Need to know
- Health insurance premiums for some funds will increase on 1 April, so it's a good time to review your cover and make sure you're getting the best deal
- Insurance for conditions like cataracts and knee or hip replacements is usually only covered by the most expensive top-tier policies
- Medibank, GMHBA, HCF and three other insurers offer policies where you won't get charged an excess for day surgery such as cataract, colonoscopy or endoscopy
As you get older, your health needs can change so it's vital to check you've got the right insurance policy to cover them.
You're more likely to need certain types of treatments and surgeries (such as cataracts or knee replacements, for example) and these are usually only covered by the top-tier Gold and Silver Plus policies.
Health insurance premiums for some funds will go up on 1 April and other funds like Medibank, Bupa, NIB and HCF are set to increase premiums later in the year, so now is the time to compare your health insurance options and shop around for a better policy if you can.
Here are our tips to help you check that you have the cover you need, and possibly even lock in a cheaper premium for the next 12 months.
Health insurance policies are categorised into four tiers:
- Basic – very little if any cover in a private hospital
- Bronze – low cover
- Silver – medium cover
- Gold – full or top cover.
In between these main tiers there are also Silver Plus, Bronze Plus and Basic Plus policies that cover at least one service more than the normal Silver, Bronze or Basic policies. For example, a Silver Plus policy could include cover for pregnancy or cataract surgery (services usually only covered under Gold policies).
It's a sad fact of life but as we age, we're more likely to need certain types of treatments and surgeries.
For instance, about 40% of all elective surgeries including hip and knee replacements carried out in Australia in 2020–21 were for people aged 65 and over. Older people are also more likely to end up in hospital, with over 65s accounting for more than 40% of day and overnight hospital admissions according to the Australian Institute of Health and Welfare (despite the fact this age group accounts for only just over 15% of the population).
|To be guaranteed cover for:||Choose:|
|Heart surgery||Silver or Gold|
When reviewing your current policy or comparing quotes, here are some things you should consider.
- You might find cover for these treatments in lower level tiers, but it's not guaranteed. If you do choose a cheaper policy such as Silver Plus, keep a close eye on the policy to make sure it retains the cover you need.
- If you're upgrading your cover, a 12-month waiting period applies for conditions you weren't covered for on your old policy. So if you require surgery, make sure it's scheduled for after you've served the waiting period.
Even though you're at the stage of your life where you're done having kids, whether you should downgrade to a policy that doesn't include cover for pregnancy and fertility is not as simple as it seems.
Pregnancy and IVF are covered by the top-tier Gold and some Silver Plus policies – but these tiers are also suited to people over 65 who want to be covered for surgery typically needed later in life, such as cataract surgery or hip or knee replacements.
A few health funds offer Silver Plus policies without pregnancy, but before taking one out, make sure:
- it's actually cheaper than the cheapest Gold policies – we found a number of rip-off Silver Plus policies that are very expensive
- there aren't other restrictions on things you do need – for example, many Silver Plus policies don't cover hip and knee replacements or rehabilitation in a private hospital.
Until the health insurance reforms of 2019, the highest excess you could opt for was $500. But now you can choose to pay a higher excess of up to $750 per person and $1500 per couple/family to reduce your premiums.
An excess is an amount of money you pay out of your own pocket towards a hospital visit. You pay an excess once per hospital visit, and it's usually capped at once (single) or twice (couple/family) per year.
But if you think you'll need surgery within the next two years, choose a policy that has a lower or no excess – you might pay a bit more for the premiums, but you won't be hit with high out-of-pocket costs if you do have to stay in hospital.
CHOICE tip: If you're switching from paying a higher excess to paying a low or no excess, keep in mind you'll have to serve a 12-month waiting period (you'll still be covered during the waiting period but you'll have to pay the higher excess).
If you think you'll need day surgery, such as cataract surgery, look for a policy that doesn't charge an excess for same-day patients.
These health funds don't charge an excess for day surgery on some of their policies:
- Health Care Insurance
- RT Health
While public hospitals in Australia provide world-class health care if you have a serious or life-threatening illness, they can have long waiting times for elective surgeries such as cataract surgery or hip and knee replacements. So if you already have health insurance and can afford it, we don't recommend dropping it.
Consider the below factors.
- Increasing value for money: Australians aged 60–79 use their hospital insurance more than any other age group.
- Higher rebates: When you hit 65, you're entitled to a higher rebate – that's the amount the government pays that helps reduce your premiums. For singles earning up to $93,000 and couples/families earning up to $186,000, you'll go from a 24.6% rebate to a 28.7% rebate. As of 1 April 2021, this increases to 32.8% at age 75.
- Partners and families benefit: When one member of a family or a couple is 65, the government rebate applies to the whole family or couples policy.
You could, however, consider dropping your extras cover and funding those services (dental, optical, physio etc.) yourself. According to our calculations, the average annual extras premium for a single person in Australia is about $630, and the average benefit (cash you'll receive back from your provider) is only $435.
If you have difficulty budgeting, and would rather pay an insurer monthly than fork out hundreds of dollars in one hit for a large dentist bill, extras cover may be useful. But just be aware you could be paying more than you'll ever get back, and we suggest you compare quotes from providers on standalone hospital and extras cover rather than a combined hospital and extras policy.
We've put together a handy five-step action plan to help you through the process of reviewing, comparing and switching your health insurance policy.
Just a few minutes could potentially save you hundreds of dollars per year: one of our CHOICE editors saved herself over $1800 annually just by reviewing and switching cover for her young family.
Follow these five easy steps below.
Stock images: Getty, unless otherwise stated.