Medicare vs Private Health Insurance

When it comes to medical cover there is a question that’s on most people’s minds, will Medicare cover me or will I need a private health insurance cover?  Medicare is our public health scheme providing free or subsidised healthcare to all Australians that are permanent residents. Medicare is made up of three main areas: hospital, medical and pharmaceutical. 

Each eligible person in Australia is issued a Medicare card to present every time you see a doctor, go to hospital, or get a medical test done. 

Comparing private health insurance plans with Medicare is the best way to ascertain whether you will have the correct cover and whether you require a mix of both Medicare and private health to give you the most affordable private health insurance. In this month’s blog we will cover everything you need to keep in mind when making your final decision.  

The Advantages of Medicare 

No Cost to You – supplemented by the Australian Government 

  • medical services provided by doctors, specialists, and other health professionals (if your doctor bulk bills, you won’t have to pay for anything)
  • Free or at a lower cost prescription medicine
  • Save money on medical costs by registering your family for the Medicare Safety Net 

What is covered by Medicare 

Medicare partially or fully covers:

  • seeing a GP or specialist
  • tests and scans, like x-rays
  • most surgery and procedures performed by doctors in the public system
  • eye tests by optometrists

For instance, when you are visiting your GP and they have a bulk billing service, Medicare will cover the costs of the visit and you will not have any out-of-pocket expenses. It’s always a good idea at the time of booking to ask your medical practice if they bulk bill and if not enquire how much you will get back as a rebate from the overall fee. 

A great reference tool to find a practitioner that bulk bills can be found here, simply choose the service required and add your postcode or location. It will also give you an idea of what providers offer a competitive charge so you have a comprehensive health plan.

What’s not covered by Medicare 

Unfortunately, Medicare does not cover ambulance levies so you will need to find and organise an Ambulance provider or make sure you’re covered through a private health policy for this service. 

Other items not covered under the Medicare scheme:

  • hearing devices
  • workers’ compensation check-ups or life insurance
  • in home nursing assistance
  • most dental services
  • Chinese medicine, alternative therapies, or complementary medicine (unless it has been ordered by a doctor)
  • Glasses and contact lenses.

About the Medicare Safety Net

A provider of larger rebates to those that have substantial healthcare costs, the Medicare Safety Net offers further assistance with out-of-pocket costs. For example, when you spend a certain amount on healthcare over the course of a year and reach the Medicare Safety Net threshold, Medicare will provide a larger rebate for a wide range of services, including:

  • biopsies
  • blood tests
  • healthcare professional consultations
  • pap smears
  • psychiatry
  • radiotherapy
  • scans
  • ultrasounds
  • x-rays.

Mixing Medicare with Private Health Insurance

Even if you have private health insurance you can still access benefits from Medicare. Some customers opt to have their hospital insurance through their private health fund which allows you to have treatment in a private hospital or as a private patient in a public hospital. The private health system is divided into three areas: hospital, extras, and ambulance.

Advantages of private health cover:

  • Nominate your own doctor/ specialist
  • Less waiting time for non-elective surgeries
  • Choice of hospital 

Private health insurance doesn’t cover:

  • GP visits
  • some specialist visits
  • visits to hospital emergency departments, both public and private
  • any x-rays or other scans
  • any blood tests or other pathology tests.

It’s all about Affordability 

Whether you can afford to pay for private health insurance is a big factor. You may choose only to have Medicare cover, due to the cost of private health cover. It really comes down to your budget and what works best for your financial situation.  Medicare is still a great alternative option for your health and well-being.

Some important things to keep in mind

If require non-urgent, elective surgery or treatment the waiting times can be longer in the public Medicare system. So, choosing a private health policy that will cover your surgery and speed up the process may be something to think about.  

Chat to us Today

To compare private health insurance  – speak to one of our team members today on 1300 861 413 or email us

You might be interested in...
I’ve exhausted my extras this year, what can I do?

Each calendar year, your extras cover on your private health policy resets on January 1. Some funds vary, but mostly all extras policies reset around this time. Extras policies can cover such services as dental, optical, and physiotherapy. So, what can you do if you’ve exhausted all your extras limits for this year? Don’t worry, there are still options available to you. Let’s explore some practical solutions to help out if you’ve used up all your extras cover.

Prioritise essential treatments:

1. When you’ve exhausted your extras limits, it’s important to plan ahead so you know when the limits reset and prioritise your essential treatments. Focus on services that are necessary for your health and well-being. For example, if you have ongoing dental issues, make sure to book your regular check-ups to avoid extra out-of-pocket expenses if you need extra fillings or dental work done. By prioritising essential treatments, you can ensure that you’re taking care of your health while making the most of the coverage you have left before the ailment becomes a major issue.

Source discounted packages from health providers:

2. Look for professionals who offer competitive rates or discounted packages. Some providers may also offer a combination of bulk-billing and payment plans to help out. By researching and comparing different provider options, you might find more affordable alternatives for the health services you need.

Review your policy:

3. Take the time to review your current private health policy. Check if there are any additional benefits or options that you may have overlooked. Some policies offer loyalty bonuses or additional coverage for specific services. By understanding the details of your extras component of your private health policy, you can make informed decisions about utilising your benefits and potentially find hidden perks that you haven’t taken advantage of yet.

Consider waiting until the new year:

4. If you’ve exhausted all your extras limits and can afford to wait, you may consider postponing non-urgent treatments until the new year. By doing so, you’ll be able to take advantage of the refreshed limits and maximise your extras coverage once it resets. 

Seek professional advice:

5. Talk to your private health fund, they can provide guidance based on your specific policy and circumstances. They’ll help you navigate the policy, understand your options, and give suggestions for strategies to make the most of your extras coverage.

Reaching the extras limits on your private health cover doesn’t mean you’re out of options. By prioritising essential treatments, exploring alternative providers, reviewing your policy or waiting until the new year, you can still make the most of your coverage. Remember, the key is to be proactive when it comes to your healthcare needs and plan ahead. 

Chat to us Today

To compare private health insurance extras and discuss what’s  best for you – our friendly team are ready to talk you through the options. Call us on  1300 861 413 or email us

You might be interested in...
Just married. Do we need couples’ private health cover?

Just got hitched? You might be wondering whether switching to a couples private health policy is right for you. Well, the good news is, there’s no hard and fast rule that says married couples have to switch to a joint private health insurance policy. Ultimately, the decision is up to you and your spouse, and it will depend on your specific situation.

One of the advantages of opting for a couples private health policy is that it can potentially lower the overall cost of your private health insurance premium compared to having two separate single policies. 

Here are some benefits of couples’ private health insurance to consider:

  1. Lower overall cost: Couples policies may come with lower premiums compared to two individual policies. More convenient, as you’ll only have one policy to pay, and managing just one account will definitely simplify things.
  2. Flexibility: Some private health insurers offer the flexibility to choose a policy with a combined annual limit. This allows each partner to select the extras services that suit their individual needs. For example, one partner could choose to spend more on optical while the other opts to spend more on dental care.
  3. Enhanced coverage for family planning: Couples private health policies tailored towards individuals in their 20s and 30s typically offer more comprehensive coverage for family planning needs such as fertility treatments and pregnancy services.

It’s important to remember that your private health cover needs may change over time due to various factors like getting married, a long-term relationship, starting a family, health conditions, or changes in your lifestyle or life stage. These factors can greatly influence your private health insurance requirements.

For example, if you’re at the stage of planning a family, comparing private health insurance options becomes really important. There are numerous options available when it comes to pregnancy and starting a family. It’s worth noting that pregnancy, birthing, and reproductive services like IVF typically fall under top-tier Gold hospital cover. Some private health insurers may also offer specific Silver Plus policies tailored for couples looking to start a family.

It’s important to keep in mind the waiting periods that come with obstetric services such as pregnancy, birthing, and IVF; they usually have 12-month waiting periods. So, if you want to take advantage of the benefits offered by top-tier cover, it’s essential to take out a policy well ahead of time before you start to try for a baby.

Does couples’ private health cover provide double access to extras treatments?

The answer is no. Usually, when it comes to an extras policy, claim limits still apply per person but some private health providers allow couples to combine their extras annual limits. It’s worth checking with your private health fund if they offer this option. 

Before deciding on a joint private health policy once married, it’s important to ask yourselves these five questions:

What kind of coverage do we need?

1. Even though you’re now married, it’s a good idea to consider your individual health needs and the level of coverage that suits you both best. Take a look at options such as Gold, Silver, Bronze, or Basic levels of hospital cover, ambulance cover, extras cover, or a combined hospital and extras policy. 

What are your partner’s requirements?

2. It’s essential to understand your partner’s health needs as well. Do their requirements align with yours, or would both of you benefit from different types of coverage?

Will your health needs change in the future?

3. Keep in mind that all hospital policies have waiting periods of up to 12 months, and some extras policies may have even longer waiting periods. Consider this if you anticipate changes in your or your partner’s health needs. 

Are either of you subject to LHC loading?

4. If either of you obtained a hospital policy after your 31st birthday and on or after July 1, you’ll need to pay the government’s LHC loading in addition to your hospital policy premiums. This loading fee increases by two percent for each year you didn’t have hospital cover. For a couples hospital policy, the applicable LHC loading will be averaged out between the two of you and added to your premiums. 

Are either of you eligible for the age-based discount?

5. The age-based discount offers premium discounts on certain hospital policies if you take out health insurance before turning 29. On a couples policy, the discount is averaged between both individuals. So, if you qualify for a 10% age-based discount on a singles policy but your partner doesn’t, a couples policy would receive a 5% discount, averaged between the two of you.

As you build a future together, making sure your private health cover aligns with your new life stage and individual needs will give you peace of mind. Find the policy that’s right for you and get the most out of your coverage today by comparing private health plans.

Call our friendly team today on 1300 861 413 or email

You might be interested in...
Can private health insurance help with braces and orthodontics?

Are you considering getting braces or orthodontic treatment for yourself or your child? It’s understandable that you may have concerns about the cost, time commitment, and overall inconvenience of the process. However, it’s important to remember that corrective dental braces offer numerous benefits beyond just a perfect smile. They can significantly improve your oral health as well. Braces are commonly recommended during childhood or early adolescence, but adults are increasingly opting for them as well.

If you have orthodontic private health cover it will assist in offsetting the cost of orthodontic treatments like braces, aligners, and retainers. If you want coverage for orthodontics along with other services such as optical and physiotherapy, you should look for an extras private health insurance policy that specifically includes orthodontics. It’s crucial to pay close attention to the benefits and features provided by different policies, and you can conveniently compare them by talking to

What cover do I need for orthodontics?

Usually, you will require a private health insurance plan with extras cover for dental treatment and it’s split into three categories.

  • General dental: Includes cleaning, plaque removal, X-rays and minor fillings
  • Major dental: Includes crowns, bridges and dentures and wisdom teeth extraction
  • Orthodontics

How do you know if you or your child actually require braces or orthodontic work? 

Here are some indications that there is a need for orthodontic treatment:

  • Teeth coming out too early, too late, or irregularly
  • Crowded or misaligned teeth
  • Protruded teeth
  • Excessive overbite or underbite
  • Difficulty chewing
  • Jaw popping, shifting, or clicking
  • Crooked or unevenly spaced teeth
  • Underbites, overbites, or crossbites
  • Limited breathing
  • Gaps between teeth

What are the different types of orthodontic treatments available:

  1. Traditional Metal Braces: These consist of small metal brackets bonded directly to the teeth, along with an archwire that connects all the brackets. The brackets can be either “twin” brackets, requiring coloured, silver, or clear elastic modules for archwire attachment, or “self-ligating” brackets. Each bracket is designed for a specific tooth, considering its unique features and requirements.
  2. Clear Braces: Clear or tooth-colored braces are often used for upper teeth that are more visible when talking and smiling. Patients have the option of clear braces in either twin bracket or self-ligating design, including the option of clear braces for lower front teeth.
  3. Lingual Braces: If you prefer braces that are completely “invisible,” another option is lingual braces. These braces are fitted to the inside or lingual surface of the teeth, which provides custom-made braces for accurate fit and placement. 
  4. Invisalign: Invisalign is an almost invisible alternative to braces. It involves using a series of thin, clear aligners that resemble mouthguards. These aligners are worn full-time, except when eating, and are changed every two weeks to gradually move the teeth to the desired position. 
  5. Plates: Dental plates are removable plastic devices designed to adjust or stabilise teeth using wires and springs. Unlike fixed braces, these plates can be easily taken out of the mouth whenever desired.
  6. Retainers: After undergoing orthodontic treatment, wearing a retainer is recommended to maintain the new shape of your teeth. Retainers can be removable appliances or bonded retainers that are glued to the back of the teeth so they are not visible.

Are braces and orthodontics covered by Medicare?

Generally, Medicare does not cover braces and orthodontic treatments. Dental treatments, in general, are not covered by Medicare, although the Child Dental Benefits schedule does provide some dental coverage for kids. However, orthodontics and braces specifically do not qualify for this coverage through Medicare.

What should I look for in a private health policy for my orthodontic needs?

  1. Take the time to compare different providers online, chat to your dentist and talk to friends and family for referrals. Spending some time researching can potentially save you hundreds of dollars in the long run.
  2. Pay attention to the annual limits of the private health policies you’re considering. The annual limit is the maximum amount you can claim for orthodontic treatment in a year. Higher limits allow you to claim more, but keep in mind that premiums are usually higher as well. 
  3. Lifetime limits are another important factor to consider. Some private health insurers set a maximum lifetime limit for orthodontic coverage. If you anticipate needing extensive orthodontic work, make sure to check the lifetime limit, as it represents the maximum amount you can claim over the course of your policy, regardless of how long you hold it.
  4. Waiting periods is another key factor to take into consideration, usually with most policies – braces or orthodontic work have a 12 month waiting period before you can claim. Check with your private health provider as some waiting periods may vary.
  5. Price is undoubtedly a crucial factor in your decision-making process. However, it’s important to strike a balance between cost and private health coverage. Avoid simply opting for the cheapest policy without thoroughly comparing your options. You might find a better deal elsewhere without compromising the coverage you need. On the other hand, be mindful of your budget and avoid policies that stretch your financial limits.
  6. Consider the additional benefits offered by extras policies. These policies often provide various perks beyond orthodontic coverage. You might enjoy additional discounts on services like massages, physiotherapy appointments, or even gym memberships. 

To find the best provider for braces and orthodontic cover, we recommend comparing online with us. Don’t limit yourself to a familiar brand or rely solely on recommendations from friends. By researching online, you can discover a private health insurance policy that suits you best and potentially save hundreds of dollars. Look at the annual limits for orthodontics, as they determine the maximum amount you can claim in a year. Consider the lifetime limits as well, which indicate the maximum amount you can claim over the duration of the private health policy.

To compare private health insurance that best covers your dental and orthodontic needs – Call us on 1300 861 413 or email hello@healthmarketing

You might be interested in...
How to reduce your tax with Private Health Cover

Have you ever wondered how you could lower your taxes just by signing up for private health insurance? In Australia, we have something called the Medicare levy surcharge (MLS), which is a tax implemented by the Government to encourage people to use private hospitals alongside Medicare. This tax applies to individuals and families with higher incomes who don’t have eligible private hospital coverage. Its purpose is to ease the strain on the Medicare system by directing the funds collected back into it.

So, how does the Medicare levy surcharge actually work? 

It’s pretty straightforward. The tax is calculated as a percentage of your taxable income, total reportable fringe benefits, and any amount for which family trust distribution tax has been paid. Once you hit the means testing amount you start paying the MLS. At the low end of the MLS you will pay 1% and 1.5% at the top end. For more information click here.

Now, let’s talk about the private health rebate

The private health insurance (PHI) is a Government assisted rebate amount provided to assist with the cost of your private health insurance premiums. This rebate is subject to income testing, meaning your eligibility for it depends on your income for surcharge purposes. As a higher income earner, your entitlement to the rebate may be less or you may not be entitled to a rebate at all.

You might be wondering how the private health rebate can help you with your tax. 

Well, if you qualify for the rebate, there are two ways to claim it. Firstly, you can have your private health insurance provider apply the rebate directly to reduce your premiums. Alternatively, you can claim the rebate as a refundable tax offset when you lodge your tax return. 

So, by having eligible private health cover, you not only benefit from the private health rebate, you may potentially avoid paying the Medicare levy surcharge, which can reduce your tax liability. It’s a win-win situation where you can take care of your health and save on your taxes at the same time.

To compare private health insurance – Call us on 1300 861 413 or email

Useful links

Private health insurance rebate eligibility – Find out if you are eligible for the private health insurance rebate and how you can claim the rebate

Medicare levy surcharge income, thresholds and rates – Based on your income for MLS purposes, you can work out which income threshold and MLS rates apply to you.

You might be interested in...
The Essential Guide to Private Health Cover for Singles

As a single person, your private health coverage requirements may differ from those of a couple, single parent, or family. That’s why it might be beneficial for you to consider a singles policy that is specifically tailored to your current stage of life, overall health, income, and personal preferences. When it comes to safeguarding your health and well-being, having private health cover as a single is a wise choice.

For singles navigating the world of private health insurance, understanding the ins and outs of various plans can be overwhelming. In this post, we’ll explore the key aspects of private health coverage for singles, explain its importance, and provide useful insights to help you make an informed decision. Whether you’re a young professional, a self-employed individual, or simply someone looking for comprehensive private healthcare options, this guide will equip you with the knowledge you need to find the perfect policy.

What exactly is singles private health cover?
It’s a policy designed to cover the private healthcare needs of a single individual. Unlike couples or family policies that provide coverage for multiple individuals, a singles policy focuses solely on one person.

The key advantage of a singles private health insurance policy is the ability to customise it according to your specific needs. Unlike couples or family private health plans, where everyone is covered for the same set of benefits, a singles policy can be personalised based on your unique requirements. If you are part of a couple, you also have the option to consider obtaining two separate singles policies. This allows each of you to tailor the policy to your individual needs and desired level of coverage.

By opting for a singles private health policy, you can have peace of mind knowing that your healthcare needs are adequately covered. Whether you’re looking for comprehensive coverage or have specific medical concerns, a singles policy can be tailored to suit your preferences and provide the necessary protection for your well-being.

Understanding Private Health Coverage for Singles:
Private health coverage for singles offers additional benefits and services beyond what is provided by our public health system. For singles, it provides tailored coverage, flexibility, and a higher level of control over your healthcare choices. Here are some essential aspects to consider:

⦁ Comprehensive Coverage: Private health cover offers a wide range of benefits that go beyond what is typically provided by our current public health system. These policies often include coverage for hospital stays, surgeries, prescription medications, and preventive care.
⦁ Faster Access to Healthcare: With private health cover, you can typically avoid long wait times for medical treatments and consultations. This means you’ll receive prompt attention and care when you need it the most.
⦁ Choice of Healthcare Providers: Private health insurance cover grants you the freedom to choose your preferred healthcare providers, including doctors, specialists, and hospitals. This flexibility ensures you receive care from professionals you trust.
⦁ Additional Services: Many private health plans offer additional extras services such as dental care, eye care, mental health support, and alternative therapies. These extras will enhance your overall well-being and provide a comprehensive healthcare solution tailored to your needs.
What are the different types of singles private health insurance policies?
There are three different types of private health insurance:
⦁ hospital cover,
extras cover and
⦁ combined hospital and extras cover.

What do the different types of private health cover mean?
Hospital cover provides you with the opportunity to receive medical treatment as a private patient in either a private or public hospital. With hospital cover, you typically have the freedom to choose your own doctor. It also helps in managing some of the medical expenses incurred during your hospital stay.

Hospital policies are categorised into four main tiers: Gold, Silver, Bronze, and Basic.

Each tier ensures a minimum standard of treatments. Additionally, Silver, Bronze, and Basic tier policies may offer a “Plus” option that provides extra coverage beyond the minimum standard.

On the other hand, extras cover assists in covering you for the costs of various health services that fall outside of hospital treatment. These services can include dental care, chiropractic treatments, physiotherapy sessions, and optical needs like glasses and contact lenses. Unlike hospital cover, extras policies are not bound by the tier requirements. Instead, the coverage provided by extras policies depends on the specific policy and provider you choose.

Why is private health cover so important?
Private health cover is incredibly important for several reasons. Firstly, it offers individuals greater control and choice over their healthcare. With private health cover, people have access to a wide network of healthcare providers, allowing them to select the doctors, specialists, and hospitals that best meet their needs.

Additionally, it provides financial security when it comes to your health and wellbeing by covering the cost of expensive medical procedures, medications and treatments that may not be covered by the public healthcare system.

Explore your options
Ultimately, private health cover offers peace of mind, knowing healthcare is readily available. Talk to our friendly staff today to discuss your singles private health cover options. They will assist you in comparing private health insurance policies that best suit your situation and stage of life.

Call us on 1300 861 413 or email

You might be interested in...
Lifetime Health Cover Explained

Are you turning 31 soon or have you already passed that age milestone? If so, it’s important to know about Lifetime Health Cover (LHC) loading and how it may affect your private health insurance. Here we’ll explain what LHC is, how it works, and how it can impact your healthcare costs. We’ll also provide some tips on how to compare private health insurance plans to find the best coverage for your needs.

What is Lifetime Health Cover?
The Australian Government has an initiative called Lifetime Health Cover (LHC) that encourages young people to take out private hospital cover sooner rather than later. This is because the more people who have private health insurance, the less strain there is on the public health system.

How does it work?
If you don’t have hospital cover by 1 July following your 31st birthday and choose to take it out later in life, a loading of 2% will be added to your hospital cover premium for every year over the age of 30 you were without it. This means that if you wait until you’re 35 to take out hospital cover, your premium will be 10% higher than it would have been if you had taken it out at 31. If your birthday is in the second half of the calendar year, you’ll have until July 1 in the following year to purchase hospital cover prior to the 2% loading being applied. So as an example, if you turned 31 in October, you won’t have to pay the extra 2% loading until 1st of July the following year.

How is LHC calculated for couples and families?
If you’re on a couples or family private health policy, the LHC loading is calculated by taking an average of the loadings applied to the adults on the hospital cover. So, for instance, if one person has an 18% loading and their partner has no loading, the loading applied is 9% overall.

Calculate your LHC loading
To determine your Lifetime Health Cover loading on your hospital cover simply visit this easy calculator.

What if I switch health funds?
Your LHC loading goes with you when you switch private health funds. If you’re switching to a new fund, it’s a good idea to maintain your hospital cover until the date that you transfer to avoid using up any of your permitted days without cover unnecessarily.

What if I’m going overseas?
If you’re going to be out of Australia for 2 to 24 months, you can apply to suspend your private health cover. Your LHC loading level will not be affected, if your request is approved. You’ll avoid waiting periods for pre-existing hospital conditions when you return to Australia.

Exemptions for LHC

  • Exemptions for the LHC loading include:
  • If you were born before 1 July 1934
  • If you are overseas on 1 July following your 31st birthday*
  • If you are over 30 years of age and were overseas on 1 July 2000*
  • If you are a member of the Australian Defence Force
  • If you are a Department of Veterans’ Affairs (DVA) Gold Card holder*

*You will be required to take out a level of Private Health Insurance within a certain amount of time on your return. Contact us for more detail.

Can my LHC loading be removed?
Your LHC loading can only be removed once you’ve paid the loading for 10 continuous years. Once your 10 years is up, the loading may be reapplied if you choose to drop your hospital cover and take it up again in the future. It’s best to check with your private health insurer regarding these conditions.
Lifetime Health Cover loading: Key takeaway points

  • It’s best to get private health insurance (hospital cover) before 1 July after your 31st birthday. This will help you avoid a 2% surcharge on your health insurance premiums, which you’ll have to pay for every year you don’t have hospital cover.
  • This surcharge can add up quickly and reach a total of 70% once you turn 65, but it won’t increase beyond this point.
  • The LHC loading surcharge will be removed if after 10 consecutive years you maintain an adequate level of private health insurance.

For more tips if you’ve never had private health insurance visit our blog to learn what you need to get started.

Compare private health insurance coverage today and discuss your lifetime health cover with our friendly team – call 1300 861 413 or email

You might be interested in...
What do I get with my silver tier cover?

With many levels of private health hospital cover on the market today, it’s often difficult to know what level would suit you and your budget. If gold hospital cover is too expensive or you don’t need the inclusions, silver hospital cover is often a good middle-level coverage choice. Here we will compare private health policies and the details of the inclusions of silver hospital cover.

A Silver health insurance policy typically provides coverage for a range of hospital treatments as a private patient. With this policy, you’ll will be covered for all the hospital treatments provided in the Basic and Bronze policies, as well as clinical categories such as Heart and vascular system.

What’s included in silver hospital cover?
Silver health insurance is the second-highest tier of hospital product policies available, behind Gold hospital cover. If you opt for Silver private health cover, you’ll receive the same minimum levels of coverage as Basic and Bronze policies as mentioned, with the added benefit of eight additional medical categories. These include cover for:

  • Heart and vascular system
  • Lungs and chest
  • Blood
  • Back, neck and spine
  • Plastic and reconstructive surgery (if it’s medically necessary)
  • Dental surgery
  • Podiatric surgery &
  • Implantation of hearing devices

What is the difference between gold, silver, bronze, and basic hospital cover?
In case you’re wondering about the difference between the four types of hospital cover available, let us break it down for you. In April 2020, the Australian Government mandated that private health insurers must categorise their policies into uniform tiers based on minimum service coverage requirements. These categories include Gold, Silver, Bronze, and Basic. Private health insurers must inform policyholders which category their policy falls under, allowing them to check if their cover aligns with their needs.

What isn’t covered under silver health insurance?
When you have a silver health insurance policy, there are certain hospital treatments that won’t be covered. These exclusions are typically part of the gold tier, which offers more comprehensive coverage. Here are some of the treatments that your standard silver policy may not cover:

  • Pregnancy and childbirth
  • Pain management using a device
  • Cataract surgery
  • Joint replacement surgery
  • Assisted reproductive services
  • Sleep studies
  • Dialysis for chronic kidney failure
  • Weight loss surgery
  • Insulin pumps

It’s important to note that while these treatments may not be covered under a standard silver policy, some health funds may still offer additional coverage for them under a Silver+ or Plus policy. Keep in mind that this additional coverage may come at an extra cost.

Compare levels of private health cover
Below is a summary table of what hospital treatments are covered in each level of private health cover as set out by the Government.

Is silver tier private hospital cover worth it?
Silver tier private hospital cover offers numerous advantages, such as circumventing lengthy waiting times at public hospitals, providing financial benefits towards private medical procedures, and granting you greater flexibility in terms of where and when you receive treatment. In addition, it affords you and your loved ones a sense of security, safeguarding against unforeseen medical expenses. Therefore, it is worth considering investing in silver tier private hospital cover.

What are my waiting periods?
The maximum hospital waiting periods that health insurers can apply are set down in the Private Health Insurance Act 2007:

  • 12 months for pre-existing conditions—this is defined as any condition, illness, or ailment that you had signs or symptoms of during the six months before you joined a hospital policy or upgraded to a higher hospital policy.
  • 12 months for obstetrics (pregnancy)—to be covered, the mother’s hospital admission needs to take place after the 12-month waiting period has been completed.
  • Two months for psychiatric care, rehabilitation, and palliative care, even for a pre-existing condition—this can include treatment of postnatal depression, eating disorders, and drug and alcohol rehabilitation, amongst other treatments.
  • Two months in all other circumstances.

Do my waiting periods transfer if I change to silver hospital cover?
Yes, your waiting periods follow you when you transfer to a new private health fund. Within 30 days of switching, if you are coming from another provider, the new provider will acknowledge any waiting periods you have already completed.

Switching is easy.
If you’re currently with another health fund and are considering switching, know that the process is much easier than you might think. By contacting Health.Compare we’ll take care of cancelling your existing private health cover on your behalf, so you won’t have to spend any time without coverage. Don’t hesitate to make the switch today and discuss your hospital cover options with our friendly team.

Call us on 1300 861 413 or email to compare health insurance silver tier hospital cover.

You might be interested in...
The 4 most claimed Extra’s Benefits when it comes to Private Health Cover

When it comes to taking care of your health, having private health insurance is an excellent way to ensure you have access to the best care possible. But what about those extra health expenses that Medicare won’t cover? That’s where extras policies come in handy. In this blog, we’ll take a closer look at the four most claimed extras benefits under private health cover right now.

⦁ Dental Cover
Did you know that dental care is the most popular extra benefit? Almost half of all claims fall under this category. Dental cover is split into four categories, including general dental (check-ups), major dental (crowns and tooth extractions), endodontic (root canal), and orthodontic (braces). General dental annual limits range from $200 to unlimited, while major dental and endodontic range from $300 to unlimited. So, if you’re looking for an extras policy, make sure it includes dental cover and speak to your provider about their claim limits.

⦁ Optical Cover
After dental, optical cover is the second most claimed extra benefit. The typical benefit for optical is around $180, but some private health policies may have extra sub-limits for frames, lenses, and contact lenses, so be sure to confirm how much you can claim before joining the fund.

⦁ Physiotherapy Cover
Physiotherapy cover is generally included as a component of extras, and if you have this type of cover, you may be able to claim some of the cost of your physio sessions back on your private health insurance, up to an annual limit. See what physio cover is best for you and your stage of life.

⦁ Chiropractic Cover
Chiropractic treatments are designed to address chronic back pain, sports injuries, lower back pain and/or leg pain (sciatica), neck pain, headaches, migraines, joint issues, repetitive strains, arthritic pain, posture issues, and many other connected problems. To claim a chiropractor treatment, you need to find a private health policy that includes chiropractic within its “extra” benefits (general treatment cover or ancillary cover).

What level of extras cover do you need?
Determining how you use your extras cover will assist in the cover you choose. If you have ongoing dental problems, monthly massages, buy a new pair of glasses each year, and plan to get braces for your kids, you’ll benefit from a more comprehensive private health cover. If you’re only after the basics, such as dental, optical, and physiotherapy, then a budget or medium policy may suit you best.

In conclusion, it’s important to consider a private health extras policy to cover those extra health expenses that Medicare won’t. By understanding the most claimed extras benefits, you can make an informed decision about which policy best suits your needs. So why not compare private health insurance coverage today and discuss various extras options with our friendly team?

Call us on 1300 861 413 or email

You might be interested in...
What is Gold Hospital Cover?

In 2020 the Government introduced reforms to make understanding private health insurance simpler and assist consumers to choose the right hospital cover best suited to their requirements.  Private health funds were required to change their hospital classifications to Gold, Silver, Bronze or Basic.

Gold hospital cover gives you the confidence that your health needs are supported and protected whatever stage of life you’re at. Some examples of treatments you may need to undergo are:

  • cataract surgery
  • joint replacements
  • spinal fusions
  • dialysis for chronic kidney disease
  • weight loss surgery
  • chronic illness
  • or simply planning to start a family

Have you heard of Gold cover? It’s one of the four types of private health insurance that offers the highest level of care and covers a broad range of treatments. Although it may come at a higher cost than Basic, Bronze, or Silver policies, it could potentially save you money in the long term.

So, what does Gold tier insurance actually cover? Well, it covers all medically necessary in-hospital treatments and procedures, including rehabilitation, psychiatric services, and palliative care, as well as treatments covered under Silver and Bronze policies. In addition to this, it also provides access to clinical treatments like the ones mentioned above.

But that’s not all! Gold tier insurance also covers private health insurance general treatment or extras cover services such as dental treatment, ambulance services, chiropractic treatment, home nursing, podiatry, physiotherapy, occupational therapy, speech therapy, glasses, and contact lenses as long as you have a extras package combined with your hospital cover.

Who is the Gold tier cover best suited for? Individuals with chronic or ongoing health issues, women planning on getting pregnant and wanting to give birth as a private patient in a private hospital, patients with cancer or heart issues, individuals needing dialysis for chronic kidney disease or access to insulin pumps, active people prone to injury, and older persons requiring joint replacements, hearing implants, or cataract treatment can all benefit from Gold tier cover.

Find the best gold tier health coverage today by visiting or speak to one of our friendly team members call 1300 861 413 /  email

You might be interested in...