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The initial results in the table above are sorted by Star Rating (High-Low) , then Monthly premium (approx) (Low-High) , then Provider Name (Alphabetical) . Additional filters may have been applied, which impact the results displayed in the table - filters can be applied or removed at any time.
What is hospital cover?
Hospital cover refers to a hospital-only health insurance policy that helps cover the costs of being admitted to hospital. When you have private hospital cover in place, you typically have a choice of being treated as either a private patient in a public hospital or being admitted to a private hospital for treatment.
What does hospital insurance cover?
Private hospital insurance usually covers, either in full or partially, theatre costs and hospital accommodation fees, including meals. All hospital insurance products in Australia must be classified as one of four tiers: Gold, Silver, Bronze or Basic. A hospital policy is classified into a tier according to the minimum level of cover it offers against the clinical categories (i.e. the medical treatments and procedures covered in each tier). Health insurers can also offer ‘Plus’ policies for Silver, Bronze and Basic categories, which allow them to provide cover for extra medical treatments that aren’t covered by these categories as standard.
Hospital-only insurance does not provide cover for the costs of ‘general’ treatments, such as dental care and optical, even if you receive these treatments in hospital. If you want to be covered for ‘general’ healthcare, you may want to consider a combined hospital and extras policy or an Extras-only policy if you don’t require hospital cover.
What is the benefit of hospital cover?
Hospital cover can give you choices when it comes to which hospital you’re treated in, and even which doctor or specialist treats you. It can also mean bypassing the lengthy queues that can apply to elective surgery in the public health system.
While hospital cover may be an extra household cost to bear, taking out cover before you turn 31 years old may also be advantageous due to Australia’s Lifetime Health Cover. Lifetime Health Cover loading exists to encourage young Australians to take out private hospital insurance. For each year after you turn 30 that you don’t take out private hospital insurance, premiums become more expensive, up to a set level. The rationale behind this is that if young, healthy people take up private health insurance, it will reduce some of the burden on the public hospital system.
Ultimately, deciding if you want to take out or hold onto a hospital cover policy can come down to your budget and your views around managing your personal healthcare.
What are the different hospital insurance product tiers?
The different hospital insurance product tiers in Australia are Gold, Silver, Bronze or Basic. A hospital policy is classified into a tier according to the minimum level of cover it offers against the Federal Government’s clinical categories. Gold is the highest level of hospital insurance and covers all clinical categories.
The table below shows a summary of what clinical categories are included in each product tier.
Private Hospital Cover Product Tiers
✔️ – Indicates the clinical category is a minimum requirement of the product tier. ⭕ – Optional for the insurer to include (may be offered as additional clinical categories). R – Restricted cover permitted (insurers are allowed to offer cover for the clinical category on a restricted basis*).
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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 | ⭕ R | ✔️ | ✔️ | ✔️ |
Eye (not cataracts) | ⭕ R | ✔️ | ✔️ | ✔️ |
Ear, nose and throat | ⭕ R | ✔️ | ✔️ | ✔️ |
Tonsils, adenoids and grommets |
⭕ R | ✔️ | ✔️ | ✔️ |
Bone, joint and muscle | ⭕ R | ✔️ | ✔️ | ✔️ |
Joint reconstructions | ⭕ R | ✔️ | ✔️ | ✔️ |
Kidney and bladder | ⭕ R | ✔️ | ✔️ | ✔️ |
Male reproductive system | ⭕ R | ✔️ | ✔️ | ✔️ |
Digestive system | ⭕ R | ✔️ | ✔️ | ✔️ |
Hernia and appendix | ⭕ R | ✔️ | ✔️ | ✔️ |
Gastrointestinal endoscopy | ⭕ R | ✔️ | ✔️ | ✔️ |
Gynaecology | ⭕ R | ✔️ | ✔️ | ✔️ |
Miscarriage and termination of pregnancy |
⭕ R | ✔️ | ✔️ | ✔️ |
Chemotherapy radiotherapy and immunotherapy for cancer |
⭕ R | ✔️ | ✔️ | ✔️ |
Pain management | ⭕ R | ✔️ | ✔️ | ✔️ |
Skin | ⭕ R | ✔️ | ✔️ | ✔️ |
Breast surgery (medically necessary) |
⭕ R | ✔️ | ✔️ | ✔️ |
Diabetes management (excluding insulin pumps) |
⭕ R | ✔️ | ✔️ | ✔️ |
Heart and vascular system | ⭕ R | ⭕ | ✔️ | ✔️ |
Lungs and chest | ⭕ R | ⭕ | ✔️ | ✔️ |
Blood | ⭕ R | ⭕ | ✔️ | ✔️ |
Back, neck and spine | ⭕ R | ⭕ | ✔️ | ✔️ |
Plastic and reconstructive surgery (medically necessary) |
⭕ R | ⭕ | ✔️ | ✔️ |
Dental surgery | ⭕ R | ⭕ | ✔️ | ✔️ |
Podiatric surgery (provided by a registered podiatric surgeon) |
⭕ R | ⭕ | ✔️ | ✔️ |
Implantation of hearing devices |
⭕ R | ⭕ | ✔️ | ✔️ |
Cataracts | ⭕ R | ⭕ | ⭕ | ✔️ |
Joint replacements | ⭕ R | ⭕ | ⭕ | ✔️ |
Dialysis for chronic kidney failure |
⭕ R | ⭕ | ⭕ | ✔️ |
Pregnancy and birth | ⭕ R | ⭕ | ⭕ | ✔️ |
Assisted reproductive services |
⭕ R | ⭕ | ⭕ | ✔️ |
Weight loss surgery | ⭕ R | ⭕ | ⭕ | ✔️ |
Insulin pumps | ⭕ R | ⭕ | ⭕ | ✔️ |
Pain management with device |
⭕ R | ⭕ | ⭕ | ✔️ |
Sleep studies | ⭕ R | ⭕ | ⭕ | ✔️ |
Source: Privatehealth.gov.au. *Restricted benefit means you’re partially covered for hospital costs as a private patient in a public hospital. Privatehealth.gov.au warns insurers pay only a limited amount for private hospital costs with restricted cover and you may face substantial out of pocket expenses.
How can hospital cover help you save on the Medicare Levy Surcharge?
Hospital cover can also offer tax benefits. Without hospital cover in place, you could be charged the Medicare Levy Surcharge (MLS), which applies if you earn over $101,000 as a single or $202,000 as a family (plus $1,500 for each dependent child after your first one) and don’t have an appropriate private health insurance policy in place. These income thresholds apply for the 2025-26 tax year.
The MLS can be levied between 1% and 1.5% of your taxable income depending on your personal situation. It comes on top of the 2% Medicare levy, and it doesn’t buy you any additional health services. The Australian Taxation Office (ATO) says the MLS is designed to “encourage people to take out private patient hospital cover and use the private hospital system to reduce demand on the public system.”
The ATO states that if you want to avoid paying the MLS, you should consider taking out the appropriate level of private hospital cover for yourself, your spouse and your dependents.
Is hospital cover worth it?
Whether hospital cover is worth taking out will depend on your individual circumstances. Being insured is always a personal choice, but it can be particularly complicated when it comes to your health.
You will need to weigh up the costs against the benefits to determine the worth of private health insurance for you. Some questions you may want to consider are:
- Do you have an existing health condition you wish to cover?
- Do you have any major family history of particular health conditions that could warrant hospital cover?
- Do you prefer being able to choose your own doctor, or specialist, and have more of a say over your treatment plan?
- Does staying in a private room while in hospital appeal to you?
If you’re interested in taking out hospital cover, you can use our table to compare options from our Online Partners. You can also change the table’s filters to better suit your requirements. It’s also always best to read the Private Health Information Statement (PHIS), Target Market Determination (TMD) and other applicable documentation when considering an insurance policy.
Frequently Asked Questions about Hospital Cover
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As Canstar’s Group Manager, Research, Ratings & Product Data, Josh Sale is responsible for the methodology and delivery of Canstar’s Health Insurance Star Ratings and Awards. With tertiary qualifications in economics and finance, Josh has worked behind the scenes for the last five years to develop Star Ratings and Awards that help connect consumers with the right product for them.
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This advice is general and has not taken into account your objectives, financial situation or needs. Consider whether this advice is right for you.