About private health insurance

Your starting point for information about private health insurance — what it is, what benefits it offers, who can provide insurance and who can get it, and how it works with public health care.

What is private health insurance?

In Australia, private health insurance allows you to be treated in hospital as a private patient. It can also help pay for health care costs that Medicare doesn’t cover, such as physiotherapy. How much and what it covers depends on your policy.

To get private health insurance you must:

  • buy a policy from a registered health insurer
  • pay regular premiums to stay covered

Benefits of private health insurance

More health cover and choice

Depending on your policy, private health insurance pays some or all of the costs of:

  • treatment in public or private hospitals as a private patient with the doctor of your choice
  • health services that are not covered under Medicare such as physiotherapy, dental and optical

Private health insurance might also help you access some hospital services more quickly.

Find out more about what private health insurance covers.

You can still choose to be a public patient in a hospital if you have private health insurance.

Pay less tax

Buying private hospital cover might mean you don’t have to pay the Medicare levy surcharge.

The Medicare levy surcharge is a levy of up to 1.5% of taxable income on people who:

  • don’t have private hospital cover
  • earn income over a certain level

Find out more about the Medicare levy surcharge and whether it applies to you.

Get a private health insurance rebate

You’re entitled to a private health insurance rebate from the Australian Government if:

  • you have private health insurance that provides hospital cover, general treatment (‘extras’) cover, or both
  • your income is below a certain limit

You get the rebate as:

  • lower insurance premiums through your health insurer, or
  • an offset in your annual tax return — this reduces the tax you have to pay

Read about the Private Health Insurance Rebate or use the private health insurance rebate calculator.

Avoid paying more for cover when you’re older

Lifetime Health Cover is an Australian Government initiative that lets you avoid paying higher premiums for private hospital cover. To be eligible for this you need to take out hospital cover before you turn 31 years old.

If you’re over 31 and take out hospital cover for the first time, you may pay higher premiums for the next 10 years. You won’t pay more for extras cover.

Work out what you might have to pay with our Lifetime Health Cover calculators or read more about Lifetime Health Cover.

Who can get private health insurance?

You don’t have to take out private health insurance, but you can choose to if you want cover for more health services and choice.

Most insurance is risk rated – for example, car or house insurance. Private health insurance is community rated. This means:

  • everyone pays the same price for a particular policy
  • a health insurer can’t refuse to insure you or sell you the policy you want to buy
  • you are guaranteed the right to renew your policy

If you’re in Australia on a temporary visa, you should consider buying insurance to cover the costs of medical treatment. Find out more about health cover for overseas visitors and overseas students.

Who provides private health insurance?

By law, only registered health insurers can provide private health insurance.

Some health insurers can only offer policies to people in certain industries, companies or groups. These are called restricted insurers.

Learn more about private health insurance laws.

How private health insurance works with public health care

Private health insurance works with our public health care system to offer you more choice and quicker access to some health services.

This table compares public and private health care services.

This table shows a list of health services, provides information on how those services might be provided in the public health care system and what private health insurance might offer in addition.

Health service

Public health care

Private health insurance

In-hospital services

You may be treated as a public patient in a public or private hospital.

The public health care system will cover the cost of your treatment.

As a public patient, you cannot choose your hospital, doctor or specialist.

When you choose to be treated as a private patient in hospital:

  • your health insurer covers some or all of the hospital costs (such as accommodation)
  • Medicare covers some of the doctors’ costs
  • your health insurer covers some or all of the remaining doctors’ costs

As a private patient, you can choose your hospital, doctor and specialist.

Doctor and specialist services outside of hospital

Medicare covers some or all of the costs of services such as:

  • visits to a GP
  • visits to specialists in their rooms
  • diagnostic imaging
  • diagnostic tests
     

Not covered.

By law, health insurers can’t offer cover for most of these services.

Other services outside of hospital

Medicare covers some or all of the costs for other services outside of hospital including:

  • dental care for some children
  • eye checks by optometrists
  • allied health services, such as psychology, in some circumstances
     

You can choose policies that cover some or all of the costs for many services outside of hospital.

Prescription medicines

Prescription medicines are covered by the Pharmaceutical Benefits Scheme (PBS).

You can choose policies that cover some prescription medicines not covered by the PBS.
 

Prostheses

The costs of implanted prostheses are covered if you’re a public patient.

If your policy covers the procedure to implant a prosthesis, it will also cover some or all of the cost for the prosthesis itself. Find out more about private health insurance cover for prostheses.

Ambulance

Some state and territory governments provide ambulance cover.
 

You can choose policies that cover ambulance costs when they are not covered by your state or territory government.

Learn more about what private health insurance covers.

Last updated: 
30 December 2019

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