*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.
We do not compare all health funds in the market, or all policies from our partner funds, and at times certain funds or products might be unavailable. Learn more.
Richard lowered their annual premium by
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
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
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
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
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.
Provides cover for medical conditions that require inpatient hospital treatments, such as medically necessary elective surgeries.
Extras cover, also called ancillary or general cover, pays benefits towards some eligible services not covered by Medicare, including dental, physiotherapy and prescription glasses.
Combined cover includes both private hospital and extras cover under a single policy with one health fund.
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Hi, it’s Dr. Ginni Mansberg, GP and health commentator in the media. Today we’re talking about why you might need private health insurance. Australia is lucky enough to have an excellent medical system that helps you access healthcare for many medical problems.
At the same time, the federal government strongly encourages those who can to take out private health insurance as well. If you don’t have private health insurance and you earn above a certain threshold, you’ll pay a Medicare Levy Surcharge on your tax return. On the other hand, the government offers rebates on the premiums for some of us who do take out private health insurance. Your private health insurance is there in case you need it.
It’s there for those events that most of us don’t see coming. A tooth extraction, a busted knee or radiotherapy for cancer in an emergency, you’re covered through the public system. But if you need access to allied health professionals, reduced waiting times for surgery or you want treatment in a private hospital, having private health insurance could be really beneficial for you and your family. In Australia, There are over 30 insurers offering over 3,000 different health insurance products and it pays to shop around before you jump in.
Health insurance is not a one size fits all solution, and it’s worth getting some help to find the policy that’s right for you. Chat to the experts about whether private health insurance is a good option for you. And which one best suits your needs.
Our health insurance expert, Steven Spicer, has some helpful tips for finding the right health insurance policy for you.
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.
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
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.
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.
You might want to consider private health insurance if you value having more choice when it comes to your healthcare, such as:
You can purchase private health cover in a few different forms. Private hospital cover gives you the option of being treated as a private patient, so you can choose your own available doctor, stay in a private room (when available) and potentially avoid public hospital waiting lists, among other perks. When you receive treatment as a private patient, Medicare, in combination with your private hospital insurance, will cover you for 100% of the Medicare Benefit Schedule (MBS) fee. You may still have a gap payment, which is the difference between the MBS fee and the cost of your medical treatment if your provider charges above the MBS fee.
If you had a medical issue before taking out your hospital policy, it may be considered a pre-existing condition. Luckily, you won’t have to pay any more for your policy than someone without a medical history would, but you may have to serve a 12-month wait before you can claim on any relevant treatments.
Extras cover helps pay for the treatment you receive out of hospital that Medicare doesn’t cover. For out-of-hospital treatments listed on your extras policy, your insurance provider will pay either a percentage of the total costs or a set dollar amount. The amount you can claim may be subject to limits, such as lifetime, annual or sub limits.
Always check your policy brochure before claiming as limits, exclusions and waiting periods will apply.
For hospital cover, there are four tiers of cover: Basic, Bronze, Silver and Gold. The following is the minimum clinical categories each tier must include:
Though health funds are required to meet the minimum requirements of each tier, they can also add additional clinical categories through what’s known as ‘Plus’ products. For example, a Silver-plus policy could include a clinical category that’s usually only included in Gold tier, such as joint replacement. This could potentially allow you to get the cover you need without paying the higher premium of a higher tier.
Extras cover is also often available in different levels of cover. However, unlike hospital cover, there aren’t government-mandated minimum requirements for extras cover. This means health funds can create their own levels of cover and what these levels include.
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 helps you pay for services that aren’t covered by Medicare, like dental treatment and physiotherapy. In some areas, such as optical treatment, Medicare and private health insurance work together. Medicare can pay for your eye check and consultation with the optometrist, while your private health insurance helps you pay for your prescription glasses or contact lenses.
Cover for pregnancy and birth-related services is included in Gold hospital insurance policies and some ‘plus’ policies (like Silver Plus). Hospital cover for pregnancy and birth has a 12-month waiting period, so you need to have it before you get pregnant.
Private hospital insurance with pregnancy cover can help you to pay for:
Some private hospital policies also cover assisted reproduction services, such as infertility testing, in-vitro fertilisation (IVF) and gamete intro-fallopian transfer (GIFT). However, hospital insurance only pays a benefit towards in-patient care (i.e. the treatment you receive as a patient admitted in the hospital).
Dental cover is usually only available through extras cover, but private hospital policies can help pay for dental treatment and operations you have in hospital. What’s covered by your policy depends on your level of cover, but generally dental check-ups are standard.
Your health insurance provider will usually set annual limits on how much you can claim for dental. You can check this in your policy documents.
Optical services and products can be included on either hospital or extras policies, depending on your needs. Treatments you get in hospital will come under hospital cover, while extras cover can help pay for eyewear.
Depending on your policy, your extras health insurance might help you pay for other services such as:
When looking at potential policies, consider which services you’ll need and likely use. Knowing which services you want will help you determine the right level of cover for your needs.
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:
Comparing policies allows you to see what options are on the market and can help you find a policy that better suits your needs.
The best fund for you will depend on your unique circumstances. Thanks to our handy private health insurance comparison service, we make it even easier to find health insurance. With our free tool, it takes only minutes to compare policies side-by-side to find great-value cover that suits your family’s needs. Our partner funds are:
We do not compare all health funds in the market, or all policies from our partner funds, and at times certain funds or products might be unavailable. Learn more.
Below is a list of all registered health funds in Australia. Policies are sometimes sold under secondary brand names or by another company, which aren’t included in this list.
The information provided is current as of August 2025 and sourced from the Private Health Insurance Ombudsman. This list is subject to change.
The cost of private health insurance in Australia depends on:
Private health insurance in Australia is community rated, meaning that you’ll never be charged a higher base premium than someone else for the same policy based on risk factors such as age, race, gender, pre-existing conditions or any other reason. However, several factors can still affect how much you pay in premiums or for premium increases, such as your level of cover, state of residence, rebates, discounts and LHC loading.
For hospital cover, policies are divided into four tiers (Basic, Bronze, Silver and Gold) which are priced accordingly. Taking out a higher level of hospital cover will naturally cost you more, although you can often reduce your premiums by agreeing to a higher excess instead. Extras cover levels are decided by the insurer and aren’t regulated by the government like hospital cover is.
Your premiums will also be influenced by your eligibility for an age-based discount, the Australian Government’s rebate and Lifetime health cover (LHC) loading.
While not tax deductible, private health insurance can still have an impact on your tax.
The private health insurance rebate is available to anyone who holds an eligible Medicare card and falls within the set income thresholds with a hospital, extras or combined health insurance policy. It can be claimed each year via your tax return. Alternatively, you can also choose to claim the rebate as a discount on your premiums instead.
Also, if you earn more than $101,000 as a single or $202,000 as a couple or family and don’t hold sufficient private hospital insurance, you could incur the Medicare Levy Surcharge (MLS). The MLS is a government surcharge added onto the taxable income of high-income earners who don’t hold private hospital cover. It is applied as a percentage of your annual income (e.g. 1-1.5%), which you’ll need to pay for the number of days in the financial year that you and your family didn’t hold suitable hospital coverage.
When you’re admitted to hospital as a private patient, you may have to pay a lump sum to your private health insurer, which is known as the excess. This could be in the form of a payment per hospital admission, but may only be for the first admission of the calendar, financial or membership year per person, depending on your insurance provider and policy. Choosing a higher excess may allow you to pay lower premiums.
You may also have to pay a co-payment, which is a set amount you’re required to pay each day you’re in the hospital. This is typically capped per hospital stay.
Each eligible hospital treatment has a Medicare Benefits Schedule (MBS) fee, a price the government believes is fair. Medicare pays 75% of this fee, while your health insurer pays the remaining 25%.
If your specialist charges above this fee, you may have to pay the extra amount not covered by Medicare and your private health insurance. Alternatively, your health fund may pay some or all of this gap.
For extras services, gap cover simply means that the health care provider doesn’t charge above your extras benefits limit and rebate, which results in no out-of-pocket costs.
Your insurer may have agreements with certain providers to eliminate or minimise out-of-pocket expenses. Be sure to check with your insurer before seeking treatment to understand what costs you may incur.
For more information, check out our page explaining gap payments.
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 are regulated by the government and are standard across the industry. If you have a pre-existing condition, it’ll extend the length of your waiting period for many clinical categories (usually from 2 months to 12 months). The table below offers an outline of typical waiting periods for hospital cover:
Service | Waiting period |
---|---|
Treatments for pre-existing health conditions | 12 months |
Birth-related services and pregnancy | 12 months |
Rehabilitation, palliative care and psychiatric care (even for a pre-existing condition) | 2 months |
All other conditions | 2 months |
Being aware of waiting periods allows you the chance to plan ahead. For example, if you’re planning on having children, you can take out a Gold-level policy 12 months before birth, so you’ll have the peace of mind that you’ll be covered in-hospital during delivery.
Unlike hospital cover, waiting periods for extras cover are not standardised and are decided by the health funds themselves. These waiting periods can vary from 0-2 months for services like dental and physio to 12 months for more expensive services such as major dental.
While extras cover waiting periods can vary, the table below provides some typical waiting times for some inclusions.
2 months | 6 months | 12 months | 1, 2 or 3 years |
---|---|---|---|
Physiotherapy and general dental | Optometry (e.g. glasses) | Major dental procedures, like crowns | Orthodontics and other high-cost procedures |
Sometimes, health funds may waive waiting periods on some inclusions as a promotion to attract new members, so it’s worth keeping an eye out for these offers. Usually, waiting periods will only be waived for inclusions with a shorter waiting period. A promotion is unlikely to waive a 12-month waiting period for an inclusion like major dental.
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. |
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.
Cataract surgery
Cystoscopy with biopsy
Cholecystectomy
Total knee replacement (single)
Femoral or inguinal herniorrhaphy
Total hip replacement (single)
Abdominal hysterectomy
Total prostatectomy
Septoplasty
Myringotomy
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.
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.
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
5 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.