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    What is private health insurance?

    If you have private health insurance, you have the freedom when it comes to selecting which medical procedures and treatments to undergo. Avoiding public waiting lists, picking your doctor, and staying in a quiet, private room are all perks of having private hospital insurance (on availability). Many non-hospitalized medical services, such as physiotherapy and dental care, are partially or fully covered by “extras” coverage. You can get the best of both worlds with a combined policy that covers you for everything.

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    Discover the advantages of health coverage

    Get the best care when you need it most

    Get the best care when you need it most

    If you have a preference for receiving medical care in a private hospital as a private patient, having private hospital insurance can assist you in managing the financial responsibilities involved. By opting for personal hospital coverage, you gain the ability to choose your own physician and enjoy the comfort of a private room, while also avoiding the lengthy queues typically found in public hospitals.
    Supplements to medical insurance

    Supplements to medical insurance

    Coverage "extras" can help with the costs of non-hospital medical services that Medicare doesn't pay for. This could cover the cost of new eyeglasses, physiotherapy, or a dental exam and cleaning.
    Add on extras and get the right cover when you need it

    Add on extras and get the right cover when you need it

    The coverage provided by a combined health insurance plan includes both hospitalisation and extras cover. It can help reduce the cost for a wide variety of hospital and non-hospital treatments.
    Safety net for dental care

    Safety net for dental care

    Many Australians would be in dire straits without dental insurance due to the high cost of care. This becomes even more important if you need extensive dental work, like implants or dentures. Fortunately, most health insurance policies cover both major and minor dental procedures.
    Physiotherapy cover

    Physiotherapy cover

    Rehabilitation from an injury can be aided by seeking out a physiotherapist's advice and following their prescribed treatment plan. Health insurance can help offset this assistance's cost when required.
    Pre-existing conditions

    Pre-existing conditions

    A pre-existing condition is a health problem before you purchase your policy. It's good news that you won't have to pay extra for your insurance because of your illness, but it could mean longer wait periods for related treatments.

    Frequently asked questions

    Several varieties of private health insurance are available for purchase. With private hospital insurance, you can receive personal patient care, giving you access to a broader range of services and choosing your doctor and hospital room (if available) without joining a public waiting list. Treatment received outside of a hospital not covered by Original Medicare can be costly.

    As a private patient, you won’t have to pay anything out of pocket because Medicare and your medical coverage will pay the full Medicare Benefits Schedule (MBS) premium. Even after paying the MBS fee, you may still be responsible for a gap payment equal to the difference between the cost of your treatment and the MBS fee.

    Your insurance company may pay a flat rate or a percentage of the total cost for covered out-of-hospital services if they are included in your “extras” coverage. There may be lifetime, annual, or partial limits on your compensation.

    Limitations, prohibitions, and waiting periods may apply; please refer to your Product Disclosure Statement (PDS) for details.

    Due to the community rating system in Australia for private health insurance, no individual will be charged more than another for the same policy because of demographic characteristics like race, gender, or a preexisting medical condition. The premiums you pay depend on several variables, including the type of coverage you purchase, location, applicable rebates or discounts, and whether or not you qualify for Lifetime Health Cover (LHC) loading.

    Healthcare insurance plans have a sliding scale of premiums based on four coverage tiers: bronze, platinum, gold, and standard. Tiers of extras cover are commonplace as well, but unlike hospitalisation insurance, which the government governs, extras cover the insurer sets tiers. Increasing your coverage will increase your premiums, but you may be able to save money in exchange for a higher deductible.

    Whether or not you are eligible for the Australian government rebate and the LHC loading will also affect your rates

    • Age-based discount
      If you get a policy before you turn 25, you may be eligible for a discount of up to 10% from some insurance companies, depending on your age. After turning 25, the discount will decrease by 2% annually until you purchase a policy. The reduction is 2% per year after age 41 until 0%.
    • Government rebate
      The Australian government may subsidise your premiums for private medical coverage if you meet certain age and income requirements. For instance, a premium refund of 32.812% is possible for the highest rebate tier.
    • LHC loading
      The LHC loading could cause your health insurance premiums to be higher than expected if you’re older than 65 when you sign up. The goal is to ease the burden on Australia’s welfare system by increasing the number of young adults who sign up for insurance.

    Your situation will determine which fund is ideal for you. We’ve made it even less complicated to shop for medical coverage by providing a convenient tool for comparing different kinds of private health insurance plans. You can use our no-cost comparison tool to find comprehensive coverage at a reasonable price for your loved ones in just a few minutes.

    Because Medicare does not cover ambulance transportation and treatment costs, numerous health funds around the country offer ambulance cover as an add-on to existing health insurance policies or as a separate policy in and of themselves. The cost of transportation and medical care might be covered by joining an ambulance service. The state government pays for the ambulance services.

    Healthcare in both the public and private sectors is meant to supplement one another.

    Medicare will cover up to 75% of the scheduled fee for your care if you are admitted to a private hospital as a private patient. You pay the remaining 75% out of pocket, but your private health insurance will pay for your hospital stay and the cost of the operation itself. Your insurance may make the difference if your doctor’s bill exceeds the predetermined amount.

    Dental and physiotherapy services, for example, are not fully covered by Medicare, but supplemental insurance, known as “extras,” can help offset some of the cost. The use of optical care as an example of how Medicare and commercial health insurance supplementary products might complement one another is illustrative. Medicare covers the optometrist examination and consultation, and your private health insurance will contribute to the cost of your glasses or contacts.

    Similar to other types of insurance, health insurance has excess charges. Some auto insurance plans, for instance, let you raise your deductible in exchange for a lower monthly premium. The same holds for hospitalisation benefits provided by health insurance. As an additional point of clarification, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) premium for hospitalisation. Your health fund will pay 75% of your healthcare costs if you have suitable private health insurance.

    The Australian government sets Medical Benefits Schedule (MBS) rates, although doctors can charge whatever they like for their services. Additional fees may be incurred to cover the costs of medications, analgesics, treatments, and diagnostic tests, depending on the length of your hospital stay. Some insurance companies for private medical care provide a service called “gap cover” to their customers in case they incur a large bill that their insurance doesn’t cover.

    If the treating physician agrees to participate, the health insurance company will pay for the supplementary costs. A high premium can be avoided by selecting an excess, which will help offset the cost of the premium. Depending on your policy, you may have to pay a lot each time you visit the hospital or once a year.

    When Australians reach retirement age, they often start thinking about ways to save money. As an example, they might downsize their homes, cut back on the number of cars they own, or even forego private health insurance altogether. In particular, this is true for retirees who have maintained a healthy lifestyle and rarely used their insurance. But private health insurance may be most important in your golden years. Even though a healthy diet and regular exercise can help lower your risk of developing various health problems associated with aging, there is no guarantee doing so will eliminate the risk.

    Health insurance may give you much-needed peace of mind. It is generally true that the likelihood of requiring medical attention, whether for an injury, ailment, or other health problem, increases with age. If your health problem is severe or you happen to live in a rural area, you may have to wait a long time before being seen by a doctor through the public healthcare system.

    Medicare will still pay 75% of the Medicare Benefits Schedule (MBS) premium if you receive care at a private hospital instead of a public one. On the other hand, you’ll have to pay the remaining 75%, not to mention any additional fees that may be incurred based on the duration of your stay and the specifics of your treatment.

    Keeping your health insurance as a retiree has additional advantages. If you end up needing medical attention, you won’t have to wait your turn for public healthcare and can see any doctor you like. Preventive care services may also be available depending on your plan’s coverage. The Australian government provides a more significant rebate to its citizens over the age of 65 than it does to its younger citizens; this rebate rises again at 70.

    Private medical insurance premiums are not tax deductible but may affect your tax situation.

    You can get a tax rebate yearly if you have a private health insurance policy (either hospital, supplements, or combined). Your other option is to use the refund to lower your monthly premium payment.

    In addition, the Medicare Levy Surcharge may apply to you if you have an annual household income of more than $90,000 ($180,000 for a family of four) and do not have enough private hospital insurance (MLS). You’ll have to pay this according to the number of days in the fiscal year that you went without insurance coverage (e.g., 1.5% of your yearly income).