Health insurance - 糖心Vlog /money/insurance/health You deserve better, safer and fairer products and services. We're the people working to make that happen. Wed, 29 Apr 2026 01:37:39 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.4 /wp-content/uploads/2024/12/favicon.png?w=32 Health insurance - 糖心Vlog /money/insurance/health 32 32 239272795 Best health insurance for pregnancy and birth /money/insurance/health/articles/cheapest-health-insurance-for-pregnancy-and-birth Wed, 29 Apr 2026 01:37:36 +0000 /uncategorized/post/cheapest-health-insurance-for-pregnancy-and-birth/ Do you need health insurance to have a baby? We compare public versus private care, and reveal the best policies.

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Pregnancy and childbirth can be full of surprises. But you can have control over what type of care you receive during your pregnancy.

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.

On this page:

Public vs private care for pregnancy and birth

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.

However, the rate of “natural” births is higher in public hospitals. The statistics are pretty clear on this: there are more natural births (non-instrumental vaginal births with or without pain relief) in public hospitals and more caesareans in private hospitals.

  Public hospital Private hospital
 Vaginal birth 51% 34%
 Caesarean 38% 54%
 Vacuum suction 6% 8%
 Forceps 5% 4%
Source: AIHW data for 2023

糖心Vlog tip: It’s important to choose the right obstetrician for the type of care you want. Ask about their rate of interventions, particularly caesareans.

Public hospital vs private hospital

Giving birth in a public hospital as a public patient

Pros
  • Lower rate of interventions and higher rate of natural births.
  • 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.
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 
  • Higher rate of interventions and lower rates of natural births. 
  • 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.  
  • 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. 

糖心Vlog tip: Some public hospitals may encourage you to use your private hospital cover as a public patient in a public hospital without any cost to you 鈥 while there is no difference in your medical care, you may have a better chance of getting a private room.

Text-only accessible version

In 2022, about 293,400 people gave birth in Australia; the vast majority 鈥 97% 鈥 in a hospital.
Of those who birthed in hospital, here’s a breakdown of where they birthed:
74% in a public hospital
26% in a private hospital

Source: Australian Institute of Health and Welfare (AIHW).

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 鈥 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 糖心Vlog 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 糖心Vlog 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.

Unlock this article and more

  • Information you can trust
  • See the best brands
  • Avoid the worst performers

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Should you get health insurance for braces? /money/insurance/health/articles/extras-for-orthodontics Tue, 14 Apr 2026 00:54:10 +0000 /uncategorized/post/extras-for-orthodontics/ Is getting extras cover for orthodontics worth it? We crunch the numbers to help you decide.

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Orthodontics is a big investment, in both time and money. Health insurance can help with the costs, but how do you know whether you鈥檙e getting a good deal?

This article is for people who are considering buying extras cover, or upgrading their existing cover, in order to claim benefits for orthodontics. It is primarily written for families whose children need braces, but the advice is just as valid for adults considering orthodontics.

Is it worth getting extras for orthodontics?

Not all extras policies are created equal. Some might only cover a couple of hundred dollars worth of orthodontics per year, while a few premium policies will pay out over $2500. If you’re considering using extras to help manage the cost, you have to consider a few things.

It only works if you claim back more than you spend

This is the most important part, and it’s actually not too difficult to calculate whether an extras policy is likely to save you money. If you spend more on premiums than you claim, you’re wasting your money. Good cover for orthodontics comes at a price, so you should be looking at ways to reduce the amount of time you’re paying for a top-shelf policy.

Our research shows that that claiming against only one course of orthodontics won’t be enough to cover the premium over three years.

Extras policies that include cover for orthodontics typically cost around $2100 a year for a family 鈥 more if your household income is higher than $202,000, due to the lower government rebate. Over three years you might expect to pay $6300 in premiums. But the average annual limit for claiming on orthodontics is generally around $800鈥$1000 per year, per person, and there is usually also a lifetime limit of around $2500.

Our research shows that that claiming against only one course of orthodontics won’t be enough to cover the premium over three years

As you can see, you will have paid out more in premiums than what you’ve claimed back if you’re only claiming for one child’s braces (or even possibly two). So to make a policy worthwhile you’ll need to make sure you’re getting extra value through other claims.

Even if you include rebates for twice-yearly dental checkups for two parents and a child, most policies don’t stack up financially.

You’ll also need to claim things like optical and physio

In almost all cases, making sure you also claim on services other than orthodontics is the only way to make your extras policy worthwhile. Claiming on glasses, physio, massages and psychology are all ways to get value from your extras. Will your orthodontic treatment require a tooth extraction? Get it done at your dentist and you may also be able to claim a couple of hundred dollars for this as well (dentistry and orthodontics will have seperate caps).

Plan your year in advance. Know how much you will need to claim to make it worthwhile. Extras can be a good budgeting tool, but you still need to write up that budget.

Who should get cover?

If you just want cover for a child who needs braces, you might be on the lookout for a child-only policy. Unfortunately, only Navy Health and Defence Health offer children-only policies, so unless you qualify to be a member of one of those funds, you’ll likely need to get cover for at least one parent to fund braces for your child.

There’s typically little or no price difference between policies for childless couples and two-parent families. However, if you’re a single parent you’ll pay more to cover your children than you would to cover just yourself. The good news is, adding extra kids doesn’t affect the cost of a policy.

If you’re a two-parent family and your main focus is cover for the kids’ braces, a cheaper policy covering just one parent might be worthwhile. Actual discounts depend on the fund, and not all funds offer discounts for single parents. The downside to this plan is you’ll have one less person on the policy able to make claims for physio and optical, so consider whether this will make it harder to claim back the full premium.

When you should take out cover

Extras policies typically have a 12-month waiting period for orthodontic cover. Since a typical course of orthodontics lasts between one and two years, you will need cover for two to three years (including the waiting period).

You can’t know ahead of time what your policy will cost in two years, but a five per cent increase every year on 1 April is a good estimate. If you’re expecting your income to increase past the rebate thresholds, your premium will increase even more.

Health funds usually reset their annual limits on 1 January or 1 July. If you start your course of treatment in the last few months of the year, you can spread your claims out over three benefit years. Check with your health fund when their benefits reset.

Starting treatment during the waiting period

What if you can’t wait? Can you still claim against your extras? Funds have different rules, but will usually still cover you if the treatment is ongoing after the waiting period ends. The important factor is when you pay your orthodontist, not when you actually receive the treatment. In this case, you shouldn’t take the pay-up-front discount, as your health fund will be unlikely to cover you.

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Compare Reserve Bank Health Society health insurance /money/insurance/health/funds/compare-reserve-bank-health-society-health-insurance Tue, 24 Mar 2026 03:38:12 +0000 /?p=1056344 How Reserve Bank Health Society rates for member complaints, gap cover and ambulance.

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On this page:

Who is Reserve BankHealth?

is a restricted access health insurer for current and former employees of The Reserve Bank of Australia and Note Printing Australia, and their families. It’s a nonprofit fund and is part of Members Health, an alliance of nonprofit and mutual health funds.

Phone: 1800 027 299

Website: 

Does RBHS get many complaints from members?

RBHS has a Medium complaints rating.

When we score policies we give each fund a complaints rating, based on the number of complaints and serious disputes the Ombudsman deals with. We take into account the size of the fund, so big funds don’t get automatically penalised for having more complaints.The ratings are Low, Medium and High. A Low rating is better than a High rating 鈥 it means the fund has fewer complaints and fewer serious disputes for its size.

How good is RBHS’s gap cover?

A medical gap is the difference between Medicare’s recommended fee and what your doctor actually charges for a treatment or service.

Health funds have agreements with particular doctors and hospitals to cover all of the gap, which are called ‘no gap agreements’, or part of that gap, which are called ‘known gap agreements’ (these will have lower out-of-pocket costs, usually less than $500).

Our graphic below displays the 糖心Vlog gap rating, which takes into account the percentage of services where members either paid no gap or a known gap, compared to the state average.

Rating scale

  • Well above average
  • Above average
  • Average
  • Below average
  • Well below average

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Text-only accessible version

Australian Capital Territory

Below average.

New South Wales

Average.

Northern Territory

Average.

Queensland

Above average.

South Australia

Above average.

Tasmania

Below average.

Victoria

Above average.

Western Australia

Average.

How many hospital agreements does RBHS have in each state?

The benefit amount your fund pays you for hospital services depends not only on the type of cover you buy, but also whether your fund has an agreement with the hospital where you’re treated. 

The table below shows how many hospital agreements RBHS has in your state compared to the fund with the highest number (the industry maximum). Note that public hospitals don’t have agreements with specific funds and are generally treated as though they’re agreement hospitals.

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Police Health hospital agreements

In the Australian Capital Territory this fund has…

5 private hospital agreements out of an industry maximum of 7.

8 day hospital agreements out of an industry maximum of 12.

In New South Wales this fund has…

92 private hospital agreements out of an industry maximum of 95.

87 day hospital agreements out of an industry maximum of 113.

In the Northern Territory this fund has…

1 private hospital agreement out of an industry maximum of 1.

2 day hospital agreements out of an industry maximum of 2.

In Queensland this fund has…

50 private hospital agreements out of an industry maximum of 63.

47 day hospital agreements out of an industry maximum of 61.

In South Australia this fund has…

17 private hospital agreements out of an industry maximum of 17.

25 day hospital agreements out of an industry maximum of 36.

In Tasmania this fund has…

7 private hospital agreements out of an industry maximum of 7.

8 day hospital agreements out of an industry maximum of 12.

In Victoria this fund has…

69 private hospital agreements out of an industry maximum of 75.

58 day hospital agreements out of an industry maximum of 80.

In Western Australia this fund has…

21 private hospital agreements out of an industry maximum of 23.

20 day hospital agreements out of an industry maximum of 33.

Does RBHS offer any discounts?

Discount for direct debit: 0%

Discount for annual prepay: 0%

Total discount for annual prepay via direct debit: 0%

Does RBHS offer ambulance cover?

All RBHS extras, hospital and combined policies have emergency ambulance cover.

Do you need ambulance cover?

Depending on where you live, you may not need a policy with ambulance cover. 

  • Queensland and Tasmania: Emergency ambulance services are covered by the state government. 
  • New South Wales and the Australian Capital Territory: All hospital policies come with emergency ambulance cover 鈥 so you’ll be covered with any hospital or combined policy you select. 
  • South Australia, Victoria and the Northern Territory: You can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover ambulance in your state or territory or refund at least part of the cost of the ambulance service cover. 
  • Rural Western Australia: You can buy emergency ambulance cover directly from the ambulance service. Alternatively, some health fund policies will cover ambulance or refund at least part of the cost of the ambulance service cover. 
  • Metropolitan Western Australia: If you want to be covered for ambulance you need to buy a health insurance policy with ambulance cover.

Does RBHS offer family policies that cover adult children?

  • Adult children are covered on family policies for free until they turn 18
  • Full-time students are covered on family policies for free until they turn 25.

Does RBHS let you claim online or in-app?

You can claim via an app.

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Health insurance price hikes higher than ever: What you鈥檙e really paying /money/insurance/health/articles/health-insurance-price-hikes-higher-than-ever-what-youre-really-paying Wed, 18 Mar 2026 03:06:00 +0000 /?p=1056323 A 糖心Vlog analysis shows that Australians with private health insurance will be hit by increases of up to 25% when price rises come into effect on 1 April.

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Need to know

  • A 糖心Vlog analysis of the big five health funds (Bupa, HCF, HBF, Medibank, NIB) shows that some Australian consumers will be hit with price increases well above the government-approved average increase of 4.41%
  • HCF customers with a Gold-level policy are facing a 25% increase in the cost of their health insurance 鈥 that鈥檚 over five times the advertised average
  • The latest hikes mean that the price of Gold cover across the five big funds has increased on average by 71% in five years. 糖心Vlog experts say this points to a creeping affordability crisis in health insurance, where Australians will be increasingly unable to afford comprehensive top-level cover

As the cost of living continues to bite, Australians are facing another increase to the price of health insurance, with the largest average hike in premiums we鈥檝e seen since 2017 coming into effect on 1 April.

Minister for Health and Ageing Mark Butler announced the 4.41% average premium increase to the price of health insurance policies in February. 

But 糖心Vlog experts say that the advertised average increase does not tell the full story, and does not reflect the true price rises many Australians will face, particularly those with top-level Gold insurance, which covers things like pregnancy, psychiatry services and joint replacements.

Average increases not the full picture

鈥淭he average increase to premiums of 4.41% is just that 鈥 an average,” says 糖心Vlog health insurance expert Mark Blades. “It鈥檚 useful for understanding how much taxpayers increasingly spend to subsidise health insurance 鈥 which is now at $7.9 billion 鈥 but it’s of very little use to consumers.鈥

鈥淥ur research has found that there is a huge difference between the increases consumers will face, depending on the level of policy they hold.鈥

Mark says that while some Australians will face no price rise, a 糖心Vlog analysis of policies available for sale shows that the cover for Gold policies across the largest five funds will rise in price by an average of 13.3%, while those on Basic, Bronze and Silver policies will face increases from 2.6% to 3.3% on average.

HCF has biggest Gold-level price rise of main funds

Of the big five funds, HCF has the largest increase of 25% (more than five times the average of all policies) to its Hospital Optimal Gold cover in all states and territories. This policy was already one of the most expensive, and requires policyholders to also take out an Extras policy.

Of the big five funds, HCF has the largest increase of 25% to its Hospital Optimal Gold 鈥 more than five times the average of all policies

In NSW, often the most expensive state, the smallest increase to a Gold policy was by HBF at 7.9%. HBF customers in Western Australia, where HBF has its largest member base, will also cop the 7.9% increase.

Average increases to cost of Gold policies by fund:

HCF 鈥 25%

Bupa 鈥 12%

NIB (Qantas) 鈥 11.65%

Medibank 鈥 9.93%

HBF 鈥 7.89%

Top cover increasingly unaffordable, up 71% in five years

糖心Vlog experts looked back over the increases to the price of health insurance for the past five years.

Despite the average 鈥榞overnment-approved鈥 cumulative increase of 14.8% in this time, prices for Gold cover across the five biggest funds (Bupa, HCF, HBF, Medibank, NIB) has actually increased by a massive 71.1%.

A single person in NSW comparing comprehensive Gold cover in 2022 from the largest five funds could find cover at $257/month, or $3080 a year.

After the price rise in April, the same Gold cover will cost on average $439/month, or $5270 a year.

Practice of phoenixing has disguised price rises

Mark says that Gold policy 鈥榩hoenixing鈥, where insurers have closed older policies to new members and open new identical policies with the same name at a higher price, is partly to blame for the huge price increase.听

鈥淭he good news is that federal legislation outlawing the sneaky 鈥榩hoenixing鈥 loophole used by insurers was introduced in February, but we鈥檙e still seeing the trend that top-level cover is becoming increasingly unaffordable for Australians,鈥 he says.

Australians dropping top-level cover

The significant rise in the price of Gold-level coverage has caused a notable drop in the number of Australians with comprehensive level cover: from 39% in 2020 to 28% at the end of 2025.听

Many Australians drop their insurance to a lower level to avoid being 鈥榦ver-insured鈥 for cover they鈥檙e unlikely to use 鈥 for example, pregnancy and IVF services. However, 糖心Vlog consumer surveys consistently show the cost of private health insurance is a top concern for household budgets.

The significant rise in the price of Gold-level coverage has caused a notable drop in the number of Australians with comprehensive level cover

Mark says Australians should look out for communication from their fund about the price increase to their policies. He notes that a range of different cost increases will apply to individual policies. 

聽鈥淚f you鈥檙e able to prepay for 12 months before your fund increases the price, you can make some good savings and delay the 2026 price increase, but this isn鈥檛 possible for many Australians.鈥

The problem with private health insurance in Australia

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

鈥淲hen 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 people’s ability to make informed choices about health insurance,鈥 says Mark.听

Top-level Gold cover is designed for the many Australians who have specific high-level needs … Often these are the people who can least afford higher premiums聽

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.
Often these are the people who can least afford higher premiums.听聽

Taxpayers fork out almost $8 billion annually to private health insurers in rebates, and many Australians are encouraged to take out ‘junk’-level cover to avoid the Medicare Levy Surcharge. In return, private health insurance is meant to complement the public system through relieving pressure and offering an affordable option accessible to many.

Instead, Australian taxpayers are propping up an industry with increasingly unaffordable insurance policies and with more exclusions than ever.

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Free health cover for young adults on a family policy /money/insurance/health/articles/free-private-health-cover-for-young-adults Fri, 06 Mar 2026 02:30:30 +0000 /uncategorized/post/free-private-health-cover-for-young-adults/ You can insure your adult children on your health insurance policy, but conditions apply.

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Need to know

  • Bupa, Medibank, HBF, HCF, NIB and many smaller funds will cover young adults on family policies to 31 years of age
  • While full-time students are often covered for free, you may have to pay up to 50% more if you want other young adults covered
  • Whether it makes financial sense to keep a young adult on the family policy depends on individual health needs.

Young Australians are feeling the pinch with the cost of living, with many young adults still living with their parents.

Adult children can also stay on their parents’ health insurance policy until they鈥檙e 31 years old even if they’re not a student, and there’s no age limit for dependants living with disability (NDIS participants).

But is it a good idea for adults to stay on their parents’ policy? Rules and costs vary by fund and policy, and whether it makes financial sense depends on both of your health needs.

On this page:

Does adding adult children to health insurance save money?

While children and full-time students up to age 31 can often stay on the regular family policy for free, there is usually an additional cost to keep older dependants and non-students covered 鈥 depending on the insurer, this can add 15鈥50% to your premium. 

It’s a good idea to keep your kids on your family policy while there’s no additional cost.

But once you need an extended family policy, it’s time to carefully consider everyone’s cover needs. If you’re on a top cover Gold, or Silver-Plus policy it could be cheaper for an adult dependant to take out their own low to medium cover policy 鈥 especially if you have a higher family income and don’t get the full health insurance rebate.听

A young adult is probably eligible for the rebate and a youth discount. 

If you’re under 32, the main questions you need to ask yourself are: do I need health insurance? And does my parents’ cover meet my needs?

Is the level of cover appropriate?

If you’re considering taking out an extended family policy, it’s important to consider whether the young adult in your family needs the same level of cover as the older family members. Here are some things to consider.

  • Older adults may have chronic health conditions or need cover for knee-replacement or cataract eye surgery, which is only available through expensive Gold or Silver Plus health insurance policies.
  • Healthy young adults may only need Bronze cover, which includes cover for broken bones, flu, and skin and breast cancer. This level of cover is significantly cheaper, so it may make sense to take out a standalone policy. 
  • Extras cover may also be overkill for some healthy young adults. If they’re only using it for dental check-ups and a few physio sessions now and then, they’re better off paying as they go.

Do all health funds cover young adults on family policies?

It’s not mandatory for private health funds to allow young adults on family policies, but most funds do. Health insurers also set different age limits, so while some funds only allow young adults on family policies up to age 24, others may allow them to stay up until their 32nd birthday. And some funds have extended age limits for students but not for non-students or vice versa.

Funds also have different conditions when it comes to dependants and family policies. Normally you can’t be married or in a de facto relationship, but with some health insurers you also need to live with your parents and be financially dependent on them, or there might be a cap set by the insurer on how much you can earn. There may also be a requirement to take out a combined policy, or the dependant may need to take out their own extras policy to be covered under their parents’ hospital policy.

It’s important to check the individual policy. For example, Bupa excludes apprentices while Teachers Health includes apprentices, interns and cadets

There are also differences in the definition of a full-time student (who can usually get insured for free), so it’s important to check the individual policy for details. For example, Bupa excludes apprentices while Teachers Health includes apprentices, interns and cadets. 

It’s best to check with your fund and make sure you understand the rules. If your adult child is no longer covered with your fund but another fund covers them, you could consider switching health insurance

What the most popular health funds cover

Bupa, Medibank, HBF, HCF and NIB cover adult children up to at least 31 years, usually for an additional fee. There are rules and requirements for dependants. For example, they cannot be covered on a family policy if they are married or in a de-facto relationship. Here are the age limits set by the funds.

Bupa

  • Adult children are covered on family policies for free until they turn 21.
  • Full-time students are covered on family policies for free until they turn 32.
  • Adult children younger than 32 can be covered on extended family policies for an extra cost. 

HCF

  • Adult children are covered on family policies for free until they turn 22.
  • Full-time students are covered on family policies for free until they turn 31.
  • Adult children younger than 31 can be covered on extended family policies for an extra cost. 

Medibank (includes AHM)

  • Adult children are covered on family policies for free until they turn 21.
  • Full-time students are covered on family policies for free until they turn 31.
  • Adult children younger than 31 can be covered on extended family policies for an extra cost. But there’s no additional cost to add an older non-student to an ambulance-only policy with AHM, or Healthy Living Extras with Medibank.

NIB

  • Adult children are covered on family policies for free until they turn 21.
  • Full-time students are covered on family policies for free until they turn 31.
  • Adult children younger than 32 can be covered on extended family policies for an extra cost. Or for free on an ambulance-only policy or Basic Extras

HBF

  • Adult children are covered on family policies for free until they turn 21.
  • Full-time students are covered on family policies for free until they turn 31.
  • Adult children younger than 31 can be covered on extended family policies for an extra cost..
Funds offering free cover for students on family policies

These funds offer free cover for students up to at least age 30 on some or all of their family policies:

  • AAMI
  • AHM
  • Apia
  • Australian Unity
  • Bupa
  • CBHS Corporate
  • CBHS
  • Defence Health
  • Doctors’ Health
  • Emergency Services Health
  • HBF
  • HCF
  • HCI
  • Health Partners
  • HIF
  • ING
  • Latrobe
  • Medibank
  • Navy Health
  • NIB
  • Nurses and Midwives
  • Real
  • Peoplecare
  • Police Health
  • Queensland Country Health
  • Qantas
  • RT Health
  • Seniors Health
  • Suncorp
  • Teachers Health
  • TUH
  • Union Health
  • UniHealth
  • Westfund.
Funds offering cover for non-students on family policies at an extra cost

These funds allow non-students at least up to age 30 to stay on an extended family policy, normally for an extra cost:

  • ACA
  • AAMI
  • AIA
  • AHM
  • Apia
  • Australian Unity
  • BUPA
  • CBHS
  • CBHS Corporate
  • Doctor’s Health
  • HCF
  • Health Partners
  • HCI
  • Health Partners
  • ING
  • Latrobe
  • Medibank
  • Mildura
  • NIB
  • Nurses & Midwives 
  • Peoplecare
  • Priceline
  • Qantas
  • Queensland Country Health
  • Real
  • RT Health
  • Seniors
  • Suncorp
  • Teachers
  • TUH
  • UniHealth
  • Union Health
  • Westfund.

How much does it cost to add your adult kids to your family policy?

Just because you can keep insuring your young adult on the family policy doesn’t mean you should. Using AHM as an example, let’s look at the difference in premiums between family and extended family policies for a family with a high income and high health cover needs.

Insuring a young adult on a lower cover policy can end up being substantially cheaper not only because of the cheaper policy, but particularly if they qualify for the full health insurance rebate and a youth discount of up to 10%.

Example: Family with a 23-year-old non-student

A family who earns above the health insurance income cap and therefore is not eligible for the health insurance rebate. But their adult child is a 23-year-old non-student dependant, who is eligible for the full health insurance rebate.

They have AHM Deluxe Flexi Silver Plus with an excess of $500. 

They want private health insurance for their 23-year-old and are asking themselves if they should take out:

  • an extended family policy, or
  • a separate Bronze cover policy and a budget cover extras policy.

The best option? Insuring the 23-year-old on their own with a lower cover policy will be over $1700 cheaper per year.

The policies on offer from different funds will vary, so it’s important that you carefully consider your personal circumstances before opting for an extended family policy.

The policies on offer from different funds will vary, so it’s important that you carefully consider your personal circumstances before opting for an extended family policy just because it’s available.

Our calculations
Option 1 AHM Deluxe Flexi Silver Plus for a family of two adults with a 23 year-old dependant ($500 excess). 
  • Annual cost of an extended family policy, including an adult dependant: $11,486* (without the health insurance rebate).

Option 2 

Couple policy 鈥 AHM Deluxe Flexi Silver Plus ($500 excess)
Single policy 鈥 AHM Simple  Bronze Plus Hospital ($750 excess) and Value Extras policy
  • Annual cost of couple policy: $8313* (without the health insurance rebate).
  • Annual cost of single policy: $1396* (includes the health insurance rebate and a youth discount).
  • Annual cost of buy couple policy, and a separate singles policy: $9,710

Saving by not keeping your young adult on the family plan: $1776

*Annual premiums as of February 2026 in NSW.

Cover for people with a disability

While most funds have extended the age limit for student and adult dependants, cover for NDIS participants aged over 31 on their parents’ policy is currently only available from the following insurers: 

  • HCI
  • Doctors’ Health
  • OneMedifund
  • Emergency Services Health
  • Police Health 
  • Reserve Bank
  • Westfund.

There is no age limit if a policy allows you to add an NDIS participant.

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Australia’s most complained-about health insurers revealed /money/insurance/health/articles/the-most-complained-about-health-funds Thu, 26 Feb 2026 06:11:20 +0000 /uncategorized/post/the-most-complained-about-health-funds/ We analysed complaint data over 12 months to find the funds with the worst overall ratings.

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Need to know

  • 糖心Vlog experts analyse complaints data for all the health insurance funds on the market
  • We give each fund a rating of low, medium or high 鈥 low is better than high
  • Some funds seem to have some unhappy members, earning themselves a high complaint rating in our comparison

There’s more to finding the right health insurance than just assessing the monthly hit to your pocket. 

Aside from getting the coverage you need (which can be complicated enough in itself) for a good price, you’ll also want to find a health insurance fund with good customer service, including how it handles complaints.  

To help you find the best insurer for your needs, our health insurance experts have trawled through the data and scored each private health fund on its member complaints, so you know which ones have a great track record for this (and which don’t).

Funds with the worst complaint ratings

Our health insurance experts have analysed data about health insurance fund complaints in the 12 months to September 2025 and given AIA, Defence Health, Latrobe Health and Police Health a complaint rating of high.

We explain how we rank funds below in the ‘How we calculate funds complaint ratings’ section.

Defence Health still feeling fallout from IT failure in 2023

Complaints about Defence Health continue to trend downwards. At the end of 2025, the fund accounted for 3% of complaints to the Ombudsman 鈥 beyond its 2% market share 鈥 but much lower than it has been over the past two years.

In the second half of 2023, Defence Health implemented an IT upgrade that resulted in the failure of automatic payments, which in turn resulted in problems with claims and very long call centre wait times. Defence Health has acknowledged that it let down its members and has apologised, promising to do better.

The Ombudsman says: “While the overall volume of contacts was significant, this event emphasises the need for a robust and scalable complaints resolution system for any insurer undertaking a large systems transformation.”

Want all the details? Here are the .

Text-only accessible version

How to lodge a complaint about your health fund

Follow the below steps to make a complaint to the ombudsman about your private health fund.

1. Is your complaint about private health insurance?

The ombudsman only deals with complaints about private health insurance, not the quality of care you received.

2. Complain directly

Lodge a complaint with the insurer, hospital or doctor directly first 鈥 tell them the outcome you want. 

Complaint still not resolved? Escalate it to the ombudsman.

3. Gather information

– Make a note of key details and dates.

– Include your membership number.

– Review any correspondence.

– Note any relevant contact.

4. Send it to the ombudsman

– Keep it brief (500 words).

– List key dates and any contact.

– Provide your contact details.

Visit for more information.

How we calculate funds’ complaint ratings 

We assign each fund a complaint rating of low, medium or high. 

Our health insurance experts take a look at the number of complaints and disputes a fund has received in the last four financial quarters. 

They then standardise them for fund size, so a large fund isn’t penalised for receiving many complaints just because it has lots of members. For instance, Medibank and Bupa receive the highest number of complaints overall, but they’re also the two biggest insurers on the market.

The data we use comes from quarterly complaints bulletins published by the Commonwealth Private Health Insurance Ombudsman. 

Some funds may be subsidiaries of another fund 鈥 for example, Nurses & Midwives Health and Teachers Health. For these funds we score them together, since they share the same claims-handling departments.  

What’s the difference between a ‘referral’ and an ‘investigation’? 

If a referral (complaint) is taken up by the Private Health Insurance Ombudsman (PHIO) for intervention, it’s then considered an ‘investigation’ (dispute). When we calculate complaint ratings, we give greater weight to referrals because only a small number of complaints reach the investigations stage. 

How does your fund compare with the rest of the industry?

For each fund, we compare their complaint/dispute rates with the overall industry rates, so you can compare apples with apples. 

If a fund consistently has the same rate of complaints, but the industry overall experiences a fall in complaints, then the fund’s complaint rating is likely to change for the worse. 

To see how your health insurer stacks up, check our health fund pages, including:

If you’re looking to switch health insurance policies, find the best fit for you with our health insurance comparison tool, where we compare policies from over 40 different health funds.

What do most people complain about?

These are the most complained-about issues:

  • pre-existing condition waiting periods
  • membership cancellation
  • hospital exclusions and restrictions
  • general treatment benefits
  • verbal advice.

“Unfortunately, we don’t have much detailed data on the reason for the complaints for each fund, nor the outcomes of these complaints,” says 糖心Vlog health insurance expert Daniel Graham. “If we did, we’d take these into account.”

“But the complaint rating is indicative of the quality of a fund’s internal complaints-handling processes, so we think it’s the most useful metric we have to measure a fund’s performance in this area.”

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Should you drop extras health insurance? /money/insurance/health/articles/do-you-need-extras-health-insurance Mon, 23 Feb 2026 23:30:18 +0000 /uncategorized/post/do-you-need-extras-health-insurance/ Private health insurance is increasingly expensive and your extras health insurance may not be giving you value for money.

The post Should you drop extras health insurance? appeared first on 糖心Vlog.

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Unlike hospital insurance, which covers you for treatment in hospital, extras insurance helps pay for services outside of hospital, such as dental care, glasses and treatments like physio or chiro. 

Most extras policies only pay a percentage or capped amount towards the cost of these services. According to APRA*, the financial services industry regulator,聽on average:

  • Health funds pay just $68 for a visit to the dentist, $84 for the optometrist, $42 for a trip to the physio
  • You’re still out of pocket $63 for each visit to a covered service
  • you only get $498 per person per year in total from your extras policy.

*APRA quarterly health insurance statistic, December 2025.

If your extras insurance doesn’t pay out more than your extras premium, it pays to either switch to a better policy or drop it altogether. Compare health insurance now to see if you can get a better deal.

On this page:

How much does extras health insurance cost?

The average extras cover for a single person costs about $684 per year (without the health insurance rebate). And with the average person only receiving $498 per year in value, it follows that plenty of people would be better off without their extras insurance. Therefore, it鈥檚 essential you shop around. There are is a wide range of covers and premiums to choose from, or you may decide you don鈥檛 need extras cover at all.

Bupa and Medibank extras health insurance

Australia’s two biggest health insurance companies, Bupa and Medibank, have a range of extras policies. The catch with their policies is that to get the full benefits, you need to use their provider network. If you want to use your own dentist and they’re not in the network, your benefits will be smaller.

Bupa, Medibank 鈥 most expensive extras health insurance 
  • Bupa’s most expensive extras cover is Top Extras 90 and costs about $2440 per year*.
  • Medibank’s most expensive extras cover is also called Top Extras 90 and costs $2107 per year*.
  • The deal with both policies is that they cover a wide range of services including specialist services like hearing aids or home nursing and pay around 90% of your bill up to annual limits at their associated providers. Bupa and Medibank pay at least 90% for popular services including dental, optical, physio and chiro, as long as you go to one of their network providers. You can go to providers outside the fund’s network but you may receive a smaller benefit. 
  • It’s a tall order to use enough services to get your premium back in benefits, let alone more, therefore we’ve called them bad value extras health insurance. 
Bupa, Medibank 鈥 cheapest extras health insurance
  • Bupa’s cheapest extras cover is Extras Saver at about $192 per year.*
  • Medibank’s cheapest extras cover is Healthy Living Extras at about $239 per year.*
  • Bupa’s policy pays up to 50% of your bill at all providers for general dental up to a total maximum limit of $350 (or you may get up to 100% back for 6-monthly check-ups at their provider), and that’s it. If you need a physio, a new pair of glasses or a massage it’s not covered.
  • The Medibank policy’s draw card is also dental, with 100% off one check-up per year covered at a member dentist. They also offer up to $40 back for one vaccination per year, and 20% off a gym membership at certain gyms. There’s no cover for chiro, physio, glasses or anything else.
  • Both policies also include ambulance cover 鈥 read more about ambulance cover.
  • Are they good value? Not really. You may be able to claim back a little more than you spend on the premium with Bupa鈥檚 product 鈥 it is easier to make sure you get your money back with cheaper extras products than with the most expensive policies. But with Medibank鈥檚 Healthy Living Extras, if you don鈥檛 use their member provider鈥檚 dentist your payout is capped at $100 per year. Even if you claim all of this, plus the full benefit for a vaccination ($40) each year, that鈥檚 only $140 back for a policy that costs $239/year (or $180 will the full 24% health insurance rebate). Even if you claim 20% off a gym membership, it certainly doesn鈥檛 sound like good value to us!

While Bupa and Medibank have a good range of extras policies, some other providers offer better value cover. Compare health insurance to see what your options are.

*All premiums are for singles in NSW without the health insurance rebate, February 2026.

How to give your extras cover a check-up

Considering that many people pay a higher extras premium than what they get back in benefits, it’s important to work out if your extras health insurance is offering you value for money.

  • Request or download an annual claims statement from your fund’s website, which shows the total benefits you received in the last financial year.
  • Compare your premium with your extras benefits. Are you paying more than you’re getting in return?

If, like many people, you have a combined extras and hospital policy, a bit of maths will come in handy.

  • Select a hospital insurance policy from your fund that’s comparable to the hospital cover in your combined policy (with the same excess and cover level). 
  • Deduct its price from the premium you pay. 
  • The difference will be the amount you pay for extras health insurance.

If you find your premium is substantially higher than the benefits you receive and you don’t anticipate your health needs will change any time soon, consider switching to a less expensive policy or cancelling extras health insurance altogether. 

If you cancel your extras insurance, be aware that you’ll be subjected to waiting periods before you can make a claim if you take up extras again. If you switch cover, your new provider may not make you wait again if the new policy has similar benefits.

Will I be penalised if I drop extras cover?

Perhaps you signed up for health insurance to avoid the government’s Medicare Levy Surcharge (MLS) and the Lifetime Health Cover (LHC) loading. Well, your insurer might have “forgotten” to tell you that government surcharges only apply if you don’t have private hospital insurance 鈥 you don’t need extras insurance to avoid the charges. Check if at tax time. 

糖心Vlog tip: Health insurers often have specials that allow new members to claim straight away for many health services like a dental check-up or physio treatment (although usually not the more expensive services like dental crowns or braces).

Who can benefit from extras cover?

Extras health insurance works differently to other types of insurance.

  • Home, travel and car insurance cover you for unexpected events that may otherwise cost you thousands. You pay a known amount (the excess) and they cover the rest.
  • Extras insurance works more like a budgeting tool. The insurer pays a known amount, or percentage, and then you cover the rest. It’s meant to help with smaller ongoing costs, such as a dental check-up, pharmacy costs, physiotherapy, going to the osteopath or a new pair of glasses.

Two groups of people tend to get good value from extras insurance.

  • Families: Families pay the same health insurance premium as couples 鈥 or double the singles premium 鈥 so children are insured for free. Some health funds offer no-gap cover for kids, for example for dental. Read about the best health insurance for families.
  • People aged 55鈥79: Of all the age groups, this one makes the most claims on their extras cover benefits and therefore receives a much larger average benefit per person than other age groups. Read about the best health insurance for seniors.

Couples, on the other hand, can lose out. A couples policy normally costs exactly the same as two single policies. So if a basic policy suits you best but a medium policy suits your partner better, go for two different extras cover policies rather than a medium-cover couples policy. Read about the best health insurance for singles and couples.

Tips and tricks to get more out of extras health insurance

Look for percentage benefits

Rather than simply paying a fixed amount for a service, such as up to $30 for a physiotherapy session, some policies cover a percentage of your bill, usually from 60% up to 100%. This can be useful if you go to a dentist or other healthcare provider who charges above-average prices. Where these types of benefits apply, it’s worth making sure they apply to the providers you usually use.

Look for funds with provider schemes

A number of health funds offer provider schemes or even their own optical or dental centres. The fund may have negotiated a price (usually lower than the normal price) with, for example, the dentist or optometrist, and may also pay a higher benefit to you. Full cover for services such as a dental check-up or a pair of glasses is sometimes available.

Check for loyalty bonuses

Some health funds pay higher benefits to loyal members. While this is good for you if you’ve been with them for a long time, it can be a disadvantage for new members since your time with another fund is not counted towards these bonuses.

Have you used your lifestyle cover?

Some extras policies offer benefits for services such as massage or gym classes and even sunscreen.

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761524 Do you need extras health insurance? We explain how to make sure you're getting value for money from your extras insurance and compare Medibank and Bupa's most expensive and cheapest extras policies.
Insurers hiding soaring increases to top-level health cover /money/insurance/health/articles/health-insurers-hiding-increases-to-top-level-cover Thu, 19 Feb 2026 00:08:44 +0000 /uncategorized/post/health-insurers-hiding-increases-to-top-level-cover/ Some Australians are paying almost four times the headline premium increase for top policies.

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Need to know

  • Our analysis has found the price of top level Gold hospital cover has increased by about 58% over five years
  • These price hikes are much higher than the 16% average increase across all cover reported by the Department of Health and Aged Care over the same period
  • Insurers’ sneaky tactics include quietly closing cheaper Gold policies and then releasing more expensive policies for new customers

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.听

But until now, the insurers only need approval to raise premiums for existing policies, not new policies.

This year the government has drafted new legislation that will require funds to seek approval for new policies too, aiming to outlaw the practice known as 鈥減hoenixing鈥.

The insurers were quietly closing an existing policy, and opening a new policy with the same or similar cover, but with a jacked up price

This follows our discovery that insurers were quietly closing an existing policy, and opening a new policy with the same or similar cover, but with a jacked up price 鈥 bypassing government oversight.

Phoenixing has contributed to an increase in the price of Gold hospital insurance of about 58% over five years. The ‘approved’ premium increase over the same period was just 16% across all hospital and extras policies.

Top cover even less affordable

A single person in 2021 paid around $237 per month, or $2847 a year, for Gold hospital cover (with a $750 excess). In 2025 prices, they were slugged with premiums closer to $340 per month, or $4078 per year, on average for the same level of cover.

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

Our analysis, which compared policies available to new customers in 2021 with those available in 2025, found the cost of Gold hospital policies from the big five has skyrocketed, all with increases even higher than the Australian average of 58%.

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

Looking at policies in NSW with a $750 excess, Bupa’s April 2025 Gold hospital policy cost 56% more than the policy they offered in January 2021. Medibank’s policy cost 68% more, and NIB’s Qantas Gold policy was 72% more expensive. But HCF’s whopping policy increase was more than double the average with a 97% increase.

In WA, HBF’s 2025 Gold policy was 82% more expensive than the Gold policy it was selling five years ago.

Text-only accessible version

Sneaky sky-high increases to top hospital cover

Government figures say average health insurance premiums have increased by 16% over the past five years, but 糖心Vlog research has found the cost of top cover Gold hospital policies has skyrocketed far beyond that.


  • Medibank 鈥 68% (New South Wales)



  • NIB (Qantas) 鈥 72% (New South Wales)



  • Bupa 鈥 56% (New South Wales)



  • HCF 鈥 97% (New South Wales)



  • HBF 鈥 up to 82% (Western Australia)


We compared Gold policies available to new customers in January 2021 with those available in April 2025 in New South Wales, except for HBF where we looked at Western Australia, as this is their largest customer base.

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 this year, 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.

HCF closed their existing Gold policy, and opened a new one with more restrictions and a 35% price increase

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 鈥 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.

woman comparing health insurance policies
With so many policies on offer, it pays to do your research before choosing one.

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 鈥 they spruik their newer, pricier policies instead.

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

Even when some funds keep cheaper Gold policies open to new customers, they don’t advertise them

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 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 鈥 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 鈥 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.

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

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 insurance 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.

Australian taxpayers are propping up private health insurers who are selling us increasingly unaffordable 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 more than $7 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.

How we calculated the increases

To analyse the average increase in the cost of Gold hospital cover over the past four years, we compared premiums for Gold policies available to new customers with a $750 excess on 1 January 2021 with those available on 1 April 2025. Restricted membership funds and corporate policies were not included in the analysis.

Using this method, we found the national average price increase of Gold hospital policies over the past five years was 58%. There may be small differences in cover between the policies we compared in 2021 and 2025.

All prices given in the article are monthly premiums for single policies with a $750 excess for people living in NSW, with the exception of HBF policies, where we used premiums for WA, HBF’s largest customer base. Premiums are rounded to the nearest $5, and do not include the health insurance rebate, any discounts (such as for prepay or direct debit) or Lifetime Health Cover surcharges.

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Health insurance premiums to increase by average of 4.41% on 1 April /money/insurance/health/articles/how-to-avoid-health-insurance-premium-hikes Wed, 18 Feb 2026 22:35:39 +0000 /uncategorized/post/how-to-avoid-health-insurance-premium-hikes/ Find out how you could secure your current health insurance premium until 2026.

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Need to know

  • Private health insurance funds will apply a 4.41% average increase on 1 April, but Medibank, Bupa, NIB and HCF have a higher than average increase 
  • If you’re able to prepay for 12 months before your fund increases the price, you can make some good savings and delay the 2026 price increase
  • Keep in mind these are average figures across all policies of a fund; a range of different cost increases will apply to individual policies 

As the cost of living continues to bite, Australians are facing another increase to the price of health insurance, with the largest average hike in premiums we’ve seen since 2017 due to come into effect on 1 April.

Minister for Health and Ageing Mark Butler announced the 4.41 per cent average premium increase saying it ‘reflects the rising costs of providing medical and hospital services, which rose 5% last financial year.’

Previous research by 糖心Vlog shows that many health insurance customers will find themselves facing increases much higher than 4.41%, particularly those with comprehensive Gold coverage.

Prepaying for 12 months before your fund increases the price means you can make some savings

“The average increase masks the reality of the escalating cost of comprehensive private health insurance which is increasingly unaffordable to the average consumer,” says 糖心Vlog health insurance expert Mark Blades.

“Check in with your fund to understand how much your premiums are due to increase by. Compare policies with other funds to see if you can get a better deal, or, if you want to stick with your current fund, prepaying for 12 months before your fund increases the price means you can make some savings.”

Health insurance premium increases in 2026

The average 2026 increase of 4.41% follows the 2025 increase of 3.73% and the 2024 increase of 3.03%, but Medibank, Bupa, NIB and HCF have all put in place higher than average hikes.听

“The average increase to premiums is just that 鈥 an average. It’s useful for understanding how much taxpayers increasingly spend to subsidise health insurance (now at $7.9 billion), but is of very little use to consumers,” says Mark.

“‘Our previous research has found that there is a big difference between the increases made to comprehensive Gold coverage and the junk-level Basic cover used to avoid the tax levy for high-income earners.

“When premiums increased in April 2025, 糖心Vlog found that across the largest five funds, the average price of Gold policies increased 8鈥13% for existing policies while Basic and Bronze level cover increased 1鈥3% or less.”

How does your fund stack up?

The lowest increase this year is from GMHBA, which is increasing premiums on average by 1.98%. 

AIA has the largest average increase, with a 5.98% price hike across its policies.

Of the big funds, all but HBF have above-average increases:

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2026 premium increases: Where does your health fund sit?

This bar chart shows the average premium increase for each health fund in 2026. The industry weighted average increase is 4.41%. The funds below are listed in order of their average increase.

GMHBA 鈥 1.98%
HBF Health Limited 鈥 2.15%
Police Health 鈥 2.53%
HIF 鈥 2.6%
Navy Health 鈥 2.88%
Phoenix Health 鈥 2.95%
Onemedifund 鈥 2.96%
Defence Health 鈥 2.99%
CBHS 鈥 3.25%
CBHS Corporate 鈥 3.25%
Westfund 鈥 3.26%
Doctors’ Health 鈥 3.67%
Hunter Health 鈥 3.92%
Teachers Health 鈥 3.94%
Health Partners 鈥 3.94%
Australian Unity 鈥 3.98%
Peoplecare Health 鈥 4.01%
Reserve Bank 鈥 4.13%
St Luke’s 鈥 4.25%
Mildura Health Fund 鈥 4.25%
Industry Average 鈥 4.41%
ACA 鈥 4.48%
Latrobe 鈥 4.53%
HCI 鈥 4.53%
BUPA 鈥 4.8%
HCF 鈥 4.96%
Medibank 鈥 5.1%
NIB 鈥 5.47%
AIA 鈥 5.98%

How to avoid health insurance premium hikes

An excellent way to save money is to prepay your annual premium before 31 March to ‘lock in’ your current premium. 

In addition to avoiding the price hike, some funds offer direct debit and pre-pay discounts. Of the big funds, HBF and NIB offer these discounts: 

  • HBF 鈥 4% for direct debit and 3.84% if you prepay your annual premium, which adds up to a total discount of 7.84% if you pay your annual payment by direct debit.  
  • NIB 鈥 4% for direct debit.

Some funds let you prepay for longer than 12 months. For example, NIB allows 13 months and HCF allows 18 months. But don’t leave it until the last minute to prepay as some funds require prepayment by a certain date. Check with your fund to find out.

Gold hospital insurance premiums skyrocket 

糖心Vlog experts point out these average price increases don’t tell the full story of the rising costs of health insurance. 

In the past, we’ve discovered many insurers introducing new, more expensive policies, while closing old cheaper policies in order to increase prices even more, without attracting attention. 

In fact, last year we revealed that over the previous four years, insurers have used this tactic to jack up the average price of Gold hospital cover by 45%, while the “approved” average increase over the same period was 11.9%. 

Now’s a good time to review your cover

Now is a great time to review your cover, and if you’ve opted for top-level Gold hospital cover ‘just in case’, you should seriously think about dropping it or downgrading to cheaper cover. 

If you’re thinking of upgrading your cover 鈥 for example, you want to have a baby in a private hospital, or think you may need surgery in the next year 鈥 don’t automatically upgrade with your current fund, but explore what deals are available with other funds. 

If you’re thinking of upgrading your cover, don’t automatically upgrade with your current fund, but explore what deals are available with other funds

And remember, the headline figures released by the Department of Health are an average only; check with your fund to see how much your policy will be increasing by.

The same cover with a different insurer can be hundreds of dollars cheaper. The largest savings are available for Gold policyholders, but even if you have a Silver or Bronze policy, you’ll probably be able to find a cheaper deal that will give you at least the same cover. Our experts have found that in some cases you could save up to $1870 per year.

We recommend using our independent reviews of health insurance policies and providers to help guide your decision: we compare thousands of policies from 47 insurers. Our experts assess policies based on factors such as out-of-pocket costs, price, fund complaints and more to help you find the best-value policy.

The post Health insurance premiums to increase by average of 4.41% on 1 April appeared first on 糖心Vlog.

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How to choose the best health insurance for seniors /money/articles/health-insurance-for-seniors Wed, 18 Feb 2026 03:52:08 +0000 /uncategorized/post/health-insurance-for-seniors/ Our insurance expert explains how to get the right cover for your needs and budget if you're 65 or over.

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Need to know

  • Things like cataract treatments and knee or hip replacements are usually only covered by the most expensive, top-tier policies
  • Australians aged over 60 years use their hospital insurance more than any other age group
  • You can save money by choosing the right level of cover for your needs

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

Health insurance policies are categorised into four tiers:

  • Basic 鈥 very little 鈥 if any 鈥 cover in a private hospital
  • Bronze 鈥 low cover
  • Silver 鈥 medium cover
  • Gold 鈥 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 鈥 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鈥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. 

To be guaranteed cover for:Choose:
Heart surgerySilver or Gold
Joint replacements SilverPlus or Gold
CataractsSilverPlus or Gold
DialysisSilverPlus or Gold
RehabilitationSilverPlus or Gold
Palliative careSilverPlus or Gold

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 鈥 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 鈥 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 鈥 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.

If you think you’ll need surgery within the next two years, consider choosing a policy that has a lower excess

But if you think you’ll need surgery within the next two years, consider choosing a policy that has a lower excess 鈥 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. 

糖心Vlog tip: If you’re switching from paying a higher excess to paying a low or no excess, keep in mind you’ll have to serve a 12-month waiting period. You’ll still be covered during the waiting period, but you’ll have to pay the higher excess if you have surgery in that time.

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鈥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 鈥 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) 鈥 it’s almost double the average benefit. This highlights that many people are not getting value for money from their extras insurance.  

Just be aware you could be paying more than you’ll ever get back

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 糖心Vlog 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鈥檛 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鈥檝e included these as well. 

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Get the best value health insurance for people aged 65 and over

1. Check your premium increase

Look out for a letter or email from your insurance provider.

2. Do you really need health insurance?

Is it worth it? Some people have hospital cover for peace of mind, some people will . With extras, make sure you’re getting back more than you’re paying for it.

3. Get the right level of cover

Are you covered for all the treatments you may need? Take the 糖心Vlog Health Insurance Quiz.

4. Shop around

Find a better deal by using our easy health insurance comparison tool.

5. Prepay if you can

Contact your health fund about prepaying before the annual premium increase.

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