Compare hospital cover in Australia

Finder Score - What they mean

Each month we analyse over 10,000 hospital insurance products and rate each one on price and features. What we end up with is a nice round number that helps you compare hospital cover a bit faster.

Remember that Finder Score is just one factor to consider. Look at other aspects like fees, features, benefits and risks to make sure a product is suitable for you. Double-check details that matter to you before applying or buying.

• 9+ Excellent - These products offer a balance between low pricing and more features.
• 7+ Great - Competitive products within their group.
• 5+ Satisfactory - Usually these products would either have fewer treatments covered or higher pricing.
• Less than 5 – Basic - Offering basic cover with limited features or higher pricing.

Read the full Finder Score methodology

Main benefits of hospital cover

How does hospital cover work?

If you receive an in-hospital service as a private patient, Medicare typically covers 75% of the Medicare Benefits Schedule (MBS) fee. Your private health cover will pay the remaining 25%.

However, a doctor or specialist won't always stick to the MBS fee set by the government as a fair fee for a service or treatment. In this case, you'd have to pay an out-of-pocket fee known as "the gap".

Some insurers have deals with healthcare providers that mean all or some of the gap is covered by your health fund.

Hospital cover only helps with items that are on the MBS. If the treatment you want isn't on the MBS, you won't get help from private hospital cover.

What are the hospital health insurance tiers?

Each of the different health insurance tiers has to cover a standardised set of treatments. Here's a quick summary of each tier.

*Average prices updated December 2024, in line with Finder's database of health insurance policies. Prices are based on a single individual with less than $97,000 income and living in Sydney with a $750 excess.

• Show full table of treatments

  Clinical category	Basic	Bronze	Silver	Gold
  Rehabilitation	R	R	R
  Hospital psychiatric services	R	R	R
  Palliative care	R	R	R
  Brain and nervous system
  Eye (not cataracts)
  Ear, nose and throat
  Tonsils, adenoids and grommets
  Bone, joint and muscle
  Joint reconstructions
  Kidney and bladder
  Male reproductive system
  Digestive system
  Hernia and appendix
  Gastrointestinal endoscopy
  Gynaecology
  Miscarriage and termination of pregnancy
  Chemotherapy, radiotherapy and immunotherapy for cancer
  Pain management
  Skin
  Breast surgery (medically necessary)
  Diabetes management (excluding insulin pumps)
  Heart and vascular system
  Lung and chest
  Blood
  Back, neck and spine
  Plastic and reconstructive surgery (medically necessary)
  Dental surgery
  Podiatric surgery (provided by a registered podiatric surgeon)
  Implantation of hearing devices
  Cataracts
  Joint replacements
  Dialysis for chronic kidney failure
  Pregnancy and birth
  Assisted reproductive services
  Weight loss surgery
  Insulin pumps
  Pain management with a device
  Sleep studies

Hospital health insurance and tax (the MLS and LHC)

There are 2 different government schemes that may cost you money if you don't have hospital cover.

Hospital waiting periods

With hospital cover, the Private Health Insurance Ombudsman sets the maximum possible waiting periods for every circumstance and insurers have to stick to them. This means the same waiting periods will apply no matter what hospital policy you get.

Hospital benefit	Waiting period
Most pre-existing conditions	12 months
Pregnancy and childbirth	12 months
All psychiatric care, rehabilitation and palliative care	2 months
Other in-hospital treatment	2 months
Accidents and ambulance services	No waiting period

What isn't covered by private hospital insurance?

No matter what level of health insurance you get, there are certain things that won't be covered. They include the following:

• Pre-existing medical conditions within the first 12 months
• Out-of-pocket costs (that's when your doctor charges more than the MBS item fee)
• Fees for any specialists you see outside of hospital
• Any services you receive outside of hospital
• Any medical treatment that does not have an MBS item number
• Hospital stays that are longer than 35 days
• Cosmetic surgery for non-medical reasons

FAQs

• What is hospital only health insurance?

  Hospital only health insurance allows you to be treated as a private patient at hospital, often with your choice of doctor. It's available in 4 tiers – gold, silver, bronze and basic – and pays a share of your medical costs when you're admitted to hospital.

• How much is hospital cover?

  Cheap hospital cover can start from around $25 per week. Keep in mind, your age, income, state and level of cover chosen will affect the premium.

• Is it better to have hospital or extras cover?

  Depending on personal needs and preferences, you can take out hospital cover, extras cover or consider both hospital & extras cover which can suitable in many circumstances. Some people take out hospital cover as they prefer to have more options when undergoing surgery. While other people may be looking at extras cover for out-of-hospital treatments which may include dental, physio or optical.

• What's the difference between hospital and extras cover?

  Hospital insurance pays for treatment as a private patient when you're admitted to hospital. Extras cover helps pay for services outside of hospital such as dental, physiotherapy and optometry.

• How does the MBS work?

  The MBS is a list of all the healthcare treatments and procedures subsidised by the government. These are called items and there are over 5,700 of them. There's a fee attached to every item on the MBS.

  Doctors in a private facility aren't obligated to adhere to the MBS fee for the whole cost of their service. If they charge more than the recommended MBS fee, you will likely have some out-of-pocket expenses.

• What is a plus hospital policy?

  If a policy is described as a "plus", then it will cover the minimum number of treatments for its tier, along with at least 1 treatment from the next tier up.

• Do I need hospital cover to avoid the Medicare Levy Surcharge (MLS)?

  Yes. Holding an eligible hospital policy is the only way to avoid the MLS if you're earning over $97,000 as a single or $194,000 as a couple.

• Learn more about Finder score

  Groups

  Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. They're very different machines for very different jobs. So we've separated all the hospital policies on the market into groups.

  • Groups

    We've made groups covering each cover tier, state and lifestage. Each product is put into a group, and can only be part of that 1 group.This means each product is only compared against other products that make sense. Each pool has a unique combination of:

    • Cover tier - Basic / Bronze / Silver / Gold
    • State - The state the policyholder resides in
    • Lifestage - Single / Single Parent Family / Couple / Family

    There are 4 tiers, 7 state categories (Health Insurance is the same price in NSW and ACT) and 4 life stages. That multiplies out to 112 different groups. This process makes sure each product gets a score based on their position within a similar group of products.

    The Finder Score methodology is designed by our insights team and reviewed by our editorial team. Commercial partners carry no weight, and all products are reviewed objectively.

    Once in their groups, each product gets a Price Score and a Features Score, which are then combined to give the Final Score.

  Price Score

  We calculate the net price for each product, which is compared against other products within its assigned product pool. Each product is assigned a score between 1 - 10, with the lower the price, the higher the score. The net price comprises the premium charges and excess.

  • Hospital cover price

  Features Score

  We calculate the number of hospital treatment categories covered by each product and position the number between the products that offer the most and minimum amount of treatments, within the same category, to generate a feature score between 1 - 10.

  We also assign 30% of the feature score for the Gap Score and Benefits Score, which is calculated at a provider level and assigned to each product.

  The hospital treatment categories that are included are based on the standard list used by the Australian government.

  • Feature weightings

  • Hospital treatments

  Final Score

  The Price score and Feature score are combined to determine each product's Finder Score. We assign weights between price and features based on the category level.

  Finder Score - Hospital Cover Score Weightings

  Category Level	Price Score Weights	Feature Score Weights
  Basic	80%	20%
  Bronze	70%	30%
  Silver	60%	40%
  Gold	50%	50%