Skip to content   Skip to footer navigation 

Should you use your private health insurance in a public hospital?

How to make sure you're not left out of pocket if you provide your insurance details.

two hospital beds
Last updated: 02 March 2020

Most people would have private health insurance to cover themselves for treatment in a private hospital. But what if you find yourself in a public hospital, and they ask you for your private health insurance details? 

Do you have to hand over your details?

Does using private health insurance in a public hospital give you any advantage? 

If you name-drop your insurer, will you suddenly be whisked to the front of the queue and given a cushy private room?

Will you be left out of pocket?

Here's what you need to know about using private health insurance in a public hospital.

What happens if you use private health cover in a public hospital?

It's important to realise that every Australian already has health cover through Medicare which gives us access to public hospitals. But many people choose to get private health insurance and use private hospitals instead.

"Ultimately your private health insurance is there so you can be treated in a private hospital where there'll be shorter waiting times and which might be more comfortable than a public hospital," says CHOICE health insurance expert Uta Mihm.

But if you find yourself in a public hospital for treatment, you may be asked if you have private health cover and encouraged to use it in the public hospital.

"Make sure you'll actually get some benefit and you won't incur any extra costs before handing over your private health insurance details in a public hospital when you're being admitted," warns Mihm.

Here's the deal on using a public hospital when you have private health cover:

  • You're not obliged to give your private health insurance details when you're admitted to a public hospital, or anytime during your stay.
  • If you do supply your private health insurance details, you could be left to pay for out-of-pocket costs like anaesthetists' fees that you wouldn't incur as a public patient.
  • Make sure you know exactly what you'll have to pay if you're admitted as a private patient.
  • In a life-threatening emergency situation, your private health insurance won't affect the treatment you'll receive – you'll still get top-quality healthcare thanks to Medicare.
  • Having private health insurance won't help you skip the waiting list in the public system. You'll still be allocated a surgery time according to need and how many other people are waiting.
  • Your private health insurance won't guarantee you a private room, as these are allocated based on medical need. You'll get first dibs, but only if there are any rooms left over.

Why do public hospitals ask you to use your private health insurance?

Public hospitals encourage patients to use their private health insurance as it gives the hospital money from private health insurers, on top of the subsidy they get from the government through Medicare. 

However, private health insurers argue that the practice is contributing to the rising premiums for private health cover.

Pros and cons of using your private health insurance in a public hospital

The pros

  • You may be given a private room if one is available.
  • You may be able to choose your medical specialist (although this is unlikely in a life-threatening emergency situation as you'll need to be treated immediately).
  • The money that your health insurer pays out for your admission may benefit the public hospital.

The cons

  • You're less likely to be able to choose your medical specialist than you would in a private hospital.
  • You're not guaranteed your own room.
  • You could be left with out-of-pocket costs for your surgery, anaesthesia or other treatments.
  • You may be charged the excess on your health insurance which could be up to $750.
  • Your treatment and hospital stay may not be any different than if you were admitted as a public patient.
patient talking to doctor in hospital

Ask the hospital if you'll be out of pocket if you use your private health insurance.

Should you go private in a public hospital?

"So," we hear you asking, "I might get a private room but I might not. This is so confusing! How am I supposed to know what to do?"

Good question! We recommend that you ask the hospital what it will mean if you're admitted as a private patient so you know exactly where you stand.

"You need to know that using your private health insurance in a public hospital might not have an effect on your treatment, but it might affect your accommodation options," says Mihm. 

"But you need to ask the right questions so you know whether you'll be out of pocket and by how much. Make sure there are no extra costs, or if there are, that they are worth it."

Bear in mind that you may also have out-of-pocket costs when you use your private health insurance in a private hospital, depending on how much the surgeon and anaesthetist charge.

What to ask before handing over your private health insurance details

  • Will I be charged my excess if I am admitted as a private patient?
  • Will there be any extra costs for surgery?
  • Will there be any extra costs for anaesthesia?
  • Are there any additional charges for my hospital stay?
  • Are there any other additional charges for things like blood tests, etc?
  • Is there any benefit to me giving my private health insurance details, like getting a private room?

Real-life experiences of being a private patient in a public hospital

Every quarter, CHOICE asks Australians about the financial pressures they're facing in our Consumer Pulse survey. Recently, we asked about their experiences using their private health insurance. 

In the past three years, one in four (26%) Australians with private health insurance have been a private patient in a public hospital. Just under half (48%) had a private room, and just over one in four (27%) were able to choose their specialist (compared with 58% who were private patients in a private hospital/day surgery). 

When we asked how satisfied they were with their experiences of being a private patient in a public hospital, responses were mixed. Less than two-thirds (63%) were satisfied or very satisfied with the extra benefits of being a private patient. 16% said they weren't at all satisfied with the extra benefits of being a private patient. 

Here's what some respondents said:

  • "I didn't feel any advantage of being a private patient."
  • "There was no benefit whatsoever."
  • "I did not receive any extra benefits for being a private patient in a public hospital."
  • "I no longer use private health cover in public hospitals."