You need to pay an excess when you make a hospital claim, but it can also lower your insurance premium.
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*Prices updated December 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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The excess is an extra cost that you need to pay whenever you make a hospital claim.
How big your excess is is up to you - a bigger excess will result in a lower premium.
Most funds only require you to pay one excess per person per year, twice on family cover.
What is a hospital insurance policy excess?
A hospital excess is a payment you need to make when you're admitted to hospital. You'll be required to pay this amount upfront when you go to hospital – they will then bill your insurer for the remaining costs.
Some insurers require you to pay an excess every time you're admitted to hospital, while others others cap the amount at a maximum limit per year.
Pros and cons of a higher excess
Pros
The higher the excess you pay, the lower your premiums will be.
You only need to pay an excess if you're admitted to hospital.
You usually don't have to pay an excess for same-day surgery, even though your premium is lower.
Cons
You might also have to pay a co-payment, a daily amount paid towards your hospital stay.
If you're a high income earner and you choose an excess over $750, you might have to pay the Medicare Levy Surcharge.
If you can't pay your excess when you're admitted to hospital, you might not receive cover.
Why compare health insurance with Finder?
We don't ask for your phone or email to see prices.
With 1 click, you can open your results to nearly every fund in Australia.
You pay the same price as going direct – we charge no fees.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
Hospital insurance doesn't cover every cost you'll have to pay in the private system. Suck, we know. What's worse is the excess is only one of the out-of-pocket costs most commonly associated with private hospital cover. The other big one is the gap payment.
In short, the gap payment is the different between the cost of a medial procedure and the amount that you are compensated for it by both your insurance fund and Medicare. For most treatments, Medicare will pay a little bit, and your insurance fund will pay the bulk of what's left. However, the final amount the cover can vary by A LOT. Some procedures can be fully covered, while others will leave you literally thousands of dollars out of pocket.
The government has a great website called Medical Costs Finder that can help you estimate how much a particular procedure might cost you. You can also call your health fund directly to get a more specific estimate.
Frequently asked questions
You'll be required to pay an excess before you're admitted by the hospital, who will then bill your insurer for the remaining costs.
There is a range of different excess options for hospital cover, but the most common amounts are $250, $500 and $750.
Many insurers won't charge a health insurance excess if you attend hospital for day surgery only. It's also common for health funds to waive excesses for accident-related treatment, same-day admissions or if any kids are on your cover.
No. An excess is only applicable to hospital cover, as extras benefits are normally paid as a percentage of a service provider's fee or as a set number of visits per year.
If your excess is too high, it might be a problem for your taxes, but in reality it hardly ever happens. If you earn above $97,000 a year ($194,000 for couples) you'll be hit with the Medicare Levy Surcharge unless you get eligible hospital cover. To be eligible, that policy has to have an excess of no more than $750 ($1,500 for couples). Truth is, basically every policy available has a maximum excess of $750 per person, so it's probably not a massive issue for you.
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To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 644 Finder guides across topics including:
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Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
