Health insurance for hospital care at home
Expert tips for choosing health insurance
Our health insurance expert, Steven Spicer, offers some tips on comparing and choosing health insurance options.
Steven Spicer
Executive General Manager – Health, Life & Energy
Consider your level of cover
The “best level of cover” isn’t going to be the same for everyone, so you’ll need to take your personal circumstances into account when deciding on the most suitable level of cover for your own needs. Taking into account factors such as health conditions and family history will help give you an idea of what clinical categories you’ll likely need and, therefore, the right level of cover for you.
Be aware of waiting periods
If you’re taking out private health insurance for the first time or are upgrading your policy, chances are you’ll need to serve waiting periods before you can make a claim. Waiting periods for hospital cover are 2 months for most categories. However, certain categories, such as pregnancy, have waiting periods as long as 12 months. Waiting periods will also be 12 months if you have a pre-existing condition. It is crucial to plan ahead and be aware of waiting periods to make sure you are covered when you need it most.
Read your policy documents
Whenever you take out a new policy, it’s important you understand exactly what you’re covered for. For example, health funds may only cover hospital care at home for specific treatments, and there may also be specific criteria your case needs to meet to qualify. Reading your policy documents will help give you the peace of mind that you have the cover you need.
What is hospital care at home?
Hospital in the Home (HITH), or hospital at home, is a service that helps provide short-term, professional, hospital-level care in a patient’s home or another location.1 It can be a substitute for in-hospital care for conditions that require ongoing monitoring or treatment. Although you’ll be receiving acute treatment at home, you’re still considered a hospital inpatient while receiving HITH care services.
Various care needs and support services – such as doctors, nurse practitioners, carers, allied health and some x-ray and blood tests can potentially be offered as hospital care at home.2 Rehabilitation programs for those recovering from major surgery or illness (e.g. joint reconstructions or replacements) often have at-home options for eligible patients. Referrals for HITH services can be received from your specialist, GP, hospital clinician or another health professional depending on your circumstance.
Hospital in the home services are available in both public and private hospitals, but who is eligible can depend on the program.1 For example, public HITH services may require you to be a public patient to access. The best way to find out whether you’re eligible for hospital care at home is to speak to your doctor or a member of your medical team.
Benefits of hospital in the home service
There can be advantages for both your physical and mental health by receiving personal care and treatment in the comfort of your own home. These benefits can include:2
- Reduce your hospital stay or avoid hospital admission altogether
- Spend more time with your family members, friends and pets, all of which can have a positive impact on health and wellbeing
- Comfort of a familiar environment, including your own bed and access to food you like
- Less travel to the hospital for both you and your loved ones
- More flexibility for when people can visit, with you and your loved ones deciding rather than the hospital
- Reduces some of the risks that can come with staying hospital, such as infection.
What treatments are eligible for HITH services?
Hospital care at home will only be an option when it’s safe and practical.1 Many procedures and health services must be performed in the hospital, so don’t expect hospital care at home to always be an option. While your health team will make the final call, the following treatments can sometimes be done in a patient’s home:3
- IV antibiotics for infections
- care for some respiratory conditions
- treatment for deep vein thrombosis and pulmonary embolism
- some complex wound care
- palliative care
- chemotherapy
- some post-operative care
- treatment for other conditions your healthcare professional deems appropriate for hospital care at home.
What eligibility criteria will I have to meet to get hospital care at home?
Every state and even hospital will have their own specific eligibility criteria for HITH services and your individual circumstances and health condition will also be a major factor in deciding the best treatment option for you. However, common eligibility criteria for HITH services include:4
- You would need to be in hospital if HITH wasn’t an option. In other words, your diagnosis requires acute care and couldn’t be treated by existing community services like a GP.
- Your diagnosis is that you can be safely and practically treated at home
- Your permanent or temporary residence is a suitable environment to provide and manage patient care
- You’re medically stable
- You have reliable transport available should you need to be taken to hospital
- You have reliable telephone access.
Are there exclusions from HITH services?
Not every case will be suitable for hospital care at home. You may not be able to access HITH services if there’s any concern your medical team won’t be able to provide the level of care and treatment you need from your home. Some examples of this include:1
- You require specialised or complex treatment that can’t be done in your home
- You have specific care requirements that can’t be met at home (e.g. ongoing dialysis)
- Your home is not deemed an appropriate environment for HITH
- Cases where HITH is not deemed a safe option (e.g. you’re not in a medically stable condition).
Health insurance for hospital care at home
If you have private health insurance, you may be covered for hospital care at home as a private patient. Many health funds will have provisions for home care services, especially if they’re part of a recommended recovery plan for surgery, rehabilitation or other medical treatment.
Usually, you’ll need to have the clinical category relevant to your treatment as part of your policy to have your at-home treatment covered. Therefore, it’s important you understand exactly what each clinical category covers and whether this will extend to HITH. Health funds and even individual policies will vary on what and how much they’ll cover, so be sure to read your policy documents to understand if you’d be covered for HITH.
Whether your private health insurance will cover you for hospital care at home will depend on a number of factors, including:
- Your medical condition
- Your health fund and your policy
- Your level of cover
- Your diagnosis and the recommendations of your medical team.
Private hospital cover
Private hospital cover pays benefits towards inpatient services for eligible members treated as a private patient in either private or public hospitals. This may include hospital care at home for some procedures, but this will vary depending on your health fund and policy.
Some of the benefits of being a private patient include:
- Choice in doctor or specialist (depending on availability)
- Choice of hospital or clinic (as long as they have a partnership with your health fund)
- Avoid public waiting lists for elective surgery
- Private room for recovery (subject to availability)
Extras cover
Extras cover pays benefits towards outpatient services that Medicare won’t usually cover. While extras won’t contribute to hospital care at home, some health professionals offer services like physiotherapy and remedial massage at home, which can potentially be covered by your extras policy.
How much does private health insurance cost?
The exact cost of a health insurance policy varies depending on your personal circumstances and what you’re purchasing. Some of the key factors that will influence your health insurance premiums include:
Will Medicare cover hospital care in the home?
If you’re treated as a public patient in a public hospital, your treatment will be covered by Medicare. This includes any HITH services that are considered part of your acute care.
If you’re receiving elective surgery through a public hospital, you may experience a long wait time due to high demand on the public system.
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.
Find out more about health insurance
1 Queensland Health – Hospital in the Home. Accessed August 2025
2 South Australian Health Department – My Hospital Home. Accessed August 2025
3 Monash Health – Hospital at home. Accessed August 2025.
4 Canberra Health Services -Hospital in home. Accessed August 2025.