Best Private Health Insurance Comparison in Australia: What to Check Before You Choose

Comparing private health insurance in Australia

Private health insurance in Australia is often compared across many policies and multiple providers, with the goal of matching cover to what you actually need and what you can afford. Policies can be compared at no cost to consumers through services that display options from a panel of partner providers, and the process is typically described as fast and straightforward: answer a few questions, view matching options, and get help moving to a different policy if you decide to switch.

While comparisons can make it easier to narrow down choices, it’s still important to understand the building blocks of private health insurance—what hospital cover and extras cover do, how tiers work, and what costs can still apply even when you are insured.

What private health insurance can cover (and what it may not)

Private health insurance provides coverage for health services beyond what Medicare offers. It commonly includes Hospital cover for in-hospital treatments and Extras cover for out-of-hospital services such as dental, optical and physiotherapy. People with private cover may be treated as a private patient in hospital, with some or all of the cost covered by their insurance. This can also mean more control over which hospital you’re treated at and which doctor treats you.

However, having private cover does not mean every cost is fully paid. Depending on the policy and the service, you may still face out-of-pocket costs.

• Hospital cover: Provides a benefit if you are treated as a private patient in hospital. Inclusions depend on the tier of cover and can include treatment costs and additional costs like travel and accommodation relating to covered procedures.
• Extras cover: Covers a range of treatments that occur outside hospital. Common inclusions include dental check-ups and treatments, optical, physiotherapy, and some pregnancy-related services. Policies vary by annual limits and the percentage you can claim back.
• Combined cover: Many people choose a combined approach (Hospital + Extras). In practice, this is generally two separate policies that you can “mix and match” based on your needs.
• Ambulance cover: Depending on where you live, you may be charged for ambulance services. Ambulance cover can be included in a broader policy or purchased as standalone. In Queensland and Tasmania, residents are covered by government-funded ambulance services; in other states and territories you’ll typically need separate ambulance cover through health insurance.

Understanding hospital tiers and why they matter

Hospital cover is sold in tiers that reflect the level of coverage available under the policy. The tier system is commonly described as Basic, Bronze, Silver and Gold. Comparing tiers is essential because the clinical categories covered—and the cost—can differ significantly.

• Gold: The highest level of cover, including all 38 clinical categories (examples cited include pregnancy, joint replacements and cataracts).
• Bronze: A more limited level of cover and generally cheaper than Gold (examples cited include emergency ambulance and accidents).
• Basic vs Gold cost example: A Basic policy for singles can start from around $80 per month, while a Gold policy may cost $250 or more each month.

Surveys referenced in the provided material indicate that many Australians find the tier system confusing. One survey of over 1,000 Australians reported that 69% find the tier system somewhat confusing, particularly around what each tier covers and how it impacts costs. Another finding noted that more than half of respondents were not clear on what is covered in each hospital tier.

Key costs to compare: premiums, gap payments, and excess

When comparing policies, looking only at the premium can be misleading. Private health insurance can still involve additional costs when you use it.

• Premiums: Health insurers typically increase premiums once a year on 1 April. Premiums rose by an average of 3.73% on 1 April 2025, described as the largest increase since 2018.
• Gap (out-of-pocket costs): Even with private health insurance, you might pay a “gap” when the doctor’s or hospital’s fees are higher than what Medicare and your health fund will pay. The amount can depend on the treatment, the hospital, and other factors.
• Excess: An excess is an amount you pay upfront when admitted to hospital. Some people choose a higher excess to reduce premiums, trading lower ongoing premiums for higher costs if admitted.
• Co-payment: A co-payment is an agreed amount you pay each time you receive a particular service (an example provided is $50 per day in hospital).

Cost ranges cited in the material suggest combined Hospital and Extras cover typically ranges from $95 to $360 per month for singles, and $190 to $750 per month for couples and families, though actual cost depends on multiple factors.

Waiting periods: what they are and typical timeframes

Waiting periods are timeframes you must wait after taking out a policy before you can start claiming benefits for certain services. Waiting periods commonly apply to both Hospital and Extras cover.

• Hospital cover: Waiting periods can range from two months for basic hospital treatment to 12 months for pre-existing conditions or pregnancy-related services.
• Extras cover: Examples provided include 2 months for general dental and 6 months for optical services.

The material also notes that there are some scenarios where you may be able to get health insurance with no waiting period, but this depends on the situation and policy.

Government incentives and penalties that can affect your decision

Private health insurance is not mandatory in Australia, but there are several government incentives and policies designed to encourage people to take out cover.

• Lifetime Health Cover (LHC) loading: A government initiative encouraging Australians to take out private hospital cover before they turn 31. If you don’t have hospital cover by July 1 following your 31st birthday, you may pay a 2% loading on top of your premium for every year you are over 30, up to a maximum of 70%.
• Medicare Levy Surcharge (MLS): An additional tax for higher-income earners who don’t have appropriate private hospital cover. For the 2024–25 financial year, the MLS is stated as 1% to 1.5% depending on income level, and family thresholds increase by $1,500 for each dependent child after the first.
• Private health insurance rebate: An income-tested government rebate that can reduce premium costs for eligible individuals and families. The material states savings can range from 8.095% to 32.385%, with rebate percentages varying by income, age and family status (including rates listed for under 65s, ages 65–69, and ages 70+ for premiums paid from 1 April 2025 to 30 June 2025).

Community rating: why your health status usually doesn’t change the premium

In Australia, private health insurance operates on a community rating system. This means premiums are not determined by your health status or risk. Everyone pays the same premium for the same policy regardless of age (including seniors), gender, or health conditions. This differs from other types of insurance, such as car insurance, where insurers can consider factors like age and claims history.

Switching health insurers and reviewing cover regularly

Switching health insurers is described as a simple process. You can switch at any time, and once you sign up with a new fund, cover can often start immediately or from a date you choose, including the day after you cancel your old policy. If you have paid premiums in advance, your previous fund is generally required to refund any amount paid beyond your cancellation date.

When switching, it’s important to check whether waiting periods apply to your new policy—particularly if you are upgrading to a higher level of cover, as waiting periods may apply for the higher benefits. The material also recommends comparing at least once a year to help ensure you’re not overpaying.

Discounts and sign-up offers: what to look for

When comparing providers, the material suggests watching for offers and discounts. Some providers offer 6 or eight weeks free on new eligible policies, which may be equal to hundreds of dollars in saved premiums. Another strategy mentioned is pre-paying premiums before the annual 1 April increase, although this only helps if you are confident you won’t need to cancel after paying in advance.

Choosing a policy that fits your needs

The best policy depends on your situation—your health needs, budget, income, and age. A practical approach described in the material is to assess what level of cover you require, then compare multiple providers based on premium cost, inclusions, and coverage limits. If you suspect you are paying for cover you don’t need, consider whether reducing your tier or adjusting your excess could better match your needs.

The material also notes that policyholders’ experiences can be mixed: while cost is commonly cited as a barrier and many people feel unclear about what they are getting, a large share of policyholders say their cover provides peace of mind.