What does private health insurance cover that Medicare doesn't?
Private health insurance gives you access to the same hospital services covered by Medicare – but you get access to your own doctor, private room and waiting times are significantly shorter.
Extras insurance cover does cover healthcare costs that aren't typically covered by the public healthcare system, such as dental, physiotherapy and optical.
If you go to a private hospital as a private patient, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee. Your health insurance covers the other 25%, plus accommodation costs and theatre fees. Sometimes there's a gap between the MBS fee and the total cost of your procedure. You may need to pay this unless your health insurance has no gap cover.
A public hospital will allocate a doctor for you. You don't get to choose.
You can choose which doctor you see.
Private room
You'll likely end up in a shared room in a public hospital.
Insurance gives you access to a private room if there's one available.
Waiting lists
Waiting lists for elective treatments can range from a few weeks to a few years.
Private insurance usually involves a shorter wait. For some procedures, you may even be able to pick your date.
Treatment types
Medicare doesn't cover most dental, hearing aids or other out-of-hospital treatments.
Extras can give you cashback on out-of-hospital services such as optical, dental, psychology and hearing aids.
Ambulance costs
In most cases, Medicare won't pay for your ambulance except in Queensland and Tasmania.
Most health funds include cover for an emergency ambulance, even on Basic policies.
Pros and cons of health insurance
Pros
Cover for treatment in a hospital if you need it
Access to private hospitals and reduced wait times
Save on tax by avoiding the medicare levy surcharge (MLS)
Cons
Can be expensive and go unused
Waiting periods mean you pay before you can use
Coverage limitations and excesses mean you'll still have to pay something
Private hospital insurance covers all the same treatments as Medicare. The difference lies in the standard of care. It's kind of like choosing between a dependable budget car or something flashier. Both will get you from A to B but one is a faster and nicer place to be.
I've always been a big proponent of private health cover - and geez I was glad I had it when I was diagnosed with breast cancer in 2021. With any unexpected serious illness, the type of treatment - and crucially the speed of it - could make all the difference.
Health insurance is heavily regulated in Australia, which makes it easier to compare health insurance policies like-for-like. That said, funds still have different products and prices, so it's still important to make sure you're getting the right cover for you and your family.
Hospital Cover: Hospital cover helps pay for a range of hospital treatments in a private hospital. This can include joint reconstructions, hernia operations and childbirth.
Extras Cover: Extras cover helps towards out-of-hospital healthcare. This includes trips to the dentist, eye care by an optometrist, physiotherapists, natural therapies and more.
Health insurance rebate: The private health insurance rebate makes health insurance cheaper for most people. Your exact rebate is determined by your age and income.
Private health and tax: Whether you're a high earner or turning 30, there are a few things you need to know about private health insurance at tax time.
Switching health funds: Switching health funds is quick and easy. You can transfer your waiting periods, while potentially saving money with new sign-up deals.
"Getting health insurance had been on my to-do list for the longest time, but I found it very confusing. I realised it was actually split into two parts - hospital cover (anything in the hospital and the more expensive part) and extras cover (for the dentist and those new specs). I've actually switched policies 3 times in the last 4 years to take advantage of the sign up offers funds give when you join. I've saved around $800 so far."
We ask hundreds of Australians what they're paying for health insurance every month. Here's what their bill looked like in March 2025.
Extras only: $50
Basic: $101
Bronze: $130
Silver: $194
Gold: $236
Price based on 500+ responses for single hospital or extras insurance.
Frequently asked questions about health insurance
Private health insurance can help you cover the cost of medical care in a private hospital (hospital cover) and help pay for out-of-hospital medical costs that aren't covered under Medicare (extras cover). Most private health insurance policies also cover the cost of emergency ambulance transport, which isn't covered by Medicare in most states.
When you take out a private health policy, you have the option of going to a public or private hospital. If you go to a private hospital, or if you're treated as a private patient in a public hospital, your health fund will help cover the cost of care. The main advantages of using the private system are that you can choose your own doctor, get access to improved facilities like a private room, and have access to shorter waiting lists for important surgery.
Hospital cover is available in the following tiers; basic, bronze, silver and gold. Each covers a different list of treatments with gold being the most comprehensive hospital policy avaialable.
In the public system, prices are set according to the Medicare Benefits Schedule (MBS) and Medicare pays 100% of the cost. You won't be left out of pocket, but you won't get your choice of hospital, doctor or appointment time either. In the private system, prices are usually higher than those listed in the Medicare Benefits Schedule and Medicare will only pay 75% of what it would have, had you gone public. Your private health insurance covers at least the remaining 25%. If your private doctor charges more than a doctor in the public system, which is usually the case, you'll have to cover the extra expense. Remember, with hospital insurance, you'll also have to serve waiting periods. For example, if you have a pre-existing medical condition, you'll have to hold your policy for at least a year before your cover would chip in towards the cost of treatment.
Extras insurance helps towards non-hospital-related healthcare, such as dental work, new glasses and physiotherapy appointments. Usually, an extras policy will pay a percentage of your bill – this could be anywhere from 50% to 90%. In other cases, they will cover the whole bill, up to a certain amount. Extras policies also have waiting periods. For example, you often need to hold a policy for a year before you can claim for orthodontics.
Waiting periods apply to both extras and hospital policies - you'll need to serve these before claiming a benefit. Some extras policies let you skip some waiting periods.
Extras benefit limits place a cap on the amount you can claim. They typically reset every 12 months. A higher limit may mean a more expensive policy, but not always.
Health insurance is community rated, which means you don't have to pay more for pre-existing conditions and the price you pay isn't impacted by your age.
However, here are a few things that can impact your quote:
Your excess or co-payment. When you take out insurance, you can agree to take some responsibility for the health cover costs in return for lower premiums – this is your excess. You only pay it if you go to hospital. The higher your excess, the lower your premiums will be.
Your location. If you live in a regional area of Australia, your insurance might cost you more due to poorer access to health facilities as well as potential travel and accommodation expenses.
Which fund you choose. Some funds and policies are better value than others, charging less for similar cover. If you take the time to compare health insurance, you can find the cheapest health cover for your needs.
People from countries that Australia has a Reciprocal Health Care Agreement (RHCA) with can access some treatment from Medicare. If you don't have an RHCA, you'll need Overseas Visitor Health Cover. As of 2021, Australia has an RHCA with Belgium, Finland, Italy, Malta, the Netherlands, Norway, New Zealand, Ireland, Slovenia, Sweden and the UK. Traveling to Australia without coverage could result in huge medical bills if you are sick or injured.
Thanks to the most recent PHI reforms, which have introduced Basic, Bronze, Silver and Gold tier policies, finding cover for a specific service is easier than ever. Every tier is required to provide cover for specific services so you can check out what is included in each and select the one that covers the treatment you require. Some services often performed out of hospital are only covered when performed in a hospital, like the cost of MRI scans. Our guides for specific treatments have more details:
If you cancel your health insurance, you won't be entitled to the services you would have otherwise had access to. This means you would have to rely on the medical services provided by Medicare. Note that cancelling your health insurance may also have tax implications, depending on your circumstances.
When you switch health funds you generally won't have to re-serve waiting periods if you had similar or equivalent cover with another provider. However, if you're upgrading or didn't previously have cover for a service that your new policy includes, you will probably have to serve a waiting period.
A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146).
If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com. See full bio
Tim's expertise
Tim has written 149 Finder guides across topics including:
Get affordable cover for ambulance transport if you are not already covered under Medicare. Compare quotes from Australian funds to decide which level of protection is best for you.
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