17 days and counting: final call to use or lose your extras benefits before 1 Jan
04 Dec 2025
Australians with private health insurance extras are being urged to review their benefits balances and book in any necessary appointments before annual limits reset on 1 January, with just 17 business days left in the year.
Over 15 million Australians (55%) have extras to help pay for common expenses not covered by Medicare, such as trips to the dentist, optometrist and physiotherapist, with $6.9 billion in benefits claimed in the year to September 2025 (APRA data).
However, a new Canstar survey of almost 2,000 Australians with extras cover found 85% of policyholders don’t exhaust their limits each year, while 72% aren’t across everything that’s included in their cover.
Canstar survey of 1,961 Australians with extras cover:
- 85% of people with extras cover don’t hit their limits each year.
- 72% aren’t across everything that’s included in their extras cover.
- 44% don’t know how much they can claim for each service.
- 16% rarely or never claim on their extras cover.
Majority of providers hit the reset button on 1 Jan
Canstar research shows 90% of health insurance funds on its database reset members’ annual extras limits on 1 January, including Bupa, Medibank, HCF and nib. Other funds, such as ahm, have a reset date of 1 July.
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| Private health providers that reset extras limits on 1 Jan | ||
|---|---|---|
| AAMI Health Insurance | HCF | Priceline Health Insurance |
| AIA | HCi | Qantas Insurance |
| Apia | HIF | Real Health Insurance |
| Astute Simplicity Health | Health Partners | RT Health |
| Australian Unity Health | ING Health Insurance | see-u by HBF |
| Bupa | Latrobe Health Services | Seniors Health Insurance |
| CBHS Corporate | Medibank | St Lukes |
| Frank Health Insurance | Mildura Health Fund | Suncorp Health Insurance |
| GMHBA | nib | Westfund |
| HBF | Phoenix Health Fund | |
How to maximise your benefits before the year’s out:
With just 17 business days remaining in 2025, time is running out for those looking to schedule a final eye exam, physiotherapy appointment, dental check-up, or massage.
- Check what’s covered: Log in to your health fund app to see which services you’re eligible to claim.
- Do a stocktake of your limits: Check how much you have left to claim on services you regularly use.
- Book your appointment(s): Many providers shut up shop from Christmas Eve onwards, so secure an appointment while you can.
- Claim your benefit: Whenever possible, claim on the spot to avoid extra paperwork. If you can’t, don’t worry – many funds will allow you to submit receipts that are up to two years old, provided you didn’t exceed the benefit cap in the year you used the service.
Don’t break the bank just to hit the cap
Booking in for an overdue dental check up is a great way to get greater bang for buck out of your extras insurance, however, it’s worth remembering most services aren’t completely free of charge.
The latest APRA private health insurance data shows the average gap payment for extras cover is almost $64.
Despite this, one in three people with extras admitted to paying for treatments they didn’t need just to use up their cover before it reset at the new year.
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| Extras treatment – average out of pocket payment per service | |
|---|---|
| Sep-25 | Change from previous yr |
| $63.52 | + 5.4% |
Source: APRA private health insurance statistics, Sept 2025, released 28 Nov 2025.
| Do you pay for treatments to use your cover before it resets, even if you don’t need them? | |
|---|---|
| Yes | 34% |
| No | 66% |
Source: Canstar. Notes: based on a survey of 1,961 Australians with extras cover.
Extras cover can include more than you think
The five most commonly claimed services are dental ($3.8 billion) and optical ($1.0 billion), followed by physiotherapy ($511 million), however, many insurers include services you might not be aware of.
10 things you might not have known you can claim on your insurance
- Learn to swim classes
- Vaccinations
- Weight management
- Quit smoking programs
- Exercise classes
- Orthopaedic shoes
- Childbirth education
- Chinese herbal medicine
- Online mental health courses
Canstar’s data insights director, Sally Tindall, said: “Anyone who has already blown their extras limits, will be eagerly counting down the days until this cover resets. However, for those that need a dental check up or a pair of new glasses, this is your warning bell.”
“We might be only just rolling into December but when you knock out public holidays, there’s only 17 business days left in the year to squeeze in any last-minute appointments.
“Thousands of Australians each year miss out on free dental check-ups, new glasses, or necessary physical therapy, simply because they ran out of time.
“These benefits aren’t free. If you’re paying for cover but not claiming back the benefits you need, you’re throwing away good money that can support your long-term health.
“Most people don’t realise just how many services are tucked inside their extras cover. It’s worth checking your policy because you might be eligible for rebates on things like exercise programs, quit-smoking support, or even learn-to-swim classes.
“That said, don’t go booking appointments you don’t actually need – an unnecessary massage just to hit the cap isn’t going to do your health or your hip pocket any favours.”
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| Five most-claimed extras services ($) | |
|---|---|
| Service | Total claimed year ending Sept 25 |
| Dental | $3.8 billion |
| Optical | $1.0 billion |
| Physiotherapy | $511 million |
| Chiropractic | $315 million |
| Natural Therapies | $282 million |
Source: APRA Private health insurance benefits trends, Sept 25, released 28 Nov
Canstar private health insurance survey questions: 2025
Based on 1,961 Australians over the age of 18 with private health insurance extras cover.
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| Do you use your extras limits in full each year? | |
|---|---|
| Yes | 15% |
| No, I only use some of it | 62% |
| No, I rarely or never use it | 16% |
| Unsure | 8% |
| How familiar are you with what you can claim under your extras? | |
|---|---|
| I know everything that’s included in my extras cover | 28% |
| I know some of the things included | 56% |
| Not sure | 16% |
| Do you know the limits for each of the extras you can claim? | |
|---|---|
| Yes | 56% |
| No | 44% |
Source: Canstar.
This article was reviewed by our Consumer Editor Meagan Lawrence before it was updated, as part of our fact-checking process.
