Health insurance helps you access medical care in the private hospital system.
The private system has shorter wait times for surgery, plus a few other nice quality of life benefits.
Everyone is different, but people over 50 are likely to need more complex coverage offered by Silver and Gold policies.
What does seniors health insurance cover?
Hospital
Hospital cover gives access to treatment in a private hospital as a private patient. You can choose your doctor, get your own hospital room (where one is available) and have more flexibility over scheduling procedures. You can choose from 4 levels of hospital cover in Australia: basic, bronze, silver and gold. Which you choose is very much dependant on your specific health needs - bit more on that below.
Extras
Extras insurance helps pay for out-of-hospital treatments which Medicare doesn't usually cover. This can include dental, physiotherapy, chiro and optical. Many policies also cover ambulance fees which the public system does not pay for, unless you live in Queensland or Tasmania. What level of extras plans you pick is a personal choice. Extras area a lot like one of the old coupon books you bought from your kid's school - so long as you use the benefits, they are good value for money.
What kind of hospital policy is right for seniors?
Hospital policies come in four main flavours: basic, bronze, silver and gold. The specific treatments each tier of policy needs to cover is set by law, so it makes it a bit easier to compare apples to apples.
For most seniors, a silver of gold policy is probably going to be the best place to start comparing. This is just because we have more complex health needs as we get older, many of which are only covered by the more comprehensive policies. That's not to say you will need a silver or gold policy though - you gotta make that call for yourself.
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
Do seniors need health insurance?
Private health insurance can provide access to more services like private hospital rooms, elective surgeries, and treatments not covered under Medicare. It also offers more options for doctors and hospitals and can shorten your wait times for non-urgent procedures.
In general, it is recommended that seniors evaluate their needs, budget and existing coverage through Medicare before deciding to purchase private health insurance and compare various plans and policies offered by different insurance providers before making a final decision.
It can cancel out the MLS if you still earn an income.
Emergency ambulances are covered with basic policies.
When you hit 65, you're entitled to a higher rebate.
Cons
It may be too expensive for you – policies start from around $77 per month.
You may be happy to wait longer on the public health system.
If you've never had health insurance, you will have to pay the LHC loading – a 70% additional charge on top of your premiums.
Do seniors get a discount on private health insurance?
Yes! If you're over the age of 65 and are a medicare holder, your private health insurance rebate increases, provided you're not classified as a high-income earner ($151,001 or more for singles and $302,001 and over for families, single parents and couples).
You can claim the rebate either as a premium reduction through your health fund or as a tax offset when you lodge your tax return with the Australian Taxation Office (ATO). Keep in mind, if you've never held private health insurance before, the Lifetime Health Cover (LHC) loading may still apply if you buy a health insurance policy.
Singles
≤$97,000
$97,001–$113,000
$113,001–$151,000
≥$151,001
Families
≤$194,000
$194,001–$226,000
$226,001–$302,000
≥$302,001
Base tier
Tier 1
Tier 2
Tier 3
Up to 65
24.608%
16.405%
8.202%
0%
Age 65–69
28.710%
20.507%
12.303%
0%
Age 70+
32.812%
24.608%
16.405%
0%
Thresholds above are based on new tiers brought in by the government from 1 July 2024. Source: Private Healthcare Australia.
Public vs private waiting times for procedures
Why you can trust Finder's health insurance experts
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You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
Frequently Asked Questions
Yes. You will usually have to serve a 2-month waiting period for most treatments or 12 months for pre-existing conditions. The good news is you won't have to re-serve any waiting periods for items if you held a previous policy that also covered that treatment. However, if the policy you're switching to has higher benefit limits or cover for treatments not covered by your original policy, you will have to serve those waiting periods.
Once you turn 65, the Australian government officially considers you a senior and you may be eligible for a Commonwealth Seniors Health Card (CSHC). This is a concession card for older Australians that allows you to access cheaper pharmaceuticals and government-funded medical services. The eligibility requirements and benefits you can claim with this card are outlined below:
Eligibility criteria
Benefits
To qualify for the CSHC, you must meet the following criteria:
Be of pension age (65) or older.
Be an Australian resident currently living in Australia.
Don't qualify for a Department of Veterans' Affairs pension.
Don't qualify for any other Department of Human Services payments.
Meet an income test.
CSHC holders can access the following:
Bulk-billed visits to your GP (depending on your doctor).
Other benefits that vary depending on where you live. These may include discounted utilities bills and property rates, cheaper health care costs (including ambulance, dental and eye care) and discounted public transport.
Health insurance is community rated, which means whether you're 18 or 88, you're going to pay the same amount for the same level of cover. On average, a single hospital + extras policy can cost from $67.15 per month to $277.41 per month for a female living in NSW.
All health insurers are required to cover pre-existing conditions. However, you'll generally need to serve a 12-month waiting period starting when you take out a policy before you can submit a claim.
As with any health insurance policy, there are a number of common exclusions. Typically, this includes treatments such as laser eye surgery and specialist appointments outside of the hospital. Another common exclusion is non-medically necessary surgery. Examples include surgical face-lifts or tattoo removal.
In most cases, yes. There are some exceptions where seniors won't have to pay the LHC – for example, if you were born on or before 1 July 1934.
If you've never had health insurance before, you will likely have a LHC of 70% applied to your premium, unless you were born before 1 July 1934. This is the maximum LHC loading that can be applied. You'll also need to hold cover for 10 continuous years before the fee is removed. For example, if the normal annual premium for your seniors health insurance policy was $1,800, you'd need to pay an extra $1,260 per year, not counting any rebates you might be eligible for.
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:
I am currently a member of a health fund but since I am a senior I am attempting to compare it with senior’s funds in an attempt to find one offering what I need and hopefully, at less cost.
Is there a table I can use to compare specific funds?
Thank you
Robyn.September 6, 2016
Is there a table I can use to compare the health fund that I’m already with . I am a senior looking for a fund at a lower cost
Thank you
Finder
RichardSeptember 6, 2016Finder
Hi Robyn,
Thanks for your question.
You can compare health policies by completing the quote form found on this page.
All the best,
Richard
Finder
RichardJune 6, 2016Finder
Hi Chandler,
Thanks for your question. If you complete the contact form at the top of the page, an advisor will give you a call to discuss your options with you.
I hope this was helpful,
Richard
marieMarch 1, 2016
are all hospitals covered by health funds
Finder
RichardMarch 1, 2016Finder
Hi Marie,
thanks for your question. Most funds will have their own network or member private hospitals. If you choose to be treated in a private hospital, you can generally eliminate the majority of your out-of-pocket expenses. You can also elect to be treated as a private patient in a public hospital. All of this will depend on your level of cover and the fund you’re with. You should contact your insurer directly for more information about their cover network.
If you’re over 80 and want good value for money in your health insurance, here’s what’s good, what to avoid and how to maintain good health along the way.
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You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
I am currently a member of a health fund but since I am a senior I am attempting to compare it with senior’s funds in an attempt to find one offering what I need and hopefully, at less cost.
Is there a table I can use to compare specific funds?
Thank you
Is there a table I can use to compare the health fund that I’m already with . I am a senior looking for a fund at a lower cost
Thank you
Hi Robyn,
Thanks for your question.
You can compare health policies by completing the quote form found on this page.
All the best,
Richard
Hi Chandler,
Thanks for your question. If you complete the contact form at the top of the page, an advisor will give you a call to discuss your options with you.
I hope this was helpful,
Richard
are all hospitals covered by health funds
Hi Marie,
thanks for your question. Most funds will have their own network or member private hospitals. If you choose to be treated in a private hospital, you can generally eliminate the majority of your out-of-pocket expenses. You can also elect to be treated as a private patient in a public hospital. All of this will depend on your level of cover and the fund you’re with. You should contact your insurer directly for more information about their cover network.
I hope this was helpful,
Richard