

ACT

Residents of the ACT can take out ambulance cover through a registered Australian health fund.

People who meet the ACT Ambulance Service’s exemption criteria (including Pensioner Concession Card and Healthcare Card holders) are entitled to free ambulance services.

NT

Residents of NT can take out ambulance cover through a registered Australian health fund or a subscription from the state ambulance service. NT residents who are Pensioner Concession Card or Health Care Card holders are entitled to free ambulance cover.

The cost for Australia’s top surgeries

When you receive an elective surgery included on your hospital insurance policy as a private inpatient, Medicare will pay 75% of the Medicare benefit schedule (MBS) fee for the cost of your procedure. Your private hospital insurance will pay the remaining 25%.

Because private specialists are allowed to set their own fees, there may be a difference between the MBS fee and the actual cost you end up being charged, known as the ‘gap’. Depending on your policy and treating doctors, this gap may be partially or fully paid by your health fund through their gap cover scheme.

There are also various hospital fees associated with private treatment, such as accommodation, theatre fees, and medical devices. These hospital fees can get quite expensive; luckily, your health insurance can also cover some or all of these fees, although you may have to pay an excess or co-payment.

Any fees that aren’t covered by Medicare or your health fund will need to be paid by the patient. It’s a good idea to speak to your treating doctors and health fund prior to receiving treatment to understand any potential out-of-pocket costs.

Below are some of Australia’s most common elective surgeries1 and their typical costs in a private setting with private health coverage. Keep in mind that these are a general guide only and your own personal costs will vary.

The cost for Australia’s top surgeries

Why compare health insurance online?

With so many health insurance providers and policies available, it can be hard to know which one is right for you. Compare the Market can help you on your journey to find the best health insurance for you. You can compare health insurance through our free comparison service in minutes, or if you prefer a more personal approach, you can talk to someone at our expert run, Brisbane-based contact centre to discuss your options.

Meet our health insurance expert, Steven Spicer

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

Steven has 20 years of experience as a people-first business leader, with a focus on creating services that put customers first.

Steven Spicer, Executive General Manager

1 Australian Institute of Health and Welfare – Elective surgery waiting times, 2022-23. Accessed September 2024
2 Australian Department of Health and Aged Care – Medical Cost Finder – Cataract Surgery, 202-22. Accessed August 2025

3 Australian Department of Health and Aged Care – Medical Cost Finder – Cystoscopy with biopsy (examine bladder). Accessed August 2025

4 Australian Department of Health and Aged Care – Medical Cost Finder – Cholecystectomy. Accessed August 2025

Australian Department of Health and Aged Care – Medical Cost Finder – Total knee replacement. Accessed August 2025

6 Australian Department of Health and Aged Care – Medical Cost Finder – Femoral or inguinal hernia repair. Accessed August 2025

7 Australian Department of Health and Aged Care – Medical Cost Finder – Hip Replacement. Accessed August 2025

8 Australian Department of Health and Aged Care – Medical Cost Finder – Open abdominal hysterectomy. Accessed 2025
9 Australian Department of Health and Aged Care – Medical Cost Finder – Total prostatectomy. Accessed 2025

10 Australian Department of Health and Aged Care – Medical Cost Finder – Septoplasty. Accessed 2025

11 Australian Department of Health and Aged Care – Medical Cost Finder – Grommets/myringotomy. Accessed 2025.