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Insurers hiding soaring increases to top-level health cover

Some Australians are paying more than three times the headline premium increase for top-grade hospital insurance.

Last updated: 14 February 2024


Checked for accuracy by our qualified fact-checkers and verifiers. Find out more about fact-checking at CHOICE.

Need to know

  • We found the price of top-level Gold hospital cover has increased by about 31.5% in the past three years
  • These price increases are much higher than the 8.6% average increase across all levels of cover (Bronze, Silver and Gold) reported by the Department of Health and Aged Care
  • A sneaky tactic employed by health insurers is quietly closing cheaper Gold policies and releasing much more expensive policies for new customers

The Australian government is set to announce this year's health insurance increase, which means that come 1 April, you'll be paying more each month for the same cover. 

Many Australians, particularly those who need top-level Gold hospital insurance, are already facing sky-high premiums that make health insurance increasingly unaffordable at a time when many of us are already struggling with the cost of living. 

And now CHOICE analysis of three years of hospital insurance pricing data shows that health insurers – including the five biggest health funds – are jacking up the price of premium cover at a much higher rate than the advertised averages. 

CHOICE health insurance expert Jodi Bird says: "Average health insurance premiums across all levels of cover went up by 8.6% over the past three years, according to the Department of Health and Aged Care. 

"But when we looked at the prices actually available to an average customer shopping for insurance, we found that the price of top-level Gold hospital policies has increased by over 30% on average. 

"Top-level Gold cover is designed for many Australians who have specific high-level needs, such as management for mental health conditions or care in a palliative or rehabilitation facility. 

"Health insurers are using sneaky tactics to inflate prices for people who need health insurance for things such as surgery, management of chronic pain, or end-of-life care. Often these are the people who can least afford higher premiums," says Bird.

Top-level cover becoming even less affordable

In 2021, a family in NSW paid on average $5380 for a Gold hospital policy (with a $750 excess) per year. Now, the average price has blown out to $7090 per year.

A single person in 2021 paid around $224 per month, or $2690 a year, for Gold hospital cover (with a $750 excess). Today they'd get slugged with premiums closer to $295 per month or $3540 per year on average for the same level of cover.

The big five health funds – Medibank, Bupa, HCF, HBF and NIB – have implemented substantial price rises.

Our analysis, which compared policies available to new customers three years ago with those available now, found the cost of their Gold hospital policies has skyrocketed with increases even higher than the Australian average of 31.5%.

Looking at policies in NSW with a $750 excess, Medibank's 2024 Gold hospital policy cost 43% more than the policy they offered in 2021. NIB's Qantas Gold policy is 36% more expensive, and Bupa and HCF's offerings are about 35% higher than those available in 2021.

In WA, HBF's current Gold policy is 47% more expensive than the Gold policy it was selling three years ago.

Sneaky tactic 1: Close cheaper policies; replace with more expensive ones

Health insurance is highly regulated. Health insurers can only increase premiums once a year and they must seek approval from the Minister for Health and Aged Care to do so. 

But at any time health insurers can close policies to new members. Insurers can also release new policies at any time. And we've found many instances of funds closing existing policies to new members while at the same time opening new policies that offer essentially the same cover but with a slightly different name and a much higher price tag

"Our analysis shows several insurers are using these sneaky tactics to jack up the prices," says Bird.

Even when some funds keep cheaper Gold policies open to new customers, they don't advertise them – they spruik their newer, pricier policies instead

For instance, in June 2022 HBF closed their Gold Hospital policy in WA, which cost $215 per month with a $750 excess. They then released their Gold Hospital Elevate policy to new members at $280 per month, which is essentially the same cover with a 30% increase in price.

And in October 2023, the top hospital policy Medibank offered with a $750 excess was Gold Complete Hospital, which cost NSW customers $255 a month. In November, Medibank closed this policy and released Gold Protect. This is essentially the same cover, but costs $300 per month at the same excess level – which is an extra $525 per year, or 17% more.

Other price jumps we found include these NSW policies with $750 excess:

  • In August 2023 NIB closed their Qantas Gold Hospital policy, which cost $280, and released Qantas Gold Top Hospital for $325 (17% jump). 
  • In April 2023 Bupa closed their Gold Complete Hospital policy, which cost $265, and released Gold Comprehensive Hospital for $305 (15% jump). 
  • In March 2022 HCF closed their Hospital Gold policy, which cost $235, and released Hospital Premium Gold for $285 (more than 21% jump). 

For our analysis, we looked at individual policy examples in NSW for Bupa, Medibank, HCF and NIB, and we looked at WA for HBF. Read more under 'How we calculated the increases'.

Sneaky tactic 2: Show new customers the expensive policies only

We've also discovered that even when some funds keep cheaper Gold policies open to new customers, they don't advertise them – they spruik their newer, pricier policies instead.

Medibank currently has two Gold policies available to new customers – at the $500 excess level there's Gold Advanced, which costs $265 per month in NSW, and Gold Protect, which is $325 per month. 

But only the Gold Protect policy is shown on the Medibank website, which means many people don't know the cheaper option exists. 

If you call the insurer and specifically ask for it, you should still be able to buy the cheaper policy. You can search all currently available health insurance policies using our independent health insurance finder.

How to avoid paying too much for health insurance

Many Australians took out private health cover during the COVID-19 pandemic, but with the sky-high increases of Gold hospital insurance over the past few years and another premium increase on the way, health insurance has become even less affordable for people who really need it.

If you opted for top-level Gold hospital insurance 'just in case', now is the time to seriously think about dropping it or downgrading to more affordable cover.

And if you're thinking of upgrading to a Gold policy – for example, if you're planning to have a baby and want to deliver in a private hospital or you anticipate you'll need premium cover in the next few years – don't just automatically upgrade with your current fund. We often see that the best deals available are with smaller funds and restricted membership funds.

To help you make sense of your options, our health insurance comparison tool lets you compare policies from over 40 insurers. We're a nonprofit organisation and we don't take any commissions, so you can be sure we'll help you find the best policy for you (not what's best for the insurer).

Do you need Gold health insurance?

Gold hospital insurance policies are designed for people who want to be covered for specific health needs. For example:

  • young families who are planning to have a baby and want to deliver in a private hospital
  • people who need hip or knee replacements or cataract eye surgery
  • people who need end-of-life palliative care
  • families with a child who has a serious eating disorder needing in-hospital care
  • young people with mental illness and mothers with serious postnatal depression who need in-hospital psychiatric care
  • people who need rehabilitation after an accident or stroke
  • people who need weight-loss surgery
  • people with chronic pain; for example, because of coronary heart disease.  
We care about accuracy. See something that's not quite right in this article? Let us know or read more about fact-checking at CHOICE.

Stock images: Getty, unless otherwise stated.