Compare private health insurance from Australia's leading funds side-by-side. Hospital cover, extras cover, or combined. Understand the PHI Rebate, Lifetime Health Cover loading, and Medicare Levy Surcharge. 100% free.
One of Australia's most trusted not-for-profit health funds with consistently high member satisfaction ratings. Known for competitive premiums and a wide network of no-gap providers - click below to get an estimate.
A quick overview of how private health insurance works in Australia and why nearly half of all Australians hold hospital cover.
Private health insurance (PHI) in Australia sits alongside Medicare, the country's universal public health system. While Medicare covers essential medical services including GP visits, public hospital treatment, and subsidised medicines through the PBS, private health insurance provides additional benefits: shorter wait times for elective surgery, choice of doctor and hospital, and cover for services Medicare does not fund such as dental, optical, and physiotherapy.
Private health insurance has two distinct components. Hospital cover pays for treatment as a private patient in a hospital, including accommodation, theatre fees, prostheses, and doctor charges. Extras cover (also called general treatment) covers out-of-hospital services like dental check-ups, glasses, contact lenses, physiotherapy, chiropractic, and remedial massage. You can buy either separately or as a combined package.
The Australian Government actively encourages private health insurance through a system of incentives and penalties. The Private Health Insurance Rebate contributes approximately 25-33% of premiums for most income earners. Lifetime Health Cover (LHC) loading adds 2% to hospital premiums for every year you delay past age 31. The Medicare Levy Surcharge (MLS) penalises higher-income earners who do not hold hospital cover with an additional 1-1.5% tax on taxable income.
These government measures mean that for many Australians - particularly those earning above $93,000 (singles) or $186,000 (families) - holding private hospital cover is financially beneficial compared to paying the MLS. For more information, see ASIC MoneySmart's health insurance guide.
Key point: Approximately 45% of Australians hold hospital cover and over 55% hold some form of private health insurance (hospital, extras, or both). The three main drivers for taking out PHI are avoiding the Medicare Levy Surcharge, avoiding Lifetime Health Cover loading, and accessing private hospital treatment with shorter wait times and choice of doctor.
There are three main types of private health insurance cover available in Australia. Here is how they compare.
Covers out-of-hospital services like dental, optical, physiotherapy, chiropractic, and remedial massage. Pays set benefits per service up to annual limits. Does not satisfy MLS or LHC requirements.
Covers treatment as a private patient in hospital. Includes accommodation, theatre fees, and prostheses. Satisfies MLS and LHC requirements. Available at Basic, Bronze, Silver, and Gold tiers.
Bundles hospital and extras cover into a single policy. The most comprehensive protection, covering both in-hospital treatment and out-of-hospital services like dental and optical.
In-depth look at Australia's major private health insurance funds.
Australia's largest private health insurer with over 3.7 million members. Originally government-owned, Medibank was privatised and listed on the ASX in 2014. Offers a wide range of hospital and extras products across all tier levels, with extensive provider networks and a strong digital claims experience.
Australia's second-largest health fund and part of the global Bupa group. Covers approximately 3.5 million Australians. Known for a comprehensive range of hospital and extras products, extensive network of Bupa Members First providers, and integrated health services including dental clinics and optical stores.
Australia's largest not-for-profit health fund with over 1.8 million members. Consistently rated highly for member satisfaction and value. HCF returns surplus to members through better benefits and lower premiums rather than shareholder dividends. Offers a strong no-gap dental network.
Western Australia's leading not-for-profit health fund, now growing nationally. HBF covers over 1 million members and is consistently rated among Australia's top funds for value and satisfaction. Known for competitive premiums and a member-first approach with no shareholders to pay.
ASX-listed health fund operating in both Australia and New Zealand. Covers over 1.5 million Australian residents. Known for flexible and modular products, strong digital experience, and a growing range of health management services alongside traditional hospital and extras cover.
A Medibank-owned brand focused on simple, affordable health insurance sold primarily online. AHM targets younger Australians and budget-conscious members with competitive pricing and a straightforward product range. Claims are managed through Medibank's infrastructure.
Geelong-based not-for-profit health fund serving members across Australia. GMHBA has been operating for over 90 years and is known for competitive premiums, personalised service, and a member-owned model that prioritises value over profit.
A restricted membership fund for education sector workers and their families. Teachers Health is consistently top-rated in customer satisfaction surveys and offers some of the most competitive premiums in the market due to its not-for-profit structure and focused membership base.
A restricted membership fund for current and former Australian Defence Force members, veterans, and their families. Defence Health offers tailored products that understand the unique needs of military families, including cover for service-related conditions and family support during deployments.
A regional not-for-profit health fund based in Lithgow, NSW, serving members across Australia. Westfund is known for competitive premiums, high member satisfaction, and a community-focused approach. Its not-for-profit structure means surplus is reinvested in member benefits.
The right plan depends on your income, health needs, age, and whether you need to avoid government penalties.
A side-by-side comparison of the major private health insurance funds in Australia.
| Provider | Ownership | Key Products | Best For |
|---|---|---|---|
| Medibank | ASX-listed (privatised 2014) | Hospital tiers (Basic to Gold), Extras, Combined | Market leader |
| Bupa | Global (Bupa Group, UK) | Hospital tiers, Extras, Corporate plans | Extensive network |
| HCF | Not-for-profit | Hospital, Extras, Combined, No-gap dental | Member satisfaction |
| HBF | Not-for-profit (WA-based) | Hospital tiers, Extras, Combined | Value for money |
| nib | ASX-listed (ASX:NHF) | Hospital, Extras, Combined, OSHC, OVHC | Flexible plans |
| AHM | Medibank-owned | Hospital, Extras, Combined | Budget & online |
| GMHBA | Not-for-profit (Geelong) | Hospital, Extras, Combined | Regional not-for-profit |
| Teachers Health | Not-for-profit (restricted) | Hospital, Extras, Combined | Education sector |
| Defence Health | Not-for-profit (restricted) | Hospital, Extras, Combined | ADF families |
| Westfund | Not-for-profit (regional) | Hospital, Extras, Combined | Community-focused |
Disclaimer: Features and plans may change. Always verify details directly with the fund before purchasing. We do our best to keep all data up to date and accurate. If you have noticed something incorrect, please let us know.
A detailed breakdown of what is typically included in Australian private health insurance policies.
| Feature | Extras Only | Hospital Only | Combined |
|---|---|---|---|
| Dental (general) | ✓ Annual limits | ✗ | ✓ Annual limits |
| Dental (major) | ✓ Annual limits | ✗ | ✓ Annual limits |
| Optical | ✓ Annual limits | ✗ | ✓ Annual limits |
| Physiotherapy | ✓ Annual limits | ✗ | ✓ Annual limits |
| Chiropractic | ✓ Annual limits | ✗ | ✓ Annual limits |
| Private hospital admission | ✗ | ✓ Covered | ✓ Covered |
| Choice of doctor | ✗ | ✓ Covered | ✓ Covered |
| Elective surgery (private) | ✗ | ✓ By tier | ✓ By tier |
| Prostheses | ✗ | ✓ Covered | ✓ Covered |
| Pregnancy & birth | ✗ | Gold tier only | Gold tier only |
| Psychiatric treatment | ✗ | Silver+ tier | Silver+ tier |
| Rehabilitation | ✗ | Silver+ tier | Silver+ tier |
⚡ Hospital Tier System: Since April 2019, all hospital policies are classified as Basic, Bronze, Silver, or Gold (with optional Plus upgrades). Gold covers all clinical categories. Silver covers most but may exclude some categories like pregnancy. Bronze covers a reduced range, and Basic is the minimum level. Check the clinical categories on privatehealth.gov.au to understand exactly what each tier includes.
Understanding what is not covered is just as important as knowing what is. These are the most common exclusions across Australian private health insurance policies.
Pre-existing conditions are subject to a 12-month waiting period rather than a permanent exclusion. After serving the 12-month waiting period, your pre-existing condition is covered. A condition is considered pre-existing if, in the opinion of a medical practitioner appointed by the fund, the signs or symptoms existed in the 6 months before joining.
Elective cosmetic procedures are generally not covered unless they are clinically necessary (e.g. reconstructive surgery after an accident or cancer treatment). Procedures like rhinoplasty for cosmetic reasons, liposuction, or cosmetic breast augmentation are excluded across most policies.
Basic and Bronze hospital policies exclude many clinical categories. Common exclusions at lower tiers include pregnancy and birth, cardiac treatment, joint replacements, rehabilitation, and psychiatric treatment. If a procedure falls outside your tier's covered categories, you will be treated as a public patient or pay the full cost privately.
Pregnancy and birth are covered only under Gold-tier hospital policies and are subject to a 12-month waiting period. If you are planning a pregnancy, you must hold Gold hospital cover for at least 12 months before the birth to be covered. This is one of the most important factors for couples planning a family.
If you use a hospital or doctor that does not have a gap-cover agreement with your fund, you may face significant out-of-pocket gap payments. Always check whether your preferred hospital and doctor are in your fund's network before treatment. The gap between the Medicare Benefits Schedule fee and the doctor's actual charge can be substantial.
Private health insurance does not cover services already covered by Medicare, such as GP visits (covered by Medicare rebate), treatment as a public patient in a public hospital, or medicines subsidised under the PBS. Hospital cover applies when you choose to be treated as a private patient.
Understanding these factors can help you find a better deal.
Australia uses community rating, meaning everyone pays the same base premium regardless of age or health status. However, Lifetime Health Cover loading adds 2% for every year after age 30 without hospital cover, effectively making premiums more expensive the longer you delay.
Your income determines the PHI Rebate percentage (higher earners get a lower rebate) and whether you face the Medicare Levy Surcharge. Singles earning under $93,000 and families under $186,000 are not affected by the MLS.
Hospital cover excess ranges from $0 to $750 for singles ($0 to $1,500 for families). Higher excess means lower premiums. A $500 excess instead of $0 can reduce hospital premiums by 20-40%. Choose an excess you could comfortably pay if admitted.
Basic is cheapest, Gold is most expensive. The tier determines which clinical categories are covered. Choose based on which hospital procedures you are most likely to need. Check tier inclusions on privatehealth.gov.au.
Single policies cover one person. Couple and family policies cover two or more adults and dependent children. Family policies include dependent children at no extra cost up to age 21 (or 25 if full-time students).
Premiums vary by state due to differences in hospital costs, state-based levies, and ambulance cover requirements. Some states (e.g. QLD, TAS) provide free ambulance cover, while in others (e.g. VIC, NSW) ambulance cover through PHI is important.
Not-for-profit funds (HCF, HBF, GMHBA, Teachers Health) often offer competitive premiums as they reinvest surplus into member benefits rather than paying shareholder dividends. Restricted funds (Teachers Health, Defence Health) may offer lower premiums to their eligible members.
Extras cover ranges from basic (lower limits, fewer services) to top (higher limits, more services like orthodontics and major dental). The more services and higher limits you want, the higher the premium.
Indicative annual premiums for singles after the PHI Rebate. Actual costs depend on your chosen tier, excess, extras level, state, and fund.
Disclaimer: All prices shown are indicative estimates based on publicly available data and typical profiles as of early 2026, after applying the approximate PHI Rebate. Actual premiums vary based on your age, income tier, state of residence, chosen cover level, excess, LHC loading, and fund. These figures are not quotes. Always obtain a personalised quote from the fund directly. Prices and product features may change without notice.
Practical tips that could save you hundreds of dollars every year.
Do not just auto-renew. Compare plans from multiple funds each year, especially after the annual April premium increase. Pricing and benefits change, and switching could save you significantly. Use privatehealth.gov.au to compare policies.
Raising your hospital excess from $0 to $500 can reduce hospital premiums by 20-40%. The maximum excess is $750 for singles and $1,500 for families. Only choose an excess you can afford if you need to be admitted.
Do not pay for Gold hospital cover if you do not need pregnancy, cardiac, or joint replacement cover. A Bronze or Silver tier may cover what you actually need at a lower cost. Check clinical categories carefully.
Avoid Lifetime Health Cover loading by taking out hospital cover before 1 July following your 31st birthday. Every year you delay adds 2% to your hospital premium for 10 years. At age 40, that is a 20% loading.
Ensure you are receiving the Private Health Insurance Rebate either as a premium reduction or at tax time. The rebate is approximately 25-33% for most income levels and makes a significant difference to the effective cost.
Many funds have networks of dentists, optometrists, and other providers where you pay reduced or no gap. HCF's no-gap dental network and Bupa's Members First providers are examples. Using in-network providers maximises the value of your extras cover.
Not-for-profit funds like HCF, HBF, GMHBA, and Teachers Health often offer competitive premiums because they reinvest surplus into member benefits rather than shareholder dividends.
If you are not using your extras benefits (dental, optical, physio), you may be better off with a lower extras tier or hospital-only cover. Check your claims history against your premium to see if extras provides value.
Some funds offer a discount of up to 4% for paying premiums annually rather than monthly. If you can afford the upfront cost, annual payment saves money over the year.
If you earn over $93,000 (single) or $186,000 (family), basic hospital cover is often cheaper than paying the Medicare Levy Surcharge. Run the numbers on the ATO's MLS calculator to compare.
Switching health insurance funds in Australia is straightforward thanks to portability rules. Here is what to consider.
The government approves annual premium increases that typically take effect on 1 April. Your fund will notify you of the increase. This is the best time to compare alternatives and decide whether to switch. Check privatehealth.gov.au for side-by-side comparisons.
Under portability rules, when you switch to a new fund, waiting periods you have already served are recognised for equivalent or lower levels of cover. You will not need to re-serve waiting periods for benefits at the same tier. However, if you upgrade to a higher tier, new waiting periods may apply to the additional clinical categories.
Your Lifetime Health Cover loading stays with you when you switch funds. It does not reset. The loading continues to count down from when you first took out continuous hospital cover. After 10 continuous years with hospital cover, the loading is removed.
Set up your new policy to start on the same day your old one ends. Any gap in hospital cover could affect your LHC loading and waiting period continuity. Most new funds will coordinate the switch date with you to ensure there is no gap.
Step-by-step guide to the claims process in Australia.
Review your policy to confirm the treatment or service is covered and that you have served any applicable waiting periods. Check your excess amount for hospital claims.
For hospital treatment, ask your doctor and hospital whether they have a no-gap or known-gap agreement with your fund. This determines your out-of-pocket costs.
For planned hospital admissions, contact your fund for pre-approval. They will confirm cover, excess, and any expected gap. This avoids surprises after treatment.
For extras claims, use the fund's app to claim on the spot at the provider, or submit receipts online. For hospital claims, the hospital typically bills the fund directly.
Extras claims are typically processed instantly via the app or within 2-3 business days online. Hospital claims are settled between the fund, Medicare, and the hospital.
Key Australian facts about private health insurance and how it fits alongside Medicare.
Every Australian health fund must provide a Private Health Information Statement and policy documents. Here is what to look for before you buy.
A Product Disclosure Statement outlines everything about your health insurance policy: what is covered, what is excluded, waiting periods, excess amounts, and how to make a claim. Under the Private Health Insurance Act 2007, all funds must also provide a Private Health Information Statement (PHIS) in a standard format to help you compare policies. Read these documents before you buy, not after you need to claim.
When applying for private health insurance in Australia, you are not required to disclose your medical history. Australia's community rating system means funds cannot refuse cover or charge higher premiums based on health status. However, pre-existing conditions are subject to a 12-month waiting period, during which the fund's medical officer may determine whether a condition existed before joining.
You can change your health insurance at any time. Common changes include:
Answers to the most common questions about private health insurance in Australia.
Key terms explained in plain language.
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