What is health insurance for seniors?
While health insurance providers don’t offer products that are solely designed for seniors, there are some health insurance policies that may be appealing to seniors, because they have the broadest range of inclusions. This is especially the case with hospital cover, where the more comprehensive the policy, the more treatments you're covered for in hospital. Therefore, as an older Australian, if you want cover for the broadest range of treatments - including cataract surgery or joint replacement, for example - then you may want to seek out a more comprehensive policy.
What does health insurance for seniors cover?
Health insurance suitable for seniors can include hospital cover, extras cover (i.e. dental, optical, physio) or a combination of the two. When comparing, it can be prudent to 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 if this relates to you and your risk factors.
Cover for these types of conditions are typically found within higher level hospital or extras policies. Keep in mind 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, with Gold having the most comprehensive array of inclusions, and Basic the least. 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
Note that some procedures, such as joint replacements, are only available as standard on Gold tier cover, although it may be possible to find a Silver Plus policy that includes them
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.
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.
Are pre-existing conditions covered?
Under Australian legislation, a health insurance provider may put up to a 12-month waiting period on benefits for hospital treatment for pre-existing conditions.
According to the Commonwealth Ombudsman, a pre-existing condition is any ailment, illness or condition where the signs and symptoms of that condition exist within the six months leading up to when you purchase or upgrade your health insurance policy.
As exceptions, psychiatric care, rehabilitation and palliative care all only have a two-month waiting period, even if a condition is pre-existing.
Importantly, pre-existing conditions don’t increase the cost of health insurance premiums. If you’re an Australian resident, you can’t be charged more for coverage based on your health status, or the likelihood you’ll need treatment.
It’s up to the health fund’s appointed doctor, not your own doctor, to decide whether your condition was pre-existing when purchasing or upgrading your policy. This appointed doctor must take into account any information given to them by your own doctor.
You may need to get a medical certificate from your doctor and send it to your health fund to support some claims.
How much does health insurance suitable for seniors cost?
The cost of a health insurance policy 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. That said, Canstar crunched the numbers and found that, as of November 2025, as an Australian aged over 60, a combined hospital and extras policy could cost an average of $295 per month.
Bear in mind in Australia health insurers can’t charge you more in premiums because of factors such as your age, claims history or how healthy you are, so the cost of a health insurance policy will generally reflect how comprehensive it is in terms of inclusions.
Why consider health insurance as a senior?
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.
There are still a number of reasons 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 can have a waiting time of months to years in the public system, whereas with private health insurance you will likely 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.
Is it worth having private health insurance if I’m over 50?
Whether it’s worth having health insurance over 50 will depend on your personal circumstances, but there are a few considerations to take into account:
- Elective surgery wait times: Some elective surgeries commonly undergone by older Australians, like joint replacements, can come with considerable waits in the public system.
- Cost can be higher: Higher levels of coverage can be expensive for some seniors depending on when they took out their policy. Keep in mind you have to pay a significant loading in addition to your standard premium for every year you delay taking out health insurance from the age of 31 (up to a point) due to the Lifetime Health Cover Loading.
- Choosing your own doctor: If you’re experiencing more health issues as you age, you may prefer the option of choosing a doctor familiar with you and your medical history.
- Rebate considerations: Seniors may qualify for higher private health insurance rebates on their premiums, depending on income tiers.
How to find the best health insurance as a senior
- Compare your options carefully, looking at the premiums and benefits on offer
- Review your policy regularly to ensure that it still meets your changing health and financial needs
- Choose a suitable level of coverage that matches your health 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 with 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.
