Health Insurance For Seniors

Looking to purchase a seniors health insurance policy or reflecting on the value of your current cover during the coronavirus pandemic? Here are some of the key things to consider when researching your options.

To get the most out of health insurance as a senior, it’s important to choose the cover that best meets your needs now and into the future. Whether you’re at the height of your career or winding down towards retirement, empty nesters or still sharing your home, you can compare health insurance policies to look for one that best suits your needs with Canstar.

Looking for a seniors health insurance policy? The table below displays some of the hospital & extras policies on Canstar’s database with links to provider’s websites for seniors aged 60+, sorted by Star Rating (highest to lowest), followed by provider name (alphabetically). These results are based on a mature couple in NSW.

What is seniors health insurance?

Seniors health insurance is a type of insurance policy specifically designed to cover the needs of singles or couples who are senior citizens. The exact definition of “senior” may vary between different insurers – in some cases these policies may be available to people in their 50s, while in others the minimum eligibility age is 65. Either way, a seniors health insurance policy is one specifically created for people in these age groups, meaning it will generally provide cover for certain age-related conditions, and exclude cover for instances that are unlikely to be required, such as for pregnancy.

Canstar researches seniors health insurance policies and gives them a Star Rating based on how much value they provide for mature singles and couples aged over 60. For a policy to be considered in the Star Ratings for this profile, it must provide, at a minimum, hospital cover for heart and vascular treatment and joint replacements.

What does seniors health insurance cost?

The cost of health insurance depends on a variety of factors including whether you choose hospital, hospital and extras, or an extras only policy. Seniors health insurance policies are typically less expensive than family policies or couples policies for those planning a family because you aren’t paying for benefits such as pregnancy and obstetrics cover.

Below is what you can expect to pay for singles and couples health insurance for seniors, based on the average prices on our database for hospital and extras cover at the time of writing:

Average Annual Health Insurance Premiums – Hospital and Extras Cover For Mature Singles and Couples*

 Profile NSW VIC QLD SA WA TAS NT
Mature Singles $2,700 $2,780 $2,760 $2,658 $2,546 $2,652 $2,345
Mature Couples $5,397 $5,546 $5,508 $5,306 $5,085 $5,286 $4,689
Source: www.canstar.com.au, 19/5/20. The Australian Government Private Health Insurance Rebate Base Tier for under 65s, of 25.059% has been applied to premiums. *Mature profile is based only on products that include hospital cover for Heart & Vascular and Joint Replacements. Averages exclude Overseas Student Health Cover (OSHC ), Visitor and Corporate policies.

What does seniors health insurance cover?

Health insurance for seniors, like other health insurance policies, can include hospital cover, extras cover or both, depending on your choice of policy. It is generally worthwhile looking for a health insurance policy that covers the common health conditions that affect seniors (such as cataract surgery or joint replacements). Typically, cover for these types of treatment are found within top-tier hospital or extras policies.

Hospital

There are four hospital cover tiers currently available – Gold, Silver, Bronze and Basic. 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 the 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. A senior may 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 is a good idea to review your policy regularly to make sure the cover you’re paying for aligns with your current and future needs. You can find information about what you are and are not covered for in your product disclosure statement (PDS), or by contacting your insurer. Your insurer 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 insurer in the event you make a claim on your policy and can typically range between $0 and $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. 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 health care provider and your health insurer.

*According to Canstar Research, 17.4% of extras policies on Canstar’s database (excluding OSHC, Visitor and Ambulance-only policies) cover claims for home nursing at the time of writing.

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Why consider seniors health insurance?

Here in Australia, we have a great 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. Those who are eligible for a Commonwealth Seniors Health Care Card or a Pensioner Concession Card can also receive additional benefits such as an increased Medicare Safety Net, and help with hearing services.

However, there are a number of reasons why someone may choose to take out private health insurance. For example, surgeries that are not 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 a patient may be seen much earlier at a private hospital.

As you age you are also generally susceptible to an increased range of health risks, such as injury or illness which require regular treatments in and outside of hospital. Some of these treatments will not be covered by Medicare, so this is where private health insurance may help keep your out-of-pockets expenses down.

How about the Medicare Levy Surcharge?

It’s also worth noting that if you do not have hospital cover and you earn over $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). Find out whether a surcharge applies to you.

Seniors health insurance for aged care

At the time of writing, private health insurance does not provide cover for aged care. However, most types of aged care, including residential care in an aged care home, are subsidised by the Australian government for eligible seniors. How much you contribute towards the cost of government-funded aged care depends on things like your finances, the services you receive and care provider fees, according to the Department of Health.

Seniors health insurance and Lifetime Health Cover Loading

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 do so, for every year you are aged over 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%.

After 10 years of continuously holding any level of hospital cover, the LHC loading charges are removed. If you have been paying the LHC but don’t notice a decrease in your hospital cover premiums after 10 years, contact your insurer.

Rebates on seniors health insurance

The private health insurance rebate is an amount of money the federal government may contribute towards the cost of your private health insurance premiums. The size of the  rebate that you will receive, according to the ATO website, 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.

Pre-existing conditions and seniors health insurance

According the Private Health Insurance Ombudsman (PHIO), 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.

It is 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. However, the health fund’s appointed doctor must take into account any information given to them by your own doctor. This usually means getting a medical certificate from your doctor and sending it to your health fund.

You can get health insurance to cover your pre-existing condition, however a waiting period of up to 12 months may apply before you are able to claim benefits related to that condition. This waiting period rule is found under the Private Health Insurance Act 2007 and applies to all hospital cover. However, some insurers also apply this rule to their extras cover.

Pre-existing conditions do not increase the cost of insurance premiums.

How to look for value when seeking seniors health insurance

When choosing a seniors health insurance policy, 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.

Need to know more? These articles may be of interest:

Originally written by William Jolly

Cover image source: Nattakorn_Maneerat (Shutterstock)

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