You might have heard that one before.
So, is it true? Does taking out cover by 1 of July following your 31st give you an advantage in your 30s – and beyond?
First, we need to break down why there’s such a ‘deadline’ to getting health insurance. This is where Lifetime Health Cover loading comes in.
Lifetime Health Cover (LHC) loading is an Australian Government initiative that aims to encourage Aussies to take out – and maintain – a private hospital policy earlier in life. If applicable to you, loading increases the cost of your hospital policy premiums.
If you purchase complying hospital cover before 1 July following your 31st birthday and continue to hold cover, you won’t incur the Lifetime Health Cover loading for the length of time you hold hospital insurance.
Overall, this initiative is designed to take the pressure off our strained public health system.
LHC loading accrues at two per cent every year you don’t have hospital cover after 1 July following your 31st birthday. To avoid loading, you need to take out hospital cover before 1 July following your 31st birthday (or 1 July 2000, whichever is latest).
Loading is capped at 70%, and you’d only need to start paying it once you take out a hospital policy. If you never intend on taking out private hospital cover then you’ll never incur the LHC loading.
For example, at the age of 40, you would need to pay 20% more for your hospital premium if you hadn’t held hospital cover at any point since 1 July following your 31st birthday.
You take out a hospital policy before 1 July following your 31st birthday.
LHC loading doesn’t start accruing if you continue to hold this policy.
You don’t take out a hospital policy.
As such, your LHC loading starts accruing at two per cent every year until you take out cover – or until the loading hits the 70% cap (whichever occurs first).
Five years later, you decide to take out hospital cover. Your LHC loading is 12% and is charged on top of your hospital policy premiums.
Once you hold cover continuously for 10 years, LHC loading no longer applies (if you continue to hold cover).
Even if you’re one day late in taking out cover (2 July after your 31st birthday), you’ll accrue that two per cent loading. If you take out cover a year later, your loading will be even higher.
Here’s how much more you may need to pay annually if you’ve never had cover and take out a $1,800 policy at the following ages:
|Age||Your LHC loading (%)||How much extra you’ll pay annually*|
|65||70% (the cap)||$1,260|
|Based on a hospital policy that costs $1,800 each year (before the rebate is applied).|
You may fall under an LHC loading exemption category, though.
Days of Absence refers to the period where you can take a break from hospital cover and not accrue any LHC loading. This period totals 1,094 days (one day less than three years) throughout your lifetime.
If you use up your Days of Absence and don’t have a hospital policy, you will likely pay a LHC loading of two per cent for each year you didn’t hold hospital cover after 1 July following your 31st birthday on your hospital base premiums.
Let’s say you’re 39 years old. You’ve held your hospital policy continuously since you were 29, and therefore haven’t accrued any LHC loading.
You then take a break from your cover for two years (730 days) before resuming cover. As you haven’t used up all your Days of Absence, you haven’t accrued any LHC loading. Keep in mind that if you take a break again, you’ll only have 364 grace days before you’ll start accruing LHC loading.
You’re 41 and already paying a six per cent loading on your policy, as you didn’t take out cover by 1 July following your 31st birthday.
You’ve held cover continuously for the last eight years but decide to take a break – and you end up using all your Days of Absence. Once this grace period lapses, your LHC loading would increase to become an eight per cent loading. You take up cover again, so this loading doesn’t increase by another two per cent in the next year.
You may be eligible for an LHC loading exemption or a delay in loading if you fall under one or several groups outlined below:
If you’re an Australian resident and will be overseas on 1 July following your 31st birthday, you have a 12-month grace period to purchase hospital cover before attracting LHC loading. This grace period starts from the day you arrive back in Australia.
For any return visits you make to Australia for up to 90 consecutive days, you will still be considered overseas for LHC purposes. If you’re in Australia for longer than 90 consecutive days, your 12-month grace period will commence from the date you returned.
If you don’t purchase hospital cover before this grace period ends, you’ll be charged LHC loading as per usual if you didn’t take out hospital cover during the grace period.
If you’re heading overseas for a short period, you can reach out to your fund and apply to suspend your membership. If your fund agrees, this suspension period won’t count towards your 1,094 Days of Absence.
This suspension period will be treated as if you still hold cover, and you’ll not accrue any LHC loading. As this can vary between providers, it’s important you talk to your fund before suspending cover.
You can also cancel your hospital cover if you’re going to be overseas for at least 12 months, and it won’t be counted towards your 1,094 Days of Absence. Any return visits to Australia that are longer than 90 consecutive days will start deducting from this 1,094-day period.
If you move to Australia after 1 July following your 31st birthday and take out hospital cover within one year of becoming eligible for full Medicare benefits (a green or blue Medicare card), you won’t be charged LHC loading.
However, if you don’t purchase hospital cover within this one-year timeframe, you’ll be charged the full LHC loading that applies to you – that is, a two per cent loading for each year after 1 July following your 31st birthday you didn’t have a hospital policy from a complying Australian health fund.
For example, if you were 35 and didn’t take out health insurance within one year of becoming eligible for Medicare, and you were looking to take it out now, you would be charged an LHC loading of 10% on top of your hospital insurance premiums.
The LHC loading you pay each year doesn’t count towards your annual Private Health Insurance Rebate. This means you cannot claim any LHC loading you’ve paid in that year.
You may need to pay a Medicare Levy Surcharge (MLS) if you earn over $90,000 a year as a single, or $180,000 a year as a couple or family. This is a tax charged on higher-income earners who don’t have private hospital cover. To see how you could be affected, try our Medicare Levy Surcharge calculator.