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There’s a familiar narrative you’ll hear as you get older: healthcare doesn’t get any cheaper.

While health insurance can help you save you money, if you don’t have an up to date policy or a policy that really suits your needs, it can also quickly become unaffordable.

So, what should you look out for when it comes to health insurance in your 50s, and is it affordable?

What health issues should you look out for?

Every one of us has a different background and family history, which means we’re all susceptible to different conditions.

However, there are some trends. For example, large numbers of ageing Aussies are particularly susceptible to teeth decay and vision impairments. You will also have to look out for issues with joints, chronic illnesses, and more – all of which can be expensive to treat.

Based on your family history and your current health status, you probably already know what to look out for; including things like diabetes, prostate cancer or breast cancer and high blood pressure.

Does private health insurance do enough to alleviate medical costs?

a couple in their 50s reviewing health insurance

Private health insurance is an investment, one that truly pays off when you need it most. Indeed, older Australians tend to use their health insurance more often than younger generations, which is consistently shown in the Australian Prudential Regulatory Authority’s (APRA) statistics.[1]

Some operations can cost tens of thousands of dollars. When paying for these using a private hospital insurance policy, excesses and out of pocket expenses pale in comparison to the high cost of treatment paid for outright.

While you can simply seek out treatment as a public patient, you won’t have as much control over your healthcare. For example, a private hospital policy:

  • helps you avoid public waiting lists for elective surgeries and treatment;
  • provides benefits towards being treated in a private hospital, and in a private room (if one’s available);
  • allows you to choose the doctor who operates on you,
  • reduces the cost of private hospital treatment; and
  • helps you avoid having the Medicare Levy Surcharge (MLS) if you earn over a certain threshold.

An extras policy, on the other hand, covers treatment outside of a hospital, which you aren’t able to claim on Medicare anyway. Depending on your level of cover, extras can reduce your medical expenses for a range of treatments:

  • dental treatment
  • prescription glasses
  • physiotherapy
  • remedial massage
  • podiatry
  • psychology
  • pharmaceuticals not covered by the Pharmaceutical Benefits Scheme (PBS)
  • gym memberships and weight loss programs where medically necessary

Just how much can medical treatment cost?

For surgeries where you are treated as a private patient in a private hospital, Medicare covers 75% of the Medicare Benefits Schedule (MBS) cost, which is a price for various medical treatments the Government considers adequate for providing the service.

Typically, your health insurance covers the remaining 25% of the MBS for treatment and services that are included on your policy, but doctors, surgeons and other health professionals can choose to charge more for their services. This then leaves patients with an out of pocket cost, which is also known as a gap payment.

The cost of medical treatments varies based on what procedure you’re having done and who’s performing the operation. Let’s take a look at a couple different treatments as examples, such as a single hip replacement, colonoscopy and gall bladder removal.


TreatmentBenefits typically paid by Medicare (75% of MBS)Typical amount paid by insurerTypical doctors’ feesAverage out of pocket expense paid by patients*
Gall bladder surgery$1,200$1,100$2,700$350
Hip replacement (single)$1,900$1,900$5,000$590
*This figure is calculated after Medicare and private health insurance payouts were received and doesn’t include any costs charged by the hospital.
Source: Medical Costs Finder, Department of Health, Australian Government. 2022.

As the table shows, doctor’s fees can vary widely, and the number of people with private health insurance who have to pay out of pocket differs by surgery as well, but these out of pocket costs are significantly less expensive than if you paid for private treatment outright.

How much does health insurance cost for over 50s?

So if older generations use their health insurance more, does this mean their premiums cost more? Unlike other insurance products, health insurance is community rated, meaning that your individual risk factor and probability of making a claim doesn’t impact the cost of your policy.

This means if you take out the same level of cover as someone in their 30s, your base premiums should cost the same – though lifetime health cover loading and the government rebate can affect what you pay too.

Of course, if you make multiple claims in a year, you will also have to consider the cost of out of pocket expenses. However, some health funds offer no-gap or known gap health insurance if you visit a particular hospital or doctor. This can reduce or even eliminate ‘out-of-pockets’.

Everyone’s health status is different though, so your best course of action is to speak to an expert to see how a private insurer would help pay for services you’ll likely need to rely on.

Our experts are well-equipped to help you shop around. All it takes is one phone call or a few minutes of comparing on our website.

Plus, if we can’t find you a better deal, we’ll tell you to stay with your existing provider.

Want to retire in your own home? Learn more about ageing in place with our handy explainer.

[1] Quarterly Private Health Insurance Statics: September 2019 (released 19 November 2019). Australian Prudential Regulatory Authority, Australian Government. 2011.

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