What is private health insurance?

Private health insurance covers some of the costs of care in a private hospital. You can also use private health insurance to get treatment as a private patient in a public hospital. Private health insurance can help pay for other treatments that Medicare doesn't cover.

Medicare provides free and subsidised health services for most Australians. You can find out what services Medicare covers on the Medicare Benefits Schedule (MBS).

To get private health insurance, you need to:

• buy a policy from a registered health insurer
• make regular payments to stay covered by the insurance

What types of private health insurance are available?

There are different types of cover provided through private health insurance:

• hospital cover
• extras cover
• ambulance cover

Most private health insurers offer:

• separate hospital, extras and ambulance policies
• combined policies that have hospital, extras and ambulance cover

Hospital cover

Hospital cover helps with the costs of care and accommodation as a private patient in hospital.

You can choose to be cared for as a private patient in either a public hospital or a private hospital. You can also choose your own doctor.

Extras cover

Extras cover (or ancillary cover) covers health services provided outside of a hospital. This can cover:

• dental care
• optical
• orthodontic treatments
• physiotherapy
• speech therapy

Ambulance cover

Depending on where you live you may need private health insurance to cover transport by ambulance. Medicare does not cover the cost of ambulance services or other emergency transport.

Some insurers cover all ambulance travel, while others only cover ground travel. Check with your insurer about which type of ambulance cover best suits your needs.

What should I think about when looking into private health insurance?

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

• your healthcare needs
• what types of health care is covered by your policy
• any restrictions — such as services that are covered but only for a certain amount
• how long you need to wait before you can make a claim from your private health insurance

How much coverage do I need?

Private health insurance policies are described as:

• basic
• bronze
• silver
• gold

The higher the category, the more conditions are covered. Higher categories of hospital insurance cost more.

Are there any other costs I need to pay?

Costs for many treatments are covered by Medicare and your private health insurance.

However, doctors often charge more than the MBS fee for your care as a private patient in hospital. This is called the gap fee. You may have to pay the gap out of your own pocket.

As a private patient in a public or private hospital you might have to pay for:

• medical imaging, pathology and diagnostic testing
• x-rays and other scans
• pathology tests to diagnose conditions
• hospital accommodation
• operating theatre fees
• prostheses (surgically implanted)
• medicines and dressings

Private health insurance also does not cover:

• visits to your doctor (GP)
• visits with specialists in their rooms

If you are treated as a public patient at a public hospital, you do not have to pay anything.

Do I have to have private health insurance?

You do not have to have private health insurance in Australia. All Australian residents can get healthcare through Medicare.

Waiting times for elective (planned) surgery under Medicare can sometimes be long. Having private hospital insurance can help you get surgery more quickly in the private system.

How does the Government help people take out private health insurance?

The Australian Government helps you take out and keep private health insurance through the:

• Medicare levy surcharge
• private health insurance rebate
• Lifetime Health Cover

You must pay the Medicare levy surcharge if you earn a certain amount and don't have private health insurance. The levy is currently 1.5% of your taxable income.

The private health insurance rebate lowers the cost of your private health insurance. The amount that you get depends on your income.

Lifetime Health Cover helps you avoid paying higher premiums for private hospital cover. You need to take out hospital cover before you are 31 years old. Otherwise, you may need to pay more for the next 10 years.

Who can help me with a private health insurance problem?

If you have a problem with your private health insurance, start by talking with your private health insurer.

If you aren't happy with how your private health insurer deals with your concerns, you can call the Commonwealth Ombudsman.

Do I need health insurance if I'm an overseas visitor or student?

Most visitors to Australia are not covered by Medicare. Some countries have a reciprocal health care agreement with Australia. This mean that you might be able to get emergency healthcare in Australia.

The countries with reciprocal health care agreements are:

• Belgium
• Finland
• Italy
• Malta
• the Netherlands
• New Zealand
• Norway
• the Republic of Ireland
• Slovenia
• Sweden
• the United Kingdom

It's wise to take out travel insurance to cover you for medical emergencies while you are in Australia.

Some Australian visas need you to take out private health insurance. If you are studying in Australia and have a temporary student visa, you will need overseas student health cover.

Resources and Support

You can learn more in the article How do I pay for healthcare?

To find out more about private health insurance you can visit the Australian Department of Health, Disability and Ageing website.

The Australian Government website PrivateHealth.gov.au allows you to compare private health insurance policies. This can help you decide what type of private health insurance is best for you and your family.

The fact sheet — Making private health insurance simpler for everyone —is in languages other than English.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.