Seniors health insurance

What is seniors’ health insurance?

Health insurance helps cover the cost of certain medical treatments and hospital stays, depending on the type of policy you choose. It allows you to claim back some or all of the costs related to the treatments and services included in your cover. Providers generally don’t offer products that are solely designed for seniors. Some higher level policies, however, include cover for conditions and treatments that may be more relevant to you as an older policyholder.

For example, cover for cataracts or joint replacements might suit someone over 50, while pregnancy cover might be more relevant for people in their 30s. Choosing the right cover for your current and future health needs can help you get the most value from your health insurance as a senior.

What does seniors’ health insurance cover?

Seniors’ health insurance can include hospital cover, extras cover (i.e. dental, optical, physio) or a combination of the two. Look for a health insurance policy that covers common health conditions that can affect people later in life, such as cataract surgery, joint replacements or the need for hearing aids.

Cover for these types of conditions are typically found within higher level hospital or extras policies. Keep in mind that waiting periods usually apply before you can make a claim for certain treatments, including up to 12 months for pre-existing conditions.

Hospital cover

There are four hospital cover tiers currently available in Australia: Gold, Silver, Bronze and Basic. Each tier covers different medical procedures as a standard requirement. Health insurance providers may also offer policies with additional procedures to what’s standard, which they will call ‘Plus’, such as ‘Silver Plus’ policies. This means these policies provide all the coverage of a Silver tier policy, with additional cover, but not as much cover as to push it into the Gold tier.

A Gold tier policy offers the highest level of hospital cover available, followed by Silver. These two top-tier policies must include cover for some of the following hospital treatments, which may suit your needs as a senior:

• Heart and vascular system
• Lung and chest
• Back, neck and spine
• Dental surgery
• Implantation of hearing devices
• Cataract surgery
• Joint replacements
• Pain management with a device
• Palliative care

Extras cover

Extras cover can help subsidise certain treatments outside of hospital. As a senior you may want to look for an extras policy which covers some of the following:

• Optical treatment
• Dental treatment
• Remedial massage
• Physiotherapy
• Chiropractic care
• Podiatry
• Health aids (such as hearing aids and blood glucose monitors)
• Occupational therapy
• At-home nursing

The benefits you can access through your policy will ultimately depend on the type and level of cover you choose and what health fund you sign up for.

Review your policy regularly to make sure the cover you’re paying for aligns with your current and future needs. This information can usually be found in your policy’s Private Health Information Statement (PHIS) or by contacting your provider directly.

Keep in mind that you may need to pay some out-of-pocket expenses when claiming for any treatments through your health insurance, as the provider may only cover up to a set monetary limit for any particular procedure.

Find out exactly what you can claim for and what you’ll end up being billed for by checking with both your hospital or other healthcare specialist and insurance provider before receiving treatment.

How much does seniors’ health insurance cost?

The cost of health insurance for seniors depends on a variety of factors, including whether you choose hospital, extras, or a combined hospital and extras policy and the level of cover you choose to take out. You can use the table at the top of this page to compare policy features and estimated premium prices from our Online Partners for someone who is 60 years old. Change the filters to suit your requirements.

Bear in mind that private health insurance in Australia is based on a system of community rating, which means insurers can’t charge you more in premiums because of factors such as your age, claims history or how healthy you are.

Why consider health insurance for seniors?

In Australia, we have a public healthcare system where seniors often get bulk-billed appointments to see a GP, discounted prescription medications on the Pharmaceutical Benefits Scheme (PBS) list, and other concessions.

If you’re eligible for a Commonwealth Seniors Health Care Card or a Pensioner Concession Card you can receive additional benefits such as an increased Medicare Safety Net, and help with hearing services.

But there are still a number of reasons why you may choose to take out private health insurance.

For example, surgeries that aren’t an emergency but are important for maintaining quality of life often have a waiting time of months to years in the public system, whereas with private health insurance you may be seen much earlier at a private hospital.

Some treatments may not be covered by Medicare, so this is where private health insurance may help you to get tailored care more quickly.

How to find the best health insurance for seniors?

When looking for the best seniors health insurance policy:

• Compare your options carefully, looking at both the premiums and benefits on offer
• Review your policy regularly to ensure that it still meets your changing health and financial needs as you age
• Choose a suitable level of coverage that matches your healthcare and financial needs
• Select a policy excess (the amount you pay when making a hospital related claim) that best suits your financial situation
• Check the waiting periods for certain treatments and pre-existing conditions. If you switch between policies on the same tier (going from a silver policy to another silver policy) you won’t have to re-serve any waiting periods
• Check out the latest health insurance deals and sign-up offers and if they suit your needs. A couple of weeks of free coverage may not be worth it if you end up losing out on overall coverage.

Canstar researches and rates thousands of policy variations as part of our Health Insurance Awards. Providers who offer consumers outstanding value, either nationally or by state or territory, are awarded a 5-Star Rating. The health insurer was the most satisfied customers, as determined by our unique research methodology, is also recognised. Comparing these providers and their coverage options may be a good place to start.

Canstar Star Ratings and Awards

Looking for an award-winning product or to switch providers or brands? Canstar rates products based on price and features in our Star Ratings and Awards. Our expert Research team shares insights about which products offer 5-Star value and which providers offer outstanding value overall. We also reveal which providers have the most satisfied customers in our dedicated Customer Satisfaction Awards.

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