Health insurance changes – should you choose Gold, Silver or Bronze?


Here's what's covered under the new health insurance tiers.

Which insurance is right for you?


Government health insurance reforms have introduced four new policy level tiers for cover in hospital. The first new policies became available on 1 April 2019 and all policies will change over by 1 April 2020.

Cover levels are:

  • Basic – very little if any cover in private hospital
  • Bronze – low cover
  • Silver – medium cover
  • Gold – full or top cover

Basic Plus, Bronze Plus and Silver Plus policies  cover at least one service more than normal Basic, Bronze or Silver policies.

For example a Silver Plus policy could include cover for pregnancy or cataract surgery, services normally only covered under Gold policies.

If you haven't already, you'll receive a letter from your health fund telling you what they're going to do with your policy. We explain how to read the letter from your fund.

Which level of cover do you need?

New policies will be classified according to the level of cover they provide. 

Policies cover up to 38 categories of treatments. There are standardised definitions called 'clinical categories' for procedures in each category, which will be adopted by all insurers. The definitions are very detailed and include each procedure and its Medicare item number.

CHOICE tip: If you have specific health needs, ask your doctor which Medicare item numbers your treatment falls under. Then you can easily clarify with your insurer if your new policy covers this.

Basic policies

Will work for you if:

  • You want health insurance mainly for avoiding tax and surcharges
  • You live in a regional area with no private hospitals, but you still want to choose which doctor treats you in a public hospital. In this case, instead of choosing a more expensive Gold policy with full cover you could try to find a Basic Plus policy that covers everything in public hospitals

But not if you need:

  • Cover for stroke treatment, cancer surgery, heart disease, flu, asthma and most of the therapies available in private hospitals
  • Specialist in-hospital treatments for things like rehabilitation and psychiatric care, for example, for postnatal depression or eating disorders
  • Private cover for IVF, pregnancy and birth

All Basic policies must cover treatment in a public hospital for palliative care, rehabilitation and psychiatric care.

Rehabilitation and psychiatric care are in high demand. Choosing a Gold policy gives you access to private hospitals, and more flexibility if you're likely to need these kinds of treatments

Watch out: CHOICE considers many of these policies poor value, something the government has not addressed with these reforms. See more on junk health insurance policies.

Bronze policies

medal star rosette bronze

Will work for you if:

  • You want health insurance mainly for avoiding tax and surcharges
  • You're healthy but want back-up cover for broken bones, flu and diabetes treatment (although insulin pumps are only covered in Gold cover)

But not if you need:

  • Private treatment for psychiatric care or rehabilitation
  • Private treatment for major illnesses like heart disease or lung cancer
  • Private cover for IVF, pregnancy and birth
  • Private treatment for a hip replacement or cataract surgery

Bronze policies cover 18 categories of services in private hospital including:

  • Tonsils, adenoids, grommets, hernia and appendix
  • Breast, skin and prostate cancer
  • Chemotherapy and radiation 
  • Broken bones
  • Joint reconstruction (but not replacements)
  • Ear, nose and throat surgery 
  • Diabetes management in hospital (but not implanted insulin pumps) 
  • Endoscopy and colonoscopy
  • Gallstones and haemorrhoids
  • Miscarriage and termination of pregnancy
  • Palliative care, rehabilitation and psychiatric care (covered in a public hospital only)

Silver policies

medal star rosette silver

Will work for you if:

  • You don't have any chronic or major health issues
  • You want cover for heart attack, cancer surgery and plastic surgery (after a burn or accident).

But not if you need:

  • Private treatment for psychiatric care or rehabilitation
  • Private cover for IVF, pregnancy and birth
  • Cover for a hip replacement or cataract eye surgery
  • Cover for chronic health issues such as type 1 Diabetes

Silver policies cover 26 categories of services in private hospital, including:

  • Everything covered by Basic and Bronze
  • Heart surgery
  • Lung cancer surgery
  • Medically necessary plastic and reconstructive surgery
  • Bone marrow transplants
  • Investigation and treatment for back, neck and spine problems such as for sciatica and scoliosis
  • Dental surgery (wisdom teeth and dental implants)
  • Implantation of hearing devices
  • Accommodation in hospital for podiatric surgery
  • Palliative care, rehabilitation and psychiatric care (covered in a public hospital only)

Gold policies

medal star rosette gold

Will work for you if:

  • You need cover for IVF, pregnancy and birth
  • You need cataract eye surgery
  • You need a hip or knee replacement
  • You have chronic health issues and may need pain management with a device, insulin pumps or gastric banding surgery
  • You need private treatment for psychiatry or rehabilitation

But not if you need:

  • To keep your ongoing insurance costs low

CHOICE tip: If you're taking out Gold cover for joint replacement, cataract surgery or pregnancy you could consider downgrading to Silver or Silver Plus later.

Gold policies will cover all 38 categories of services in private hospital, including:

  • Everything covered by Basic, Bronze and Silver
  • IVF, pregnancy and birth (see Do you need insurance to have a baby?)
  • Joint replacements
  • Cataracts
  • Rehabilitation
  • Hospital psychiatry
  • Palliative care
  • Gastric banding
  • Insulin pumps
  • Sleep studies
  • Dialysis
  • Pain management with a device (for example, a surgically implanted device to manage pain caused by heart disease)


It can get confusing and expensive

These treatment categories aren't easy to understand or logical.

For example, while cancer treatment is covered under chemotherapy and radiation (Bronze), cancer surgery is covered under the category of the organ affected. So surgery for bone marrow transplants is covered under "Blood" (Silver), while lung cancer surgery is covered under "Lung and chest" (Silver).

That means you might find you have cover for one part of your cancer treatment but need a higher level of cover for the rest.

CHOICE tip: Under the old system cancer surgery was normally covered by cheap budget-type policies. If you were on that type of policy, you should check your new policy still covers everything you need.

What else changed?

  • Higher excesses may help you reduce premiums (up to $750 for singles and $1500 for couples and families).
  • Under-30s discounts of 2% per year, up to a maximum of 10%.
  • Many alternative therapies are no longer covered (such as naturopathy, homeopathy and pilates).
  • New accommodation benefits for rural Australians with hospital policies who are treated away from home.

For more information see Five things you need to know about private health insurance changes.


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