Seniors health insurance

The cost of health insurance for seniors depends on a variety of factors, including whether you choose hospital, hospital and extras, or an extras only policy. You can use the table at the top of this page to compare policy features and estimated premium prices for someone who is 60. Change the filters to suit your requirements.

The cost will be determined by the level of cover you’d like, with a higher level of cover generally meaning a higher cost.

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.

But the level or the Australian Government Private Health Insurance Rebate does vary based on age (as well as income level) which can have an impact on the cost to policyholders.

Health insurance for seniors, like other health insurance policies, can include hospital cover, extras cover or both, depending on your choice of policy.

You may want to consider looking for a health insurance policy that covers some of the common health conditions that can affect people as we age, such as cataract surgery or joint replacements.

Cover for these types of treatment is typically found within top-tier hospital or extras policies. Keep in mind health insurance waiting periods usually apply, including up to 12 months for pre-existing conditions.

Hospital

There are four hospital cover tiers currently available – Gold, Silver, Bronze and Basic.

Health insurance providers may also offer policies with additional coverage to what is required, which they will call ‘plus’, such as Silver Plus. This means these policies provide all the coverage of a Silver tier, with additional cover, but not as much cover as a 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 of 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

Extras insurance 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 insurance policy will ultimately depend on the type and level of cover you choose and what health fund you sign up for.

It’s a good idea to review your policy regularly to make sure the cover you’re paying for aligns with your current and future needs.

A Private Health Information Statement (PHIS) is available for health insurance policies in Australia. This gives a summary of key product features for your health insurance.

Other policy documentation may be available online or from your insurance provider too. Your insurance provider will also be able to outline the premium and the excess options on offer to you for a particular policy.

An excess is an amount of money you pay to your provider in the event you make a claim on your policy. An excess can typically range from $0 to $1,000.

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 insurance provider may only cover up to a set monetary limit for any particular procedure.

It’s a good idea to 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.

Here in Australia, we have a public healthcare system where seniors can 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 nevertheless important for maintaining quality of life may have a waiting time of months or years in the public system, whereas with private health insurance you may be seen much earlier at a private hospital.

As you age you’re generally more susceptible to an increased range of health risks, such as injury or illness, which can require treatments in and outside of hospital.

Some of these treatments may not be covered by Medicare, so this is where private health insurance may help you to get tailored care more quickly, depending on your personal needs. However, be sure to find out what out-of-pocket expenses you may incur, and ask for a quote.

It’s worth noting that if you don’t have hospital cover and you earn more than $90,000 a year, the Medicare Levy Surcharge of up to 1.5% may apply as an extra tax on your income, according to the Australian Taxation Office (ATO).

You can find out more about whether a surcharge applies to you.

Private health insurance doesn’t provide cover for aged care, but most types of aged care, including residential care in an aged care home, are subsidised by the Australian Government for eligible seniors.

If you can afford to, the Department of Health says “you’re expected to help with the cost of government-funded aged care”. How much you pay, it adds, varies based on factors such as “your finances, the services you receive and care provider fees”.

Under the Lifetime Health Cover (LHC) scheme, you have until 1 July after your 31st birthday to take out an adequate level of private hospital cover.

If you don’t, for each and every year of your age above 30 you will incur a 2% surcharge (called LHC loading) on your health insurance premiums for whenever you do take out hospital cover, up to a maximum of 70% (for 35 years without cover).

If you’re taking out a health insurance policy for the first time as a senior, you will likely be required to pay the LHC. After 10 years of continuously holding any level of hospital cover, the LHC loading charges are removed.

The private health insurance rebate is an amount of money the Australian Government may contribute towards the cost of your private health insurance premiums.

The size of the rebate that you may get, according to the Australian Taxation Office (ATO), is dependent on your income (including money you receive from the Age Pension, your super or account-based pension), your age and whether you are single or have your own family.

Generally speaking, the older you are and the less you earn, the higher your rebate will be.

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. But the health fund’s 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.

When looking for the best seniors health insurance policy for you, consider taking the time to compare your options carefully, looking at both the premiums and benefits on offer.

If you already have a policy in place, it may also be a good idea to review your cover regularly to ensure that it still meets your changing health and financial needs as you age.