Private health insurance: Is it worth it?

The question of whether to get private healthcare insurance is something that Australians debate often. Even one of Australia’s largest private health insurance companies, Medibank, are asking Australia the same question. Is private health insurance better? Their latest ad campaign asks the question “who is private health insurance right for?” The ad tackles a variety of issues for and against private health insurance. Sayings like,

“I don’t need health insurance. I’m fit as a fiddle.”

“Good to know the public health system is always there.”

“Health insurance is quick – if you need it now you can get it now.”

Every Australian has their own reason for either taking out private health or forgoing the expense – and it is a notable expense. So, let’s dive into private health insurance, what is it and why it’s worth considering, and does cheap health cover Australia exist?

Firstly, let’s look at the types of hospital costs

As you can imagine when you delve into hospital costs, there is plenty you don’t think about, which is why many opt for private hospital health insurance. Unfortunately for us, staying healthy can sometimes be a costly experience (whether you have health insurance or not).

Here’s a list of costs you might encounter at the hospital:

  • Intensive care
  • The difference between the doctor’s fee and Medicare payment (that’s where private health insurance comes in)
  • Hospital accommodation (some surgeries require patients to remain in the hospital for several days)
  • Operating theatre fees (doesn’t involve films or popcorn)
  • Blood tests, x-rays, or CT scans
  • Any required medication
  • Extra doctors’ fees (cause doctors don’t get paid enough)

If you are treated in an emergency unit in a private hospital (without insurance) you may be required to pay more as this unit is not covered by Medicare.

Private health insurance: basic facts

What does Private Health Insurance cover?

The flexibility of choice is the main argument for private health. Opting for private health means you’ll have access to private facilities. For example, if you’re a private patient at a private hospital, you’ll have a choice of hospital and doctor. However, if you’re a public patient at a public hospital you are limited to public hospitals (or suffer the terrifying costs) and have no choice in a doctor.

In therapy, private health insurance should cover that extra 25% of MBS for associated medical costs. Never heard of MBS? Well, it stands for the Medicare Benefits Schedule. Medicare will cover 75% of the MBS fee, and the patient pays the remaining gap. Furthermore, private health insurance should cover over 25%, depending on which cover you choose.

This last sentence is key. When it comes to private health insurance, it all hangs on how much you pay. The variety of plans that cover everything from the basic emergency hospital cover to nerve treatment (or other terrifying surgery you can think of).

Some private health insurance providers can offer the age private health insurance, so essentially health plans that are age-appropriate.

What is the best private health cover for singles?

So, let’s imagine your a single private health patient in a private hospital and you’re selected the base level of private health insurance cover. Your plan would most likely cover:

  • Ambulance services
  • In-hospital medical services
  • Overnight accommodation in private hospital or shared room in public
  • Same-day admission
  • Intensive care
  • Theatre fees
  • The minimum benefit for surgical implant prostheses included on the Australian Government Prostheses List (benefits for prostheses depend on what you require)

Now, to look at surgeries that are included in most basic plans:

  • Appendicitis
  • Rehabilitation services (only partially some plans)
  • Accidents sustained after joining
  • Removal of tonsils and adenoids
  • Wisdom teeth
  • A hernia
  • Palliative care (only partially some plans)
  • Spinal fusion
  • Colonoscopies
  • Pregnancy and birth related services

Note: This list was compiled from looking at Bupa, ahm and Medibank and the services they cover on their basic plans. It is not a complete list of surgeries that each company covers.

Top Australian Health Insurance Providers

In case you don’t watch TV, go on the internet or commute on a train, let’s take a look at private health insurance comparison to help find what suits you best:

Medibank: known for adding value to standard packages

Bupa: known for value packs, such as optional pharmacy saver

Ahm: “the cheap one.” Offers $200 off hospital plans for couples and families until 30 April

HCF: known for My Health Guardian chronic condition program

Australian Unity: known for granting freedom to tex mex for your hospital covers

Teachers Health: known for developing new programs that provide more cover

Defence Health: known for providing discounts on glasses (common though, in the field of private health). Strictly for the defence community.

CBHS: known for access to their Best Doctors network

Nib: known for offering a 30-day guarantee to new customers. You can cancel your plan within 30 days without losing your premiums

HBF: known for flexi-options that give you the freedom to update your cover

What are the benefits of private health insurance Australia?

Gap cover

You may be thinking, “Medicare covers 75% of my medical costs, so why private health insurance?” Well, depending on the surgery or procedure that 25% gap can seem like an abyss of endless payments. So, that’s when private health insurance gap cover.

Gap payments are the outstanding amount of what a hospital or specialist charges and what Medicare covers. Depending on your level of private health cover and costs, your private health may not completely cover your gap.

Gap cover is when your private health insurance provider has an agreement with the hospital or doctor to cover out-of-pocket expenses. When you’re on the hunt for a private health provider, look at gap cover and see what plans provide it. It can certainly help to reduce hefty expenses if you have any specialist appointments you’re GP urges you to book.

Avoid hideously long hospital waiting lists

When you require scheduled surgery, private health insurance no waiting period comes in handy. Scheduled surgery or elective surgery is a surgery that is not particularly urgent. It can include anything from cataract removal to joint replacements or appendix removal.

In the public health system, the waiting list for elective surgeries can be long and gruelling. Some surgery lists are years long. However, the average waiting list length in 2016-27 was 38 days. So, the waiting period and whether it’s worth taking out private health insurance would depend on the surgery required.

Another aspect of the public health system is priority patient order. Priority patient order gives priority to urgent cases in the public system. Therefore, you can have surgery scheduled months in advance, yet, if another patient needs surgery urgently, your surgery may be pushed back.

So, you guessed it, health insurance eliminates the priority patient order. You’ll be granted a surgery time and date with the doctor and hospital of your choice.

Luxury hospital accommodation (a.k.a you have access to a private room)

Being covered by private health insurance also entitled to the 5-star hospital experience. Well, actually just a private room (you can’t expect too much for a hospital). If you opt for the public health system, you’ll often have several roommates while you’re recovering.

Dental cover

Living in the public health system will give you GP visits, surgery at a public hospital and discount medications, however, for the dental care you still pay the big bucks. A dentist is considered a specialist and isn’t covered by Medicare. Even the most basic treatments like a checkup or clean are very expensive. There are state-run public dental clinics available, however, they are typically for pension or concession cardholders. In addition, paying for private health will save the stress of saving your hard own moolah for a dentist appointment.

Selecting your doctor or surgeon

When your doctor delivers the bad omen; you need surgery, you have the freedom with private health insurance to find and select your own health insurance. Having your surgery in the public system means the doctor on duty will perform your operation.

Avoid Medicare levy Surcharge

Now, despite how to may seem, the public health system isn’t free. We pay for through tax and higher-income earners contribute more through the Medicare levy surcharge. If your income is $90,00 a year single or $180,000 as a couple you may pay an extra 1% surcharge on your income. That equals about $900, and, in addition, if your income is higher the surcharge increases to 1.25% and 1.5%.

The levy was introduced to tempt higher-income earners to health insurance to take the pressure off the public health system. So, any private health insurance hospital plan with an excess of $500 or less for single, or $1000 or less for couples is the ticket to escaping the pesky levy charge.

The costs of health insurance

Like all forms of insurance, private health is a balancing act. A weigh up between risk and cost.

When you’re applying for health insurance, you’ll be quoted different rates, depending on whether your a single, couple, family or a single-parent family.

So, when it comes to health costs, it’s important to know what you have to pay.

When you have to undergo treatment at a hospital, there are three questions to ask in regards to costs. Here are three essential questions to ask your doctor or hospital staff:

  1. Does my health insurance cover this treatment?
  2. Are there any waiting periods, exclusions or minimum benefits on my health insurance policy?
  3. Do I need to pay any excess or co-payment?

Avoid unexpected medical costs by knowing what you’re in for.

So, know your plan.

Therefore, understand exactly what your private health covers and how much extra you are required to pay. If you do find yourself with an overly steep medical receipt, take a look at our medical loans to help carry the burden.

Who does health insurance work for?

The athlete

If your weekends are overrun with rugby games and gym, then perhaps consider private health insurance. Some private health insurance plans cover physio appointments and also any surgery you may require.

When you’re Mental Health is struggling

Who doesn’t fall into this category?! One in five Australians aged 16-85 experience a mental health illness in any year. Most of these illnesses being depressive, anxiety and substance use disorder. Under Medicare, everyone has access to 10 sessions with a psychologist. However, for higher-level care, private health insurance can help to combat extra costs.

Specialists junkies

If you can’t get enough of chiropractic appointments and specialist massages, then consider health insurance. Of course, it’s best to punch the numbers and calculate how much you spend on appointments compared to the cost of private health insurance premiums.

The Sugar Obsessed

If you can’t stop snacking on sweets, consider health insurance, as dental appointments will cost you on average $288. So, if you find yourself with regular trips to the dentist, perhaps consider paying that money into private health insurance and receive more benefits!

Addicted to the latest specs

Need to wear glasses and love having the latest look? Well, health insurance may be right for you! Most private health insurance Australia plans cover eye appointments and contribute money towards a new pair of trendy specs.

Taking a look at Public Health

Approximately 45% of Australians don’t have public health. So you’re not alone if you’re thinking, you don’t need it. With our excellent public health system, we can see a GP, have surgery in a public hospital, or buy PBS medications. The system covers the basic medical expenses that an average, relatively healthy person requires. Check out benefits that can be claimed for childcare.

Already decided on Private Health? Here’s how to compare plans

Furthermore, there are different services that provide private health insurance comparison. Here’s a handy list of services if you’re looking to check out private health costs:



Compare the Market

Different private health insurance funds offer different types of cover, so shop around to suit your needs, before buying.

Ensure that if you’re struggling with financial hardship that you choose the correct loan provider.

So, that’s the complete lowdown on private health insurance. When all is said and done it comes down to how much you spend on your health and whether having private health insurance will save you money.

If you find yourself in a sticky situation with medicals and you’re not covered, chat to us and apply for a fast loan for a quick fix.