Finding out if private health insurance is likely to be beneficial for your financial and health situation, and knowing about the different types available can help you decide.

What is private health insurance?

Private health insurance allows patients to be treated as a private patient. It can also pay for treatments that Medicare doesn't cover, like physiotherapy, dental and optical (eye treatment).

For example, with private health insurance, you might be able to choose your own doctor, be treated in a private hospital, or as a private patient in a public hospital. In some situations, it might mean you’re treated faster.

If you would like to get private health insurance, you need to buy a policy from a registered health insurer and pay regular premiums to stay covered.

You do not have to have private health insurance in Australia. All Australian residents have access to healthcare through Medicare. There is no evidence that private health insurance gets you better health care, or employs better doctors and nurses.

You will probably have to pay a ‘gap’ fee. This is the difference between how much the doctor charges, and the combined cover provided by Medicare and your health insurer.

Types of private health insurance and coverage

There are two types of private health insurance:

• Hospital cover: this covers treatment and accommodation in a hospital, allows you to choose your own doctor, and decide whether you will be treated at a public or a private hospital that your doctor attends.
• General treatment cover: also known as ‘ancillary’ or ‘extras’ cover, which includes health services not provided by a doctor, such as dental work and physiotherapy

Most private health insurers offer combined policies to cover both hospital and general treatment services, or you can buy separate hospital and general treatment policies.

More things are covered if you choose a higher category, which costs more.

Private health insurance can also cover transport by ambulance in states where the government does not cover ambulance costs for their residents.

Private health insurance does not cover:

• visits to the GP
• consultations with specialists in their rooms
• imaging and tests to diagnose conditions

Things to consider when looking into private health insurance

If you choose to take out private health insurance, try to make sure that:

• advice to you about what is covered is given in writing
• you fully understand what types of health care is covered and what is not covered
• you fully understand how long it takes for any health conditions you already have to be covered by private health insurance

Government surcharges and incentives

The Australian Government encourages people to take out and keep private health insurance through:

• the private health insurance rebate which reduces the cost of private health insurance
• the lifetime health cover loading which makes private health insurance more expensive if you take it out later in life
• the Medicare levy surcharge is charged if you earn above a certain income and do not have private health insurance

Overseas visitors and students

Visitors to Australia are not usually covered by Medicare, but people from some countries can use Australia’s public health system for essential treatment.

It is wise to take out private health insurance in your own country. Another option is the overseas visitor health cover.

Some Australian visas require you to take out private health insurance.

If you are studying in Australia and have a temporary student visa, you might need to have overseas student health cover.

Who can help with a private health insurance problem?

If you have a problem or enquiry about your private health insurance, contact your private health insurer directly to see if they can resolve it.

You can find out more about private health insurance on the Australian Department of Health website.

If you aren’t happy with how the private health insurer has dealt with your concerns, you can contact the Private Health Insurance Ombudsman.