On this page:

• Health insurance types and what they cover
• Will I pay more for health insurance later if I don’t get it now?
• Will I pay more in taxes if I don’t have health insurance? 
• Can I stay on my parents’ policy? 
• Am I eligible for discounts?

• What if I have a family or are planning to start one?

Taking out your own health insurance might seem like the logical thing to do when you move out of home or get a “real” job, especially if you’ve been covered by your parent’s family policy until now. 

The government starts providing incentives to buy health insurance once you turn 31 or start earning over $101,000 per annum (or $105,000 after June 30). But if you’re under 30, and don’t earn that much yet, is signing up for health insurance a savvy financial move, or a waste of precious funds?

We answer the key questions for under 30s thinking about taking out (or dropping) private health insurance.

Health insurance types and what they cover

The first thing you need to know is that there are two different types of health insurance: hospital and extras. 

Depending on your circumstances you may not need either of them. But even if you decide you need both, you can buy two policies from two different insurers to get a better deal.

Hospital insurance

Hospital cover, pays for treatment in hospital. It doesn’t help with the cost of things outside a hospital like dental or physio – for that you’ll need extras insurance, see below.

Hospital insurance can allow you to go to a private hospital, choose your own doctor and have shorter waiting times for elective surgery. However, if you have an accident you’re usually taken to and treated in a public hospital, which doesn’t require hospital insurance because it’s covered by Medicare. 

Government stats show that younger people generally get a lot less benefit from hospital insurance than older people. APRA publishes how much benefit people receive from their health insurance when they go to hospital, and they found that 20–29 year olds only receive a benefit of about $187 per year if they go to hospital, compared to $1655 on average for 80–89 year olds (12 months to March 2026).

Hospital cover is the only type of health insurance that affects Lifetime Health Cover loading (which kicks in once you turn 31) and the Medicare Levy Surcharge, which is an extra tax you need to pay if you earn over $101,000 per year and don’t have hospital cover.

So you could decide not to take out hospital cover right now, but revisit the decision when your circumstances change. Read more about these incentives below.

Extras insurance

Extras policies cover you for health care that you receive outside a hospital, and which Medicare does not cover, like dental care, glasses and clinical treatments like physiotherapy. Exactly which services are covered and how much money you get back for them varies from policy to policy.

Unlike hospital cover, extras insurance has no bearing on the Medicare Levy Surcharge or the Lifetime Health Cover loading, so the only thing to consider is simply whether you’ll receive more in benefits than you’ll pay in premiums.

Extras insurance is more like a budgeting tool than traditional insurance.

Start by adding up how much money you’ve spent on ‘extra’ health services in the last year and comparing that with the premium you’d pay to see which option is cheaper. (But keep in mind that extras policies don’t cover 100% of the cost.)

If you already have extras insurance, you can ask your insurer for a claims statement for the last year.

If you paid more in premiums than you received in benefits, you’re probably going to be better off cancelling your policy. Many Australians don’t get enough value from their extras cover to make it worthwhile.

Will I pay more for health insurance later if I don’t get it now?

Not if you’re under 31. 

You may have heard about the Lifetime Health Cover loading, a government initiative which means that if you take out hospital cover for the first time after you turn 31, you’ll pay an extra 2% on your premiums for every year you waited.

This sounds scary, but depending on your situation, it may be a better financial decision to delay hospital cover and pay the loading later. Our experts explain how you can pay the Lifetime Health Cover loading and save money.

However, while you’re under 31, this loading doesn’t apply to you and there will be no effect on your future premiums if you don’t take out cover now. It also won’t affect you if you never take out health insurance.

Will I pay more in taxes if I don’t have health insurance? 

Only if you earn more than $101,000 per year. Or $105,000 from July1, 2026.

The Medicare Levy Surcharge (MLS) is a tax-time surcharge the federal government charges high income earners who don’t have hospital cover. If you’re a single person earning less than $101,000 per year, or a couple earning less than $202,000, here’s no tax benefit to having health insurance 

If you earn over the threshold and want to calculate if having hospital cover will save you money at tax time, check out . 

If you do need to get a hospital cover policy for tax reasons, read our guide to the cheapest policies to save on tax or use our tool to compare health insurance to find the best-value cover for your needs.

Can I stay on my parents’ policy for free?

If you’re under 32 and a full time student, many funds (including Bupa, Medibank, HCF and NIB) allow you to stay on your parents’ policy for free.

If you’re not a full-time student, many funds still allow you to stay on your families’ policy, but charge an extra fee of between 15% and 50% of the total policy cost for an “extended family” policy. 

If there is an extra cost, it’s important to consider the health needs of everyone in the family to make sure they align, otherwise it’s probably cheaper to take out your own policy. 

Read more about things to consider and the different conditions funds have for dependents in our article of extended family policies. 

Am I eligible for any discounts?

If you do decide to take out health insurance before you turn 30, insurers can offer you a 2% discount off your premium every year you’re under 30, up to a maximum of 10% for people aged 18–25. 

Not all insurers offer the discount and not all policies are eligible for the discount, so shop around.

The good news is, if you stay on that policy, you’ll keep getting the full discount until you turn 41. Some funds will even let you keep your discount when you switch to a different policy, so it’s worth doing your research.

You’re also probably eligible for the health insurance rebate. If you earn $158,000 a year ($164,000 from 1 July) or less you get a discount of between 8% and 24% off health insurance premiums – depending on your income level – for hospital and extras cover.

Make sure you tick the right income box when comparing policies to make sure you’re seeing the correct price for you, both in our comparison tool, and health fund websites. 

What if I have a family or I’m planning to start one?

Pregnancy and birth

Luckily in Australia, both public and private hospitals offer high quality care for pregnancy and birth. 

The main advantage of using hospital insurance for private care is that you can choose your obstetrician and can give birth in a private hospital, which may be more comfortable. The downside obviously is private cover costs more.

Note too that specialist fees for appointments outside hospital aren’t covered though, so you will end up paying more than just your hospital insurance premium.

Read more about the pros and cons of private insurance for pregnancy. If you decide you want to go private, you’ll need to take out hospital cover 12 months before you give birth because of the standard waiting period. 

Family

Family policies generally cost the same as couples policies. This means that, for two-parent families, children are included on the policy for free.

However, single-parent families often pay the same as two-parent families, which makes it harder for single parent families to get good value from health insurance.

We’ve found the best health insurance policies for single parent families so don’t get ripped off. 

The bottom line

If you’re under 30 and not a high income earner, there’s no benefit to taking out private health insurance unless you plan to use it. If you do decide you need health insurance, you’ll want to get the best policy for your needs.

Our experts have created a tool to help you compare health insurance policies from dozens of funds – no sponsored results, no pesky phone calls, just impartial advice. 

The post 6 health insurance questions for under 30s answered appeared first on ĚÇĐÄVlog.

The decision about how and where you want to give birth, and if you want to go private or public, is very personal. We help you weigh up your options by looking at the pros, cons and costs of going public vs private.

If you already know you want to go private, jump straight to our expert picks for the cheapest health insurance for pregnancy and birth (accessible to ĚÇĐÄVlog members).

On this page:

• Do you need health insurance if you’re having a baby?
• Public hospital vs private hospital
• How much does it cost to give birth?
• Top four tips for pregnancy and health insurance
• Best policies with cover for pregnancy, birth and assisted reproduction

Do you need health insurance if you’re having a baby?

The short answer is no. In Australia, doctors in private and public hospitals alike provide high-quality care for pregnancy and birth.

The main advantage of going private is that you can choose the obstetrician who cares for you during your pregnancy and attends the birth. There’s also a better chance of getting a private room and your partner may be able to stay with you in the hospital.

However, there’s higher out-of-pocket-costs in a private hospital with private health insurance. With private health, you may have to pay a gap fee to your obstetrician, in addition to the health insurance premiums you already paid.

In a public hospital the cost of obstetricians and other specialists are covered by the public system.

Public hospital vs private hospital compared

Giving birth in a public hospital as a public patient

Pros

• Only very small, if any, out-of-pocket costs.
• Usually better facilities if you have a high-risk pregnancy or a sick or premature baby.
• Some hospitals have birth centres or midwifery programs where you can get more personalised, continuous care with your own midwife. Book in early as these programs are very popular.
• Lower rate of interventional births

Cons

• You often don’t know the doctor and midwives attending your birth and may see a different doctor/midwife each time (unless you are part of a continuous care program).
• Food and facilities may not be as nice as in a private hospital.
• You often have to share a room with other mothers and their babies.
• You may be cared for by junior doctors, who will call in a specialist when needed.

Giving birth in a private hospital as a private patient

Pros 

• Continuity of care with your own obstetrician and their midwives during your pregnancy.
• Food and facilities may be nicer than in a public hospital.
• Better chance of getting a private room and your partner may be able to stay with you.

Cons 

• High out-of-pocket-costs.
• Your obstetrician may be on leave or may not make it in time for the birth.
• You usually won’t know the midwives who attend your birth and provide postnatal care.
• Higher rate of interventions and lower rates of natural births.
• If your baby or you need intensive care, you may need to be transferred to a public hospital.
• Doctors and anaesthetists are often not on-site so have to be called in. 

How much does it cost to give birth?

Public patient

If you go to a public hospital as a public patient, you’d normally be fully covered by Medicare. But out-of-pocket costs could arise for:

• shared care with a GP who doesn’t bulk bill
• scans or pathology outside of hospital
• childbirth classes.

Private patient

Even if you have private health insurance, large and sometimes unexpected out-of-pocket costs can arise for private care. Health funds are not allowed to cover out-of-hospital care. Therefore, each time you visit your obstetrician, you may have out-of-pocket costs.

The amount depends on if and how much they charge above the Medicare Benefits Schedule (MBS) fee. The largest cost may be the pregnancy management fee – you’ll pay out-of-pocket costs between $1250 and $4550, with the highest costs being in NSW and the ACT.

Out-of-pocket costs as a private patient with health insurance for the birth itself usually range between $400 and $500, plus your excess for the hospital accommodation.

How to save money on your pregnancy if you have private health insurance

• Check with your health fund to find an obstetrician who uses the fund’s gap scheme for the birth and can attend to you in a hospital that has an agreement with your health fund.
• Use shared care with a GP who bulk bills.
• Ask your obstetrician to detail all costs beforehand.
• Consider being a private patient in a public hospital. It’s less likely that you’ll have unexpected out-of-pocket costs for blood tests, X-rays, ultrasounds, and the anaesthetist and paediatrician.
• Check with your health insurer to find out how soon you need to upgrade to family cover so that your baby is covered.
• Once you’re pregnant, check whether you’ve served the waiting period. If you give birth before the waiting period is up, consider going to a public hospital as a public patient. 

Top four tips for health insurance with pregnancy

1. Take out private health insurance well ahead of getting pregnant. There is a 12-month waiting period that applies to the date you’re admitted to hospital for the birth.
2. You won’t be covered if you have a premature birth within the waiting period or even if you give birth only a few days before the end of the waiting period.
3. Initially, only the person giving birth needs pregnancy cover. Once you’re pregnant, check with your health insurer how soon you need to upgrade to family cover so that your baby is covered.
4. Check with your obstetrician and the private hospital or fertility clinic whether they have a no-gap agreement with your health insurer. If they only have an agreement with another insurer, you can switch before giving birth without serving a waiting period for pregnancy, birth and assisted reproduction. 

Best policies with cover for pregnancy, birth and assisted reproduction

Exclusively for ĚÇĐÄVlog members, we list below the best policies in each state that cover pregnancy, birth and assisted reproduction. Log in to unlock this member-only content, or join ĚÇĐÄVlog to get instant access to all of our expert, independent reviews.

Our recommendations include open funds and restricted membership funds in every state. Find out more about the best restricted membership funds. Some of these funds are more “open” than you may realise, and they can offer great value policies. They’re for employees of specific industries or professions, such as the armed forces, teachers, union members or CommBank.

The post Best health insurance for pregnancy and birth appeared first on ĚÇĐÄVlog.

Every year, health insurers must seek government approval to increase their premiums on 1 April.

This year, the Minister for Health and Aged Care Mark Butler announced a 4.41% average annual increase to health insurance premiums across all existing hospital and extras policies. 

But until recently, the insurers only needed approval to raise premiums for existing policies, not new policies. This allowed them to quietly close an existing policy, and then open a new policy with the same or similar cover, but with a jacked up price – bypassing government oversight.

Thanks to this ĚÇĐÄVlog investigation that uncovered insurers use of the loophole, legislation is now progressing through parliament to shut it down. The new legislation will require funds to seek approval for new policies too, aiming to outlaw this practice, known as “phoenixing”.

ĚÇĐÄVlog has discovered that phoenixing has contributed to an increase in the price of Gold hospital insurance of about 71% over six years. The “approved” premium increase over the same period was just 21% across all hospital and extras policies.

Top cover even less affordable

A single person in 2021 paid around $239 per month, or $2874 a year, for Gold hospital cover (with a $750 excess). In 2026, they were slugged with premiums closer to $410 per month, or $4915 per year, on average for the same level of cover.

The big five health funds – Medibank, Bupa, HCF, HBF and NIB – have all implemented substantial price rises.

Our analysis, which compared policies available to new customers in 2021 with those available in 2026, found the cost of Gold hospital policies from the big five has skyrocketed, all with increases even higher than the Australian average of 71%.

Looking at Gold policies in NSW with a $750 excess, Bupa’s April 2026 Gold hospital policy cost 75% more than the policy they offered in January 2021. Medibank’s policy cost 85% more, and NIB’s Qantas Gold policy was 92% more expensive. But HCF’s whopping policy increase was more than double the average with a 147% increase.

In WA, HBF’s 2025 Gold policy was 97% more expensive than the Gold policy it was selling six years ago.

How it works: Close cheaper policies, replace with more expensive ones

As mentioned above, we’ve found many instances of funds closing existing policies to new members while at the same time opening new policies that offer essentially the same cover but with a slightly different name and a much higher price tag.

On 26 February 2025, the day the Health Minister announced the 2025 health insurance increase, HCF released Optimal Gold, with a NSW premium of $440 per month and closed (to new members) its Premium Gold with a cost of $325 per month with $750 excess.

This is an annual increase in the price of HCF’s Gold hospital cover of $1353, or a staggering 34.6%. And earned HCF a Shonky award.

In June 2022, HBF closed their Gold Hospital policy in WA, which cost $215 per month with a $750 excess. They then released their Gold Hospital Elevate policy to new members at $280 per month, which was essentially the same cover with a 30% increase in price.

In November 2023, Medibank closed its Gold Complete Hospital, which cost NSW customers $255 a month and released Gold Protect. This was essentially the same cover, but costs $300 per month at the same excess level – which is an extra $525 per year, or 17% more.

Other price jumps we found include these NSW policies with $750 excess:

• In August 2023 NIB closed their Qantas Gold Hospital policy, which cost $280, and released Qantas Gold Top Hospital for $325 (17% jump). 
• In April 2023 Bupa closed their Gold Complete Hospital policy, which cost $265, and released Gold Comprehensive Hospital for $305 (15% jump).
• In March 2022 HCF closed their Hospital Gold policy, which cost $235, and released Hospital Premium Gold for $285 (more than 21% jump).

For our analysis, we looked at individual policy examples in NSW for Bupa, Medibank, HCF and NIB, and we looked at WA for HBF. Read more under ‘How we calculated the increases’ at the end of this article.

New customers only shown the expensive policies 

We’ve also discovered that even when some funds keep cheaper Gold policies open to new customers, they don’t advertise them – they spruik their newer, pricier policies instead.

Medibank has two Gold policies available to new customers – at the $500 excess level there’s Gold Advanced, which costs $313 per month in NSW, and Gold Protect, which is $380 per month.

But only the Gold Protect policy is shown on the Medibank website. Medibank will go to great lengths to dissuade you from buying the cheaper Gold Advanced policy with the same cover.

In an inquiry with Medibank’s “virtual concierge” (online chat) we were told the “Gold Advanced isn’t marketable and that’s why it’s not on our website”.

If you call the insurer and specifically ask for it, you should still be able to buy the cheaper policy, but you may need to persist. You can search all currently available health insurance policies using our independent health insurance finder.

How to avoid paying too much for health insurance

With the sky-high increases to the cost of Gold hospital insurance over the past few years and another premium increase on the way, health insurance has become even less affordable for people who really need it.

If you opted for top level Gold hospital insurance “just in case”, now is the time to seriously think about dropping it or downgrading to more affordable cover.

And if you’re thinking of upgrading to a Gold policy – for example, if you’re planning to have a baby and want to deliver in a private hospital or you anticipate you’ll need premium cover in the next few years – don’t just automatically upgrade with your current fund.

We often see that the best deals available are with smaller funds and restricted membership funds.

To help you make sense of your options, our health insurance comparison tool lets you compare policies from over 40 insurers. We’re a nonprofit organisation and we don’t take any commissions, so you can be sure we’ll help you find the best policy for you (not what’s best for the insurer).

Do you need Gold health insurance?

Gold hospital insurance policies are designed for people who want to be covered for specific health needs. For example:

• young families who are planning to have a baby and want to deliver in a private hospital
• people who need hip or knee replacements or cataract eye surgery
• people who need end-of-life palliative care
• families with a child who has a serious eating disorder needing in-hospital care
• young people with mental illness and mothers with serious postnatal depression who need in-hospital psychiatric care
• people who need rehabilitation after an accident or stroke
• people who need weight-loss surgery
• people with chronic pain; for example, because of coronary heart disease.  

Why are the insurers increasing the cost of Gold Hospital policies?

Health insurers justify their price rises as they say they are in line with the increasing cost of health care, particularly on the services covered by Gold policies, as well as the risk profile and claims statistics associated with top cover Gold policies.

Nonprofit insurer HBF told us: “In looking specifically at our Gold policies, the claims HBF pays to members continue to be higher than the premiums we receive.”

Insurers also said that by opening new policies they were able to limit the premium increases for people on closed policies.

Australia’s creaking health system

Insurers, especially nonprofit funds, set prices based on their costs. But transparency is important, especially in an area such as health care where potentially sick and vulnerable people need to be able to rely on their health insurance.

When there is such a considerable difference between the highly publicised average premium increases and the reality of the higher prices affecting a range of Australians, it hinders our ability to make informed choices about health insurance.

Top level Gold cover is designed for the many Australians who have specific high-level needs, such as management for mental health conditions or care in a palliative or rehabilitation facility. 

Health insurers are using these sneaky tactics to inflate prices for people who need health insurance for things such as surgery, management of chronic pain, or end-of-life care. Often these are the people who can least afford higher premiums.  

Taxpayers fork out almost $8 billion annually to private health insurers. In return, private health insurance is meant to complement the creaking public Medicare system to help Australians pay their medical bills.

Instead, Australian taxpayers are propping up private health insurers who are selling us increasingly unaffordable health insurance.

The post ĚÇĐÄVlog shuts down health insurers’ loophole appeared first on ĚÇĐÄVlog.

Determining which health insurance policy is right for your family depends on the size of your family, how old your kids are, and everyone’s specific needs. If you’re just starting out then pregnancy cover may be top of mind. But if you’ve got teenagers, you may be more interested in orthodontics than birth cover.

If you’re a two-parent household with children, the value for money you’ll get out of private health insurance is (regrettably) much better than if you’re a single-parent household.

On this page:

• What health insurance do you need for families
• What to look for in health insurance for children
• Things to consider once the children leave home
• What does health insurance cost for a family?
• The best health insurance policies for a family

What health insurance do you need for families?

Finding the right health insurance for a family is all about balancing the health needs of your kids with your own health needs. For many families, the parents are more likely to need hospital cover than the kids are. But the kids might place a lot of demands on health costs out of hospital, which requires extras cover.

Extras cover for kids

The typical cover kids may need at this stage in life is:

• General dental – Routine treatment for check-ups, teeth cleans, scale and polish, local X-rays, fluoride and similar treatments. 
• Major dental – For more complex treatments like wisdom teeth extractions.
• Orthodontic – Cover for braces, plates and retainers. 
• Optical – Contributes to the cost of prescription glasses and contact lenses (eye tests are covered by Medicare, not your health fund).
• Psychology – You can’t claim from Medicare and private health insurance at the same time. So it’s more cost effective to obtain a Mental Health Care treatment plan from your GP for 10 sessions, and if your child needs more sessions than that in a calendar year, then use your extras cover.
• Speech therapy – Similar to Psychology, you can’t use Medicare and private health cover for the same appointment, so it’s better to maximise your use of Medicare rebates first.
• Non-Pharmaceutical Benefits Scheme medicines. Many prescriptions in Australia are subsidised by the government under the Pharmaceutical Benefits Scheme, but for prescriptions that aren’t you can use extras cover to subsidise the cost. Typical medicines under this banner may include melatonin and specialised ADHD medications.

The cost of extras policies across Australia that cover all these items ranges from $24 to $480 a month.

There are limits on the cover for each item, so it really pays to know what these items may cost your family each year versus how much you’ll have to fork out in insurance premiums (and how much they’ll pay back). 

If you already have health insurance, then it’s easy. Just ask your fund for a statement of claims for the last year, and weigh up what your fund paid you versus what you paid them, and the specialists.

If you don’t already have health insurance, ask your specialist for an estimate of what the costs for your child’s treatment may be in the next year, or in the case of orthodontics, the next few years.

What to look for in health insurance for children

Many health funds offer special benefits for kids. If you’re taking out health cover for your kids or switching to a better deal, keep an eye out for these features.

1. No excess or co-payments for children

Many funds have family policies that don’t charge an excess or co-payment for children who need to go to hospital.

ĚÇĐÄVlog tip: Basic, Bronze and Silver policies (with some cover restrictions) often charge an excess for children, so check the fine print before you sign up.

2. Free or discounted extras 

Some funds offer free or discounted extras services for children, such as dental check-ups or discounts on glasses. Note, though, that you’ll usually need to visit preferred providers to take advantage of these benefits.

3. Extended coverage for older children

Children and full-time students up to age 31 can often stay on the regular family policy for free. Older dependents and non-students can stay on an extended family policy for up to 30% extra on your premium.

Things to consider once the children leave home

Should you downgrade to a couples policy?

As couples mostly pay the same for health insurance as families, there’s no real advantage to switching to a couples policy.

However, as you both may have different health needs, especially for extras services such as dental, optometry and physio, it may make sense to switch to different singles policies. Singles policies usually cost half as much as a family or couples policy.

Should you downgrade to cover without pregnancy?

You could consider downgrading to a policy that doesn’t include cover for pregnancy and fertility if you’re done having children, or happy to use the public system.

But even though you might be happy to take out a policy that restricts conditions you think you won’t need – for example, pregnancy, fertility treatment and gastric banding – keep in mind that with these kinds of policies, health funds can change and add to the procedures that they exclude or restrict for Bronze Plus or Silver Plus policies without changing the classification of the policy.

So, unless you keep track of all the materials the fund sends you and you regularly check your policy, you might find yourself without cover for something you’ll actually need.

What does health insurance cost for a family?

Silver and Silver Plus health cover for a family policy with a $750 excess costs on average about $345 for Silver and $428 for Silver Plus (without the health insurance rebate). The cost varies depending on which state you live in, how much you earn, the level of excess, and when you first bought health insurance.

If you’d like something more budget friendly or simply to save on tax you might like to look at Bronze or Basic insurance.

The best health insurance policies for a family

It’s often better value to mix and match different hospital and extras policies from different insurers, but they’re not always easy to find.

So, exclusively for ĚÇĐÄVlog members, we’ve searched through our database to find the best hospital and extras policies for a family.

Log in to unlock this members-only content, or join ĚÇĐÄVlog to get instant access to all of our expert, independent reviews.

Hospital: We’ve selected Silver Plus policies that waive the excess for children. These policies include cover for the 26 standard categories of Silver services, including for a heart attack, cancer surgery and plastic surgery needed after a burn or accident, as well as cover for rehabilitation, and possibly more. We’ve narrowed our selection to the cheapest two policies from open funds, and restricted funds where they’re cheaper than the second-cheapest open fund. We’ve omitted funds with a high level of complaints. Prices are for two adults plus children with an excess of $750.

If you would like cover for a growing family, we have also reviewed the best policies for pregnancy, birth and fertility treatments like IVF.

Extras: We’ve selected extras policies for high usage under $200 a month (before the rebate) for a family of two adults and two kids. They cover dental, orthodontic and at least one other of the items listed above under �Extras cover for kids’. We’ve narrowed our selection to the top two extras policies from open funds and the top two from restricted funds, and omitted funds with a high level of complaints.

The post Best health insurance for families appeared first on ĚÇĐÄVlog.

On this page:

• How many Australians have private health insurance?
• Hospital insurance policyholders by age group
• Which health insurers are Australia’s biggest?
• Health funds and their brands

Private health insurance in Australia is a complex, ever-evolving beast. Cost-of-living pressures have affected industry trends significantly, with people balancing their health needs with their wallets.

Read on to find out more about who has private health insurance, what the latest trends are, and the major private health insurance players in Australia.

How many Australians have private health insurance?

From 2015–2019, the rate of Australians with private health insurance steadily declined, but this trend reversed during COVID-19. People took up private health insurance during the pandemic as they became more focused on their health.

Somewhat surprisingly, Australians took up extras cover as well, even though out-of-hospital health services such as dental, optical, chiropractic and physiotherapy were restricted due to social distancing. 

Currently, overall health insurance membership numbers hold steady.

In 2025:

• 55.3% of Australians have extras cover
• 45.6% of Australians have hospital cover
• most people have a combined health insurance policy.

Source: The Australian Prudential Regulation Authority (APRA).

It will be interesting to see how health insurance membership figures develop in the next few years.

Thinking about buying health insurance? Our experts explain what you need to know about hospital cover and extras cover as well as a few other things you should be aware of before you commit.

More Australians downgrading level of cover

While the proportion of people who have health insurance has been stable, the amount of coverage held by those who have a hospital cover policy has shifted in recent years.

Comprehensive private hospital cover, or ‘Gold cover’, has fallen from 40% of all hospital policies to less than 30% in the five years from 2020 to 2025. Premiums for Gold-level cover have also increased significantly over this time at a much faster rate than the overall average of all policies.

Increasingly, more Australian’s are downgrading their cover and choosing policies with exclusions. While downgrading coverage can be an easy way to reduce premiums, consumers should beware that they don’t love coverage for something they do need.

Hospital insurance policyholders by age group

When looking at total membership numbers for hospital insurance per age bracket, the highest amounts are in the groups aged 35 through 55 years – likely because there are more Australians in these age categories.

The proportion of the population with hospital insurance increases with age, though. People are most likely to have private hospital insurance when they’re aged 70 to 84.

Young adults aged 25 to 29 are the least likely age group to have hospital insurance. This group has generally matured beyond relying on their parents’ family policy for their health needs, but are not yet affected by the Lifetime Health Cover loading for hospital insurance, which kicks in at age 31.

They’re also less likely to incur the Medicare surcharge tax, which kicks in above a certain income if you don’t have hospital insurance.

If you currently have health insurance and want to check whether you’re getting the best deal, we developed a tool that lets you compare health insurance policies based on your needs so you can find cover that works for you, and potentially save yourself hundreds.

Which health insurers are Australia’s biggest?

Private health insurance in Australia is dominated by Medibank and Bupa, who hold 52% of the market between them, with HCF, NIB and HBF rounding out the top five.

• Medibank (including AHM) – 26.5%
• Bupa – 25.5% 
• HCF – 12.8%
• NIB – 9.8%
• HBF – 7.9% (most HBF members are based in Western Australia)
• Teachers Health – 2.6%
• Australian Unity – 2.1%
• GMHBA – 2.1%
• Defence Health – 1.9%
• CBHS – 1.4%
• Others – 7.4%

Market share of smaller health funds

There can be some distinct advantages to going with a smaller health fund. All health funds, big and small, are required to meet the same standards, and small funds will give you just as much choice over who treats you as larger funds – in a lot of instances, the smaller funds will even be cheaper.

These 18 health funds have less than 1% market share each:

• ACA
• AIA Health
• CBHS Corporate
• Doctors’ Health
• HCI
• Health Partners
• HIF
• Hunter Health (CDH)
• Latrobe Health
• Mildura Health Fund
• Navy Health
• Onemedifund
• Peoplecare
• Phoenix
• Police Health
• Reserve Bank
• St.Lukes Health
• Westfund.

Health funds and their brands

What can make health insurance confusing is the sheer number of funds you can choose from – something that gets trickier when you realise a single health insurer can operate multiple brands. In some cases it’s a matter of a premium brand and a budget brand, like in the case of Medibank (premium) which also operates AHM (budget). It’s the same for GMHBA (premium) and Frank (budget).

There are some funds with restricted membership which market themselves across multiple sectors. For example: UniHealth, Union Health, TUH Health Fund and Nurses & Midwives Health are all part of Teachers Health fund.

Some health insurers will sell the same policy under different brand names, and sometimes with different premiums. For example, NIB sells policies under the following brand names:

• AAMI
• Apia
• Australian Seniors
• Grand Union or GU (for corporate policies)
• ING
• Qantas
• Priceline
• Real
• Seniors
• Suncorp.

Other health insurers which operate different brandings:

• HBF operates the brands of Queensland Country Health and see-u
• RT Health is part of HCF.

When our experts analyse and compare health insurance, they compile data on thousands of policies from more than 40 insurers, including the brands that insurers like NIB own or administer. Unlike other comparison sites, we don’t take commissions from any insurers, which means we can show you more of the market and find the best-value policies that match your needs. 

The post Private health insurance industry statistics appeared first on ĚÇĐÄVlog.

We’re currently in the midst of the advertising blitz that health insurance providers inflict on us in the lead-up to 30 June – the time of year when many people consider switching or changing their cover for tax reasons.Ěý

Offers bouncing around include six to 12 weeks free of charge, waiting periods waived and discounts of up to hundreds of dollars.

Lifetime Health Cover

One of the groups targeted is 30–31 year-olds. This is because of a government surcharge, known as Lifetime Health Cover, that kicks in if you don’t have hospital cover by 30 June of the (financial) year you turn 31 and subsequently take out health cover any time in your future.Ěý

Although ĚÇĐÄVlog experts advise that taking out private health insurance may save you money at tax time if you earn more than $101,000, the situation is less clear cut for young people earning less than $101,000.

So before you rush into an agreement with a fund that’s wowed you with a sparkly offer, here are some things you need to consider.

1. Lifetime Health Cover loading doesn’t necessarily mean you’ll pay more

If you’ve been chatting to friends or family about health insurance, they may have mentioned that getting insurance when you’re still young could save you money on your policy when you’re older.

What they’re referring to is something called the Lifetime Health Cover (LHC) loading, a government initiative that means if you take out hospital cover for the first time after you turn 31, you’ll pay an extra 2% on your premiums for every year you waited.Ěý

But depending on your circumstances, ĚÇĐÄVlog health insurance experts say the LHC loading may not be as big a deal as it seems. In fact, in some cases it could be cheaper to pay the loading later than it is to buy health insurance now that you don’t need.Ěý

2. You may still be covered by your parents’ fund

Legislation passed in 2021 means that health funds are able to increase the age of dependants from 24 to 31.Ěý

This means if your parents have health cover and are with a fund that has increased the dependant age, you may still be covered by their policy until you turn 31 or 32 (there are factors that need to apply, such as you living with them and being financially dependent on them).Ěý

After that, if you decide you do want cover, you’ll have to take out your own policy. But don’t automatically go with the same provider your parents use – shop around to find the cheapest policy that suits your situation using our health insurance finder.

3. Even if you’re planning on having a baby at some point, you may not need health insurance

If you’re in your early 30s, you may be considering taking out private health cover in the event you fall pregnant.Ěý

You don’t need private health insurance to have a baby. Having private health cover will mean you can deliver in a private hospital with an obstetrician of your choice who manages your care throughout your pregnancy.

But the majority of people give birth in a public hospital under the care provided by Medicare (in 2021, nearly three in four women who gave birth in a hospital did so in a public hospital). And you don’t necessarily need an expensive Gold policy. See the cheapest policies with cover for assisted reproduction, pregnancy and birth.

Even if you decide you want to deliver privately, it still may be worth holding off taking out cover until you really need it (see point 1, above). Keep in mind, though, that many providers have a 12-month waiting period before you can claim on pregnancy and birth services.

4. Consider taking out health insurance for only a short time

If you decide you don’t need health insurance now but may need it in the future, for example because of starting a family or expecting your salary will increase beyond the threshold for the Medicare Levy Surcharge, there is a simple way to reduce any Lifetime Health Cover you might be paying in the future.

Take out the cheapest Basic cover policy before 30 June and keep it for a few months, then cancel it but keep your statement.

This gives you another three years to decide if you want hospital cover. You’re allowed to be without hospital cover for a total of 1094 days (i.e. three years less one day) during your lifetime, without affecting your LHC loading. This is known as ‘Days of Absence’.

So if you decide to take out hospital cover within those 1094 days after you cancelled your insurance, you won’t pay the LHC loading. If you don’t, your loading starts at 2% in the first year.

5. Will you earn more next year? Understand junk insurance 

If your income is nearing the $101,000 mark and you anticipate a pay rise in the coming year, it may be worth taking out a cheap, Basic policy. Some people will save money at tax time if they do – .Ěý

Some insurers promote Basic health policies as the best option if you’re just looking to save on tax – these Basic policies can help you avoid paying tax if you earn more than $101,000 a year.

These policies are known as junk insurance, as they’re often overpriced for what you get – a cheap policy that gives you very little cover. (If you anticipate actually using your cover, you should look at a Bronze policy or higher).

We’ve compared the cheapest Basic policies on offer.Ěý

And remember, if you’re taking out a policy to avoid tax, you only need to take out hospital cover, not extras cover. Read more about the difference between them.

The post Just turned 31? Here’s what you need to know about health insurance appeared first on ĚÇĐÄVlog.

If you think paying private health insurance premiums for years means a fee-free hospital experience, think again. 

You could still be up for consultation fees, the surgeon’s gap, an excess, a hospital co-payment and more. Tallying up a hospital bill can be mind-bogglingly frustrating.

In all of this, it’s easy to forget about the doctor whose job it is to put you under and keep you stable during surgery: the anaesthetist. 

You probably didn’t choose your anaesthetist, and you might not even meet them until the day of the operation – but there’s a good chance there’ll be a bill waiting from them when you wake up.

On this page:

• Will you have to pay for anaesthesia?
• How anaesthesia billing works
• How much will Medicare and your health insurance pay?
• Finding out your anaesthesia costs upfront
• What to ask your surgeon

Will you have to pay for anaesthesia?

If you’re using the public hospital system, and not private health insurance, then the public system will pay for your anaesthesia costs, and you won’t be left out of pocket.

For people using private health insurance, in two out of three cases the health fund and Medicare pay the entire cost for anaesthesia. Usually this outcome will involve using the health fund’s ‘no gap’ and ‘known gap’ schemes.

‘No gap’ scheme

The insurer sets an upper limit for how much they’ll pay over the Medicare Benefits Schedule fee (this is the fee the government sets for procedures, but a doctor may charge more). This upper limit is called the ‘no gap’ threshold. 

If your anaesthetist charges above the Medicare Benefits Schedule (MBS) fee, but under or up to the insurer’s ‘no gap’ threshold, you’ll be covered and have no out-of-pocket costs. 

‘Known gap’ scheme

If the anaesthetist charges more than the ‘no gap’ threshold, you may be able to take advantage of your insurer’s ‘known gap’ scheme. 

Usually, if the anaesthetist charges up to $500 more than the threshold, you pay only the difference between your health fund’s ‘no gap’ threshold and the doctor’s fee. The health fund and Medicare pay the rest. This usually limits your out-of-pocket costs to a maximum of $500.

But beware: if your bill is more than $500 above the ‘no gap’ threshold, your health fund will reduce the amount that they cover you for to the minimum that they’re required to pay by law, and you’ll have to pay the rest.

Here’s an example of how it might work:

• The MBS fee for your treatment is $400 (Medicare pays 75% of this and your insurer must pay the other 25%).
• Your health fund’s ‘no gap’ threshold for this treatment is $700, and the known gap threshold is $1200.
• If your anaesthetist charges you up to $700 for the treatment, you won’t pay any out-of-pocket costs.
• If your anaesthetist charges between $700 and $1200, your health fund and Medicare will pay $700, and you’ll pay the remainder (up to $500).
• But if your anaesthetist charges above $1200, your health fund and Medicare will pay $400, and you’ll cover the rest. So if they charge $1300, you’ll pay $900.

Here’s a table to provide another view of how it works. This is the same example as above: a treatment or procedure with an MBS-set fee of $400, for which the health fund has a ‘no gap’ threshold of $700 and a ‘known-gap’ threshold of $1200. 

Note that for the one in three people who do pay out-of-pockets costs, the average cost to them is $140.Ěý

Complex surgery more likely to result in a gap

Whether or not you’ll be paying out-of-pocket costs often depends on the type of surgery. 

“Private patients undergoing less common, more complex procedures are quite likely to incur out-of-pocket costs,” says Dr Mark Colson, Senior Member of the Australian Society of Anaesthetists (ASA) Economics Advisory Committee.

This is because complex surgery may require complex anaesthesia and post-operative pain management, he explains.

“Complex and longer surgery is much more likely to have gaps than shorter procedures such as cataract surgery, and furthermore, are much more likely to exceed known private health insurance gap limits,” says Dr Colson.

How anaesthesia billing works

Anaesthetists bill in ‘units’. The number of units they charge for a surgery depends on its complexity, including:

• the type of surgery
• the duration of the service
• whether any monitoring devices are used
• whether you have any additional interventions done to provide pain relief during or after surgery (e.g. spinal or epidural nerve blocks)
• the patient’s classification on a scale of illness severity
• the patient’s age if they’re under four years old or over 75
• after hours emergencies, which can attract a 50% penalty rate.

“A factor that may change your anaesthesia fee is whether, during your anaesthesia, there is a requirement to provide additional monitoring of your heart and blood pressure, for example,” says Dr Colson. 

“Your anaesthetist may also be required to administer a blood transfusion, and/or give you other appropriate blood products depending on medical conditions, medications taken, and whether you’re having emergency surgery.” 

How much will Medicare and your health insurance pay?

An anaesthetist sets their fees by the unit, not by the whole service. Everything has to be priced according to its relative unit weight. The only exception to this is the pre-anaesthesia consultation for which Medicare sets different amounts depending on how long the consultation lasts and the complexity of the surgery.

Medicare, insurers, and the medical profession all use relative unit pricing when they talk about anaesthesia billing. And they all have widely different views on what a fair unit price should be.

The Medicare Benefits Schedule says a reasonable unit price for anaesthesia is $23.10. The MBS was frozen from 2012 to 2019 while the cost of providing health care increased. Therefore, the Australian Medical Association (AMA) pegs it a lot higher at up to $100 per unit. 

What a health fund’s ‘no gap’ scheme will pay varies from fund to fund, but it’s between $38 and $42, with most funds fully covering you for around $39 per unit.

If your health fund has a ‘known gap’ scheme this gives you a bit of leeway if your doctor charges above the ‘no gap’ threshold. Usually, if the doctor charges up to $500 in total more than the ‘no gap’ amount for the procedure, you pay only the difference between the ‘no gap’ amount and the doctor’s fee. The health fund and Medicare pay the rest. This usually limits your out-of-pocket costs to a maximum of $500.

But beware, if your doctor charges only $1 more, instead of Medicare and your health fund covering you for around $39 per unit, your benefit goes down to $23.10 per unit and you can be left with a large out-of-pocket fee.

For the large majority, of the one in three people who have out-of-pocket costs a ‘known gap’ agreement is in place. For only 3% of people, there is no agreement used.

Finding out your anaesthesia costs upfront

It’s easy to assume an anaesthetist comes as part of your overall surgeon’s service. In reality, each specialty runs two distinct businesses, and will bill you separately for their work.

As a private patient, you have your choice of surgeon. But when it comes to other doctors present at your operation, your options are more limited.

A surgeon may work with several anaesthetists – one on this day, another at this hospital, a third on this type of operation. Likewise, an anaesthetist will spread their work among different surgeons.

And the cost may vary.

“Your anaesthetist will generally charge a fixed dollar rate for each unit,” says Dr Colson. “As with any other service, this rate can vary significantly between individual anaesthetists. For instance, one anaesthetist may charge $45 per unit, while another charges $65.” 

The surgeon usually chooses an anaesthetist based on availability and expertise, not price. The complicated game of musical operating theatres means that it’s all but impossible for a patient to ‘shop around’ for an anaesthetist. But, in some instances, it may be possible to use a cheaper anaesthetist by delaying or moving your surgery.

Informed financial consent (IFC)

This is the principle that a patient is entitled to be given an estimate of their out-of-pocket costs before going into surgery. Australian Society of Anaesthetists (ASA) guidelines say the day of surgery is a “less than ideal” time to be discussing costs, but it does happen.

ĚÇĐÄVlog member Helen says she ended up with more than $750 in gap fees for anaesthesia alone.

“I did not meet the anaesthetist until I was in the operating room with the tranquilliser already having been administered, at which point it was too late as my mind was fuzzy, and I was past the point of no return anyway,” she says. “What was I going to do? Climb off the table?”

Some anaesthetists are proactive about providing informed financial consent information. An anaesthetist ĚÇĐÄVlog spoke to has his patients fill out a medical history questionnaire, if the surgeon’s office agrees to pass it on.

He might also have a phone consultation with them where he talks them through the details of their anaesthesia and the probable costs. This information is then confirmed in a follow-up letter.

According to the ASA, best practice is for anaesthetists to speak to their patients ahead of the surgery, if the timeframe permits. But the onus is on the surgeon to give enough information to patients so that they understand who will be involved in the surgery and what costs may arise. 

Next to anaesthetists, an assistant surgeon, pathologists and radiologists can attract extra costs.

Ultimately, however, it’s up to the patient to be aware of the potential costs of surgery. Doctors sometimes take their patients’ capacity to pay into account when setting prices, so if you’ll struggle to pay a fee let them know – you may be able to negotiate a discount.

“Should you be experiencing financial distress, the best person to discuss this with is your surgeon, who may be able to assist you in finding a lower-cost solution for your surgical condition,” suggests Dr Colson.

“For instance, it may be possible to expedite your surgery in the public system, particularly if your condition involves some degree of urgency, such as cancer surgery.”

What to ask your surgeon

• What out-of-pocket costs can I expect for this anaesthetist?
• Did you choose this anaesthetist because of their experience or their availability?
• Do you work with any other anaesthetists who would charge a lower fee?
• Is it possible to use a cheaper anaesthetist by moving the date or location of the surgery?

What to ask your anaesthetist

• What is your unit price, and what factors determine it?
• Are you willing to bill using my private health insurance fund’s gap scheme?
• What out-of-pocket costs can I expect?
• Are you able to charge a lower unit price so I don’t pay a gap?
• Are we able to draw up a repayment plan so I can pay in instalments?

Remember:

• Most doctors have formal agreements with funds around gap fees. If yours doesn’t, that doesn’t mean you’ll automatically pay a gap. They just need to charge below your fund’s gap threshold. Any quote given before surgery is at best an estimate, since complications during the operation can increase the number of anaesthesia units.
• If you’re asked to pay the full fee upfront, get confirmation on whether
  this is the final price or if there could be additional charges.

The post How much will your anaesthesia cost? appeared first on ĚÇĐÄVlog.

Understandably, many older Australians with private health cover are feeling worried about the impact of the government’s latest changes to health insurance rebates. The government plans to remove age-based rebates, so that the rebates are solely dependent on your income. 

This will directly increase the cost of premiums for many Australians over 65, on top of the usual yearly premium price hikes. 

The government changes will reduce the rebate for some over 65s by 4%. While this is a substantial amount, ĚÇĐÄVlog research has found that insurers increased prices by almost double that amount this year for Gold hospital insurance – the health insurance that older Australians need the most. 

In fact, while the government changes will mean an unwelcome extra expense for many older Australians, our research shows that Gold-level cover has already been becoming increasingly unaffordable, with a 71% increase in the average cost of a policy over six years.

Proposed changes to health insurance rebates

Currently, Australians under 65 who earn less than $101,000 as a single person can receive a rebate of 24% on their health insurance premiums.

Australians aged 65–69 on the same income receive a rebate of 28%, and if you’re aged over 70, you get a 32% rebate.

The rebates shrink for higher incomes, and for couples and families the income thresholds are double that of a single person.

As of 1 April 2027, these rebates will be standardised onto the 24% rate, regardless of your age. So over-65s will get a 4% lower rebate, and over-70s an 8% lower rebate.

The government argues that basing rebates solely on income rather than age is a fairer system, with the Budget savings to be funnelled into additional aged care beds and care packages, both of which benefit all older Australians.

How the lower rebate will affect premiums

ĚÇĐÄVlog research indicates that the impact on the cost of premiums will be especially significant on the Gold-level policies, which older Australians need the most. 

Based on May 2026 prices, the average cost of a Gold-level policy for a 67-year-old single person earning under $101,000 would increase by $200, from $3590 annually to $3790. For a couple over 70, the average increase will be $800 a year if they earn less than $202,000 combined.

Increase in the average yearly cost of a Gold-level policy due to rebate changes*

How the insurers’ jacked-up premiums affect older Australians

The government rebate that you receive on health insurance is paid as a direct subsidy to insurers. You may pay less on your health insurance, but we’re still all paying insurers out of our taxes.

In spite of these subsidies, however, ĚÇĐÄVlog research has found that the insurers’ price rises have been driving Aussies out of Gold-level health insurance for years. 

In recent years, the price of Gold-level insurance has increased dramatically and at a much faster rate than the overall average for health insurance.

This year, the government announced an average increase in premiums across all health insurance of 4.41%. But ĚÇĐÄVlog found the increase applied by the big five funds to Gold-level cover was more than triple the average at 13.3%. 

For a single person, this amounted to a $555 annual increase to Gold-level cover, and for couples and families, a $1110 increase, before the rebate.

These dramatic double-digit percentage increases to Gold cover have been ongoing for several years and have pushed the price to unaffordable levels.

Where the annual cost of a Gold policy for a single person averaged $3010 in 2022 before rebates, the average price of equivalent policies is now $5000, an increase of almost $2000.

The government’s changes to rebates will increase premiums for some over 65s by 4%. But insurers have been increasing premiums for their Gold-level policyholders many times more than that amount every year, for at least the last six years.

Gold cover is especially important for seniors

As we age, we’re more likely to need certain types of treatments and surgeries. In 2023–24, those aged over 65 accounted for 44% of hospitalisations and 52% of the days spent in hospital, despite making up just 17% of the population. 

Many important and common treatments are only covered on Gold-level cover, including joint replacements (e.g. for hips and knees), and surgery for cataract removal and replacement.

You may be able to find coverage for these on cheaper Silver Plus policies, but it isn’t guaranteed. 

Insurers driving Aussies out of Gold hospital insurance

Despite the name and price, Gold coverage shouldn’t be a luxury item. It is simply the most comprehensive level of cover without exclusions.

The number of Gold policies being sold has fallen dramatically in just a few short years as consumers are pressured by price rises into downgrading their cover. 

In fact, while the percentage of the population with health insurance has remained steady at roughly 45%, the proportion with Gold-level cover has dropped from 40% in 2020 to less than 30% in 2025, with no sign of the trend changing as prices continue to rise.

Indeed, with many healthy people dropping their Gold-level cover, even more pressure is put on premiums as the average cost of claims rises.

Savings tips for seniors

A common question older Australians ask about health insurance is why should they pay for a policy that includes pregnancy and IVF services? These are covered by all Gold and some Silver Plus policies – but these tiers are also suited to people over 65 who want to be covered for surgery typically needed later in life, such as cataract surgery or hip and knee replacements. 

So before downgrading, make sure you shop around for other Gold and Silver Plus policies that cover the services you need – you may be able to find a cheaper option that offers the same coverage.

If you do decide to downgrade, make sure that the new policy is actually cheaper than what you were paying before, and that you’re still covered for things you do need, such as joint replacements. Keep in mind some Silver Plus policies might be a good option if you need to downgrade from your Gold-level cover.

Selecting a higher excess can also end up saving you money if you don’t make any claims for the first two years or so (you’re better off selecting a lower excess and paying a higher premium if you plan to claim soon). You can choose to pay a higher excess of up to $750 per person and $1500 per couple/family to reduce your premiums.

An excess is the amount of money you pay out of your own pocket towards a hospital visit. You pay an excess once per hospital visit, and it’s usually capped at once (single) or twice (couple/family) per year. 

If you are expecting an upcoming surgery, be sure to avoid policies that charge you an excess for day surgery. Cataracts are a common day surgery and some policies allow you to avoid the additional excess or daily co-payments for these.

Do you need Extras insurance?

Before dropping your hospital cover, you should also review your extras cover, which pays back a portion of the cost for services such as dental, optical and physio. The average cost of these policies is typically double the amount people actually claim in benefits, meaning that in many cases people are better off paying for these services upfront instead of through an extras policy.

The money you save by dropping this cover could be put towards a more comprehensive level of hospital insurance, which might be more worthwhile, depending on your needs.

The post Health insurance price rises penalising older Australians appeared first on ĚÇĐÄVlog.

Single-parent families are treated unfairly by health insurance providers in ways that don’t make a lot of sense.Ěý

While two-parent families usually pay the same premiums as couples (meaning their kids are insured for free), single parents are charged extra for their children’s health cover.

Single parent policies cost 60–70% more than single policies on average, and some funds even charge single parents the same premium as two-parent families.

This means it’s especially important for single parents to compare health insurance policies and see what their options are.

On this page:

• The four tiers of health insurance
• How Medibank and Bupa compare
• Should you downgrade your policy if you’re done having kids?
• Five steps to better, cheaper health insurance

The four tiers of health insurance

In Australia health insurance policies are categorised into four tiers:

• Basic – very little if any cover in a private hospital
• Bronze – low cover
• Silver – medium cover
• Gold – full or top cover.

In between these main tiers there are also Silver Plus, Bronze Plus and Basic Plus policies that cover at least one service more than the normal Silver, Bronze or Basic policies. For example, a Silver Plus policy could include cover for pregnancy or cataract surgery (services usually only covered under Gold policies).

Best health funds for single parents

Since April 2007, private health funds have been able to give single parents a reduced premium compared to the family rate. Before that time, health insurance regulation meant that single parents always paid the same premium as two-parent families. 

So single parents generally don’t pay as much as they used to, but they still pay more than singles without kids. And not all health funds charge single parents lower premiums than two-parent families.

ĚÇĐÄVlog tip: If you’ve been a loyal customer and stayed with the same fund and policy for the past 10 years or more, you may be stuck in the old system. Check with your insurer.

For the funds that do offer lower premiums to single-parent families, the amount can vary. Most of them charge single parents 10–40% less than two-parent families. On average, funds charge single-parent families 20% less than two-parent families for extras policies and 40% less than two-parent families for extras policies.

Policies offering single parents a better deal

The policies we found that penalise single parents the least are: 

• HCI Bronze Plus and Silver Plus policies, which cost 40% more for single-parent families compared to singles.
• Medibank Bronze Plus, which costs single parents 43% more than a single person without a child.
• Navy Health Gold, Silver Plus and Bronze Plus, which cost 45% extra on top of standard single cover.
• AHM Advanced Gold ($500 excess), which costs single parents 46% extra.

When looking at trends across all their policies, HCi, Navy Health, Latrobe and TUH are giving single parents the best deals, but they’re still charging an average of 40–50% more for single parents than single people without kids, when two-parent families pay the same as couples without children.

Worst policies for single parents

The below hospital policies charge single-parent families about the same as two-parent families.

• Reserve Bank (Bronze Plus and Gold policies) 
• Hunter Health (there are no policies specifically available for single parents, which means you have to pay for a family policy)
• NIB brands (AAMI, ING, NIB, Real, Suncorp and Seniors) Gold.

Check what’s included

Discounts aren’t everything. Some funds that charge single parents the same as two-parent families may offer cheaper policies with better value for money than other funds that do offer a single-parent discount. Use our comparison tool to review health insurance policies and see which ones are best for your situation and needs.

Special perks for kids

Some insurers give special treatment to kids, whether you’re a single or a two-parent family, including:

• no excess or co-payments for children if they need to go to hospital
• free extras services for children (if they go to the dentist, for example)
• extended coverage for full-time students on your family policy up to age 31 (an extra cost may apply for other young adults). 

Read more about the perks available for children in the best health insurance for families.

How the Big Five compare

On average, two-parent families are charged the same as couples without children for hospital and extras insurance, but single parents are always charged more than single people without children. The price difference for single people to add children to an extras policy tends to be greater than the price difference for doing the same thing on a hospital insurance policy. The big 5 are no exception.

So, how much more do the biggest five health funds charge to add children to single health insurance policies?

*We compared the cost of the same policy for singles vs single parents. How much more single parents were charged often varied from policy to policy. This is the range by which single parent prices exceeded those of standard single prices, broken down by insurer and policy type.

Should you downgrade your policy if you’re done having kids?

If you’ve finished having children, you may be considering downgrading to a policy without pregnancy and fertility cover – but this isn’t as simple as it might seem. 

In principle it makes sense not to pay for cover you won’t be using, but very few policies exclude pregnancy and fertility services without also excluding things you may still need, and those that do are often only a few dollars cheaper than full cover Gold policies. Some are even more expensive than policies that cover everything.

There’s another pitfall, too: policies that restrict or exclude some procedures can be changed to exclude more procedures. So unless you keep track of all the material the fund sends you and regularly check your policy, you might find yourself without cover for something you’ll actually need. 

In general, you tend to be better off with a policy that covers everything, as funds are much less likely to add restrictions to those.

How to find better, cheaper health insurance

We know getting a handle on this stuff can seem like a chore. It’s why our health insurance experts have put together a handy comparison tool to help you through the process of reviewing, comparing and switching your health insurance policy. 

Health insurance terms explained

Excess

An extra amount, such as $500, charged once per hospital stay. It usually applies once (singles) or twice (couples and families) per year.

Co-payments

An extra amount, such as $70, that you pay per day while in hospital. It’s usually capped per hospital stay or per year.

Preferred providers

Health funds sign up dental practices or optical stores as part of their preferred provider network. Some clinics are even owned by the fund. 

Preferred providers may offer a discount to a health fund’s members, or the health insurer may pay members higher benefits if they go to preferred providers. For example, instead of a set dollar benefit, the fund may pay a percentage benefit, such as 75% of the bill, which can result in lower out-of-pocket costs for you.

The post How to choose the best health insurance for single-parent families appeared first on ĚÇĐÄVlog.

As you get older, your health needs can change, so it’s vital to check you’ve got the right insurance policy for your current stage of life.

Seniors are more likely to need certain types of treatments and surgeries (such as cataract surgery or knee replacements, for example) that are usually only covered by the top-tier Gold and Silver Plus policies.

Here are our tips to help you check that you have the cover you need.

On this page:

• The four tiers of health insurance
• Do you have the right level of cover?
• Your policy includes pregnancy – should you downgrade?
• Should you pay a higher excess to reduce your premiums?
• Should you drop health insurance altogether?
• Five steps to better, cheaper health insurance

The four tiers of health insurance

Health insurance policies are categorised into four tiers:

• Basic – very little – if any – cover in a private hospital
• Bronze – low cover
• Silver – medium cover
• Gold – full or top cover.

In between these main tiers, there are also Silver Plus, Bronze Plus and Basic Plus policies, and these cover at least one service more than the standard Silver, Bronze or Basic policies. 

For example, a Silver Plus policy might include cover for hip replacements or cataract surgery – services usually only covered under Gold policies.

Do you have the right level of cover?

As we age, we’re more likely to need certain types of treatments and surgeries.

For instance, more than 40% of all hospital admissions for elective surgery (including things like hip and knee replacements) carried out in Australia in 2022–23 were for people aged 65 and over. 

And older people are also more likely to end up in hospital. Over 65s make up less than 20% of the population, yet account for more than 40% of day and overnight hospital admissions, according to the Australian Institute of Health and Welfare.

Our table below shows the policy level you need to guarantee cover for these more common surgeries for seniors. You might find cover for these treatments in lower level tiers, but it’s not guaranteed. 

What to consider if changing tier

Waiting period

If you’re looking at upgrading your policy to cover certain surgeries, remember that a 12-month waiting period applies for conditions you weren’t covered for on your old policy. So if you require surgery, make sure it’s scheduled for after you’ve served the waiting period.

Downgrading later

You may want to consider downgrading your cover once you’ve had the treatments you need. Top-level Gold policies can cost almost twice as much as the cheapest Silver policy offered by the same provider. This means you could be paying a premium to secure coverage for a handful of extra services you may never need, such as cover for pregnancy and birth.

Your policy includes pregnancy – should you downgrade?

Even if you’re at the stage of your life where you’re done having kids, the decision to downgrade to a policy that doesn’t include cover for pregnancy and fertility is not as simple as it seems.

Pregnancy and IVF are covered by the top-tier Gold and some Silver Plus policies – but these tiers are also suited to people over 65 who want to be covered for surgery typically needed later in life, such as cataract surgery or hip and knee replacements.

A few health funds offer Silver Plus policies without pregnancy, but before signing up, make sure:

• it’s actually cheaper than the cheapest Gold policies
• there aren’t other restrictions on things you do need – for example, many Silver Plus policies don’t cover hip and knee replacements or rehabilitation in a private hospital.

Should you pay a higher excess to reduce your premiums?

Until the health insurance reforms of 2019, the highest excess you could opt for was $500. But now you can choose to pay a higher excess of up to $750 per person and $1500 per couple/family to reduce your premiums. 

An excess is the amount of money you pay out of your own pocket towards a hospital visit. You pay an excess once per hospital visit, and it’s usually capped at once (single) or twice (couple/family) per year.

But if you think you’ll need surgery within the next two years, consider choosing a policy that has a lower excess – you might pay a bit more for the premiums, but you won’t be hit with high out-of-pocket costs if you do have to stay in hospital. 

Health funds that waive the excess for day surgery

If you think you’ll need day surgery, such as cataract surgery, see if you can find a policy that doesn’t charge an excess for same-day patients. A few policies waive the excess for day surgery, but this is becoming less common.

Should you drop health insurance altogether?

Hospital cover

Public hospitals in Australia provide world-class health care if you have a serious or life-threatening illness. However, they can have long waiting times for elective surgeries such as cataract surgery or hip and knee replacements. 

Consider these factors as you get older:

• Increasing value for money: Australians aged 60–79 use their hospital insurance more than any other age group.
• Higher rebates: When you hit 65, you’re entitled to a higher private health insurance rebate – that’s the amount the government pays that helps reduce your premiums. 
• Partners and families benefit: When one member of a family or a couple is 65 or over, the government rebate applies to the whole family or couples policy.

Extras cover

You could consider dropping your extras cover, which pays you back a portion of expenses for services such as dental, optical and physio, and instead fund these yourself. 

According to the Australian Prudential Regulation Authority, the average annual benefit paid out by the funds (the money that members receive back from their provider in a year) is only $475 per person. Compare this with the average extras premium of $936 for a single person in NSW (without the health insurance rebate) – it’s almost double the average benefit. This highlights that many people are not getting value for money from their extras insurance.  

Extras cover may be useful if you have difficulty budgeting and would rather pay an insurer monthly rather than fork out hundreds of dollars in one hit for a large dentist bill. 

But just be aware you could be paying more than you’ll ever get back. And we suggest you compare quotes for separate hospital and extras cover (you don’t have to get them from the same provider) rather than a combined hospital and extras policy, as you might find savings. 

What are the cheapest hospital insurance policies for Seniors?

Below, we reveal the best value policies for Seniors. Log in to unlock this members-only content, or join ĚÇĐÄVlog to get instant access to all of our expert, independent reviews.

We have included the cheapest Silver Plus policies that cover cataract and joint replacement surgery and the the cheapest Gold polices with above average gap cover in your state. If you need more help choosing between Silver Plus and Gold, use our comparison tool to find the best policy for you.

All premiums are for a single person with a maximum of $750 excess (families and couples pay about double). They are the cheapest policies that provide cover for cataract and joint replacement surgeries and have at least average gap scores. These prices don’t take into account the health insurance rebate. 

Some funds have restricted membership for employees of specific industries or professions, such as the armed forces, teachers, union members or CommBank. Where available (and where cheap), we’ve included these as well. 

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