Health Insurance Frequently Asked Questions (FAQs)

Private health insurance helps cover medical and hospital expenses that aren’t fully covered by Medicare. It typically falls into two categories: Hospital cover and Extras cover.

Hospital cover contributes to the cost of treatment and accommodation if you're admitted to hospital as a private patient. It provides you with the option to choose your doctor and hospital, and can often reduce public hospital wait times.

Extras cover helps pay for health services not usually covered by Medicare, such as dental, optical, and physiotherapy – depending on your policy. It can also help you manage unexpected medical costs and better plan your healthcare budget.

Private health insurance can be worth it if you want more healthcare options like choosing your doctor, avoiding long public wait times, or help to reduce out-of-pocket expenses for specific services like dental, physio, and optical. It can also help you avoid the Medicare Levy Surcharge and benefit from rebates, depending on your income.

Changing your health insurance provider in Australia is simple and can be done at any time. Start by comparing policies to find one that better suits your needs and budget. Once you've chosen a new provider, you can apply for the new policy without needing to cancel your current one first. After your new cover is confirmed, your new fund can help cancel your old policy. If you're switching to a similar or lower level of cover, your waiting periods usually carry over, so you won’t have to start from scratch. Just make sure to check for any cancellation fees or refund options with your current fund before making the switch.

Health insurance costs in Australia can vary widely depending on your stage of life, health needs, and the level of cover and excess you choose. Whether you're a young adult looking for basic protection, a family needing broader cover, or planning for retirement, there are options to suit your lifestyle and budget. You can select hospital cover, extras (like dental, optical, and physio), or a combined policy – giving you the freedom to select your preferred level of cover. Compare options available through Choosi for your current needs online today.

Private health insurance is not tax deductible in Australia. However, you may be eligible for the private health insurance rebate, which helps reduce the cost of your premiums based on your income and age. You can claim this rebate as a premium reduction or as a refundable tax offset when lodging your tax return. Additionally, after you turn 30, having eligible hospital cover may help you avoid the Medicare Levy Surcharge if you earn above a certain income threshold.

Lifetime Health Cover (LHC) loading is a government initiative designed to encourage Australians to take out private hospital cover earlier in life and maintain it. If you don’t have hospital cover by 1 July following your 31st birthday, and you decide to take it out later, you may have to pay a 2% loading on top of your premium for every year you’re aged over 30 when you join.

The loading can go up to a maximum of 70% and applies for 10 continuous years of holding eligible hospital cover. Taking out cover earlier can help you avoid this extra cost and save money in the long run.

Having private health insurance is not mandatory in Australia, but it can provide you with additional healthcare and medical treatment options. Here are some questions you may want to ask yourself to work out if health insurance is for you:

• Do you have a pre-existing medical condition or an ongoing health issue?
• Do you want to choose your own doctor or hospital?
• Can you afford to pay out-of-pocket for medical expenses?
• Do you want to avoid waiting lists for non-urgent treatments?
• Are you self-employed or not covered by your employer's health fund?
• Are you earning over $101,000 (singles) or $202,000 (couples/families) and want to avoid paying the Medicare Levy Surcharge on your taxable income?
• Are you 31 or older and don't have private hospital cover? If so, you might be charged a Lifetime Health Cover (LHC) loading on your premium if you take out cover later in life.

Medicare may cover anaesthetist fees in a private hospital, but only partially. If the anaesthetist charges more than the Medicare Benefits Schedule (MBS) fee, you could face out-of-pocket costs. Cover depends on the procedure and whether it's eligible under Medicare. Private health insurance may help cover the gap, so it's important to check with your insurer and anaesthetist before treatment.

Private health insurance can cover a range of medical and hospital expenses, including:

• Doctor and specialist visits
• Hospital stays and procedures
• Surgical and theatre fees
• Radiotherapy and chemotherapy
• Pathology and X-ray services
• Dental, optical, and physiotherapy (depending on your policy)

Some policies may also cover:

• Ambulance transportation
• Pregnancy and birth-related services
• Rehabilitation and mental health services
• Natural therapies (such as acupuncture and chiropractic care)

The specific services and treatments covered by your policy will depend on the type of cover you choose and the level of excess or co-payments you're willing to pay.

Private health insurance in Australia doesn’t cover GP visits. By law, out-of-hospital medical services such as general practitioner consultations, specialist visits in their rooms, and diagnostic tests are covered by Medicare, not private health insurance. If you visit a GP, Medicare typically pays a portion or all of the cost depending on whether the doctor bulk bills.

Most Australian residents can apply for private health insurance, regardless of age or health status. However, there are some eligibility considerations:

• Age: You can apply at any age. While there are no strict upper age limits, older applicants may face higher premiums, especially if they delay taking out hospital cover past age 31 due to the Lifetime Health Cover loading.
• Residency: You must be an Australian citizen, permanent resident, or hold an eligible visa. Many temporary visa holders can access private health insurance, though cover requirements may vary.
• Visa holders: International students and working holidaymakers can apply for specific types of health insurance, such as Overseas Visitor Health Cover (OVHC) or Overseas Student Health Cover (OSHC).
• Pre-existing conditions: You can still apply, but insurers may impose waiting periods (typically up to 12 months) before covering treatment for pre-existing conditions.
• Pregnancy: Pregnancy-related services may be covered under hospital policies but usually come with a 12-month waiting period.

It’s always best to confirm eligibility and any specific conditions that may apply to your situation before taking out a policy.

Many health insurers offer family health insurance policies that can cover you, your partner, and your financially dependent children.

Here’s a breakdown:

• Family health insurance policies typically cover the policyholder, their partner (if listed), and their children.
• Couples cover is available for two adults without children.
• Single parent cover is also an option for one adult and their children.
• Children can usually stay on a family policy until they turn 22, or up to 31 if they’re full-time students and meet certain criteria.

Waiting periods are the time you must wait before claiming benefits after taking out or upgrading a private health insurance policy. For hospital cover, common waiting periods include 12 months for pre-existing conditions and pregnancy, and 2 months for psychiatric care, rehabilitation, palliative care, and most other services. Extras cover (like dental or physio) may have different waiting periods depending on the insurer and the service. Always check your policy details to understand what applies to you.

The private health insurance rebate is a government initiative that helps reduce the cost of private health insurance premiums for eligible Australians. The rebate amount depends on your income, age, and policy type, and can be claimed either as a premium reduction through your insurer or as a tax offset when lodging your tax return. Most Australians with eligible Hospital, Extras, or ambulance cover receive this rebate, making private health insurance more affordable.

Medicare doesn’t cover the full cost of surgery in a private hospital. While it may subsidise part of the doctor’s fees (such as your surgeon or anaesthetist), it doesn’t cover hospital charges like accommodation, theatre fees, or other private hospital costs. That’s where hospital cover comes in – it can help pay for these kinds of costs. Always check with your insurer and healthcare provider to understand what’s covered and any potential out-of-pocket costs.

Laser eye surgery isn’t covered by Medicare as it's considered elective and not medically necessary. However, some private health insurance policies may offer partial reimbursement for laser eye surgery costs. Cover and benefit limits vary significantly between insurers, so it's important to compare policies and check with your provider to see if laser eye surgery is included.

Invisalign® or braces may be covered by private health insurance in Australia, but only under certain extras policies that include orthodontic treatment. Cover depends on your insurer, the level of dental cover, and whether it’s considered part of your orthodontic benefits. Many policies have a 12-month waiting period before you can claim for orthodontics. It's important to check your policy details or speak with your insurer to confirm what's included and any limits or conditions that apply.

To find out your Lifetime Health Cover (LHC) loading, you can use the official Lifetime Health Cover calculator. This tool helps you estimate how much loading may apply to your hospital insurance premium based on your age and when you first took out cover. LHC loading is a government initiative that adds 2% to your premium for each year you’re over 30 without hospital cover, up to a maximum of 70%.

Private health insurance in Australia generally, doesn’t cover specialist appointments outside of hospital settings. These consultations, such as seeing a dermatologist or cardiologist in their rooms, are typically covered by Medicare, which pays a portion of the cost based on the Medicare Benefits Schedule (MBS). If the specialist charges above the MBS fee, you may have out-of-pocket costs. Private health insurance may help with specialist fees only, if the consultation is part of a hospital admission.

Private health insurance can cover ambulance services, but it depends on your policy and your state or territory. Medicare doesn’t cover ambulance transport, so many Australians rely on either private health insurance with ambulance cover or a state-based ambulance subscription. Some states, like Queensland and Tasmania, provide ambulance services free to residents, while others require separate cover. Health insurers may reimburse part or all of your ambulance costs or subscription fees, so it’s important to check your policy and local rules to ensure you’re protected.

Extras cover can be worth it if you regularly use services not covered by Medicare, such as dental, optical, physiotherapy, or chiropractic care, to name a few. It can help reduce out-of-pocket costs for these treatments and can offer reassurance that you're covered for routine health needs. However, its value depends on your lifestyle, health priorities, and how often you claim. If you rarely use these services, you might find the premiums outweigh the benefits. Comparing policies and estimating your annual usage can help you decide which level of extras cover suits you.

You generally can't claim Extras cover itself as a tax deduction, but if you hold an eligible private health insurance policy, including Extras only, you may still be entitled to the private health insurance rebate. This rebate is a government offset that helps reduce the cost of your premiums and is applied either through your insurer or when you lodge your tax return. Even if you only have Extras cover, you should still complete the private health insurance section in your tax return. If you have questions about claiming a tax deduction, please speak to a professional.

If you're visiting Australia on a tourist visa with your child, it might be a good idea to get health insurance, even though it’s not a visa requirement. Kids on tourist visas aren’t covered by Medicare, so without insurance, any medical care could prove expensive. Having private health insurance or Overseas Visitor Health Cover (OVHC) can give you peace of mind, knowing your child is protected if they need to see a doctor or visit a hospital during your stay. It’s all about staying safe and avoiding unexpected costs while you enjoy your time in Australia.

You can get extras cover without hospital cover. Extras cover can help with the cost of out-of-hospital services like dental, optical, physiotherapy, and more. Many insurers offer it as a standalone policy, so you can choose extras cover on its own or combine it with hospital cover depending on your needs and budget. It’s a flexible way to manage everyday health costs without committing to a full hospital and extras insurance package.

Many pensioners choose private health insurance for the added peace of mind. It’s a personal choice based on your health needs, lifestyle, and budget. And while Medicare covers a wide range of services, private health insurance can offer shorter wait times, access to private hospitals, and offers more choice of doctors and specialists, especially for elective procedures like joint replacements or cataract surgery.

Pensioners in Australia may be eligible for a private health insurance rebate, which can help reduce the cost of premiums based on age and income. While there isn’t a specific "pensioner discount", many older Australians benefit from this rebate, especially if they’re on a lower income. Some insurers also offer tailored policies or perks for seniors, so it’s worth comparing options to find a plan that suits your needs and budget.