What private health insurance covers
Private health insurance provides cover for health care not covered by Medicare such as physiotherapy and glasses. Depending on the policy you take out, it might let you have treatment in hospital as a private patient.
Depending on the policy you take out, private health insurance:
- lets you have treatment in hospital as a private patient
- can help pay medical costs that Medicare doesn’t cover.
You can still choose to be a public patient in a hospital if you have private health insurance.
Types of cover
Private health insurance policies offer hospital cover and extras cover (general treatment).
If you want both, you can take out combined cover or mix and match separate policies to meet your needs.
You can also take out ambulance cover if your state or territory government doesn’t cover it for you.
Hospital treatment cover
Hospital cover helps with the costs of treatment as a private patient in hospital.
Extras and ambulance cover
Extras cover helps with the cost of out-of-hospital health services that Medicare does not cover.
Ambulance cover can help with the cost of emergency transport and medical care.
What isn’t covered
By law, private health insurance does not offer cover for out-of-hospital medical services including:
- GP visits
- consultations with specialists in their rooms
- out-of-hospital diagnostic imaging and tests.
Medicare covers these services.
Private health insurance policies can’t cover some natural therapies. Ask your insurer, or see our fact sheet on changes to cover for natural therapies.
Out-of-pocket costs
You may have to pay out-of-pocket costs if your specialist charges more than the Medical Benefits Schedule (MBS) fee. Your out-of-pocket cost is the difference between the amount charged, and the combined amount paid by Medicare and your insurer.
You may also have out-of-pocket costs for hospital charges such as accommodation, theatre, or medical device fees. Your insurer may cover some or all of the hospital charges. Check what your policy includes and what they restrict or exclude.
Waiting periods
You might have to serve a waiting period before you can claim some medical costs. There is a once-only exemption for some mental health services and treatments.
Find out more about waiting periods and exemptions for mental health.
Cost of cover (premiums)
Your premiums will depend on the policy you take out. Your premiums will be higher if you want:
- cover for more health services such as extras
- a higher level of hospital cover
- zero excess or co-payments.
Government rebates and loadings may also affect your premiums.
- Under Lifetime Health Cover, if you take out hospital cover when you’re over 30 you may pay a higher premium for the next 10 years.
- If you’re eligible for the Private Health Insurance Rebate, you can use it to lower your premiums.
Premium increases
Your insurer must let you know in advance if your premium is going to increase. This gives you time to shop around and compare health insurance policies.
Premium increases are governed by private health insurance laws.
Problems with your cover
If you’re not happy with your health insurer’s service, contact the Commonwealth Ombudsman.