What does private health insurance cover in WA?
State-based differences can affect how private health insurance works in practice. While core cover is regulated federally, factors such as ambulance arrangements, hospital availability, and local provider networks vary by state, meaning the same policy may offer slightly different benefits, costs, or access depending on where you live.
Options for private health insurance in WA will often cover:
- Hospital treatment as a private patient and give you your choice of doctor and access to private hospitals.
- Treatment and services not covered by Medicare through an extras cover policy.
- The cost of ambulance services in WA, as Medicare does not provide cover for them.
Are ambulance services covered by private health insurance in Western Australia?
In WA, ambulance services are not covered by Medicare and must be paid for out-of-pocket unless you have specific ambulance cover. Many private health insurance policies offer ambulance cover as part of hospital or extras, but levels of coverage differ between funds. It’s important to check whether your policy includes:
- Unlimited emergency ambulance
- Non-emergency ambulance transport
- Call-out fees
- Statewide vs interstate coverage
In WA, ambulance services. You can purchase ambulance cover as part of your private health insurance policy or, or if you live in a regional area, you may need to purchase Country Ambulance Cover separately.
About private health insurance in Western Australia (WA)
Health insurance in WA can help provide extra cover beyond what’s available through the public healthcare system or Medicare.
Medicare covers treatment as a public patient in a public hospital, generally at no cost. However, you can’t choose your doctor or hospital, won’t usually receive a private room and you may face long waiting times for non-urgent procedures.
Private health insurance gives you the choice to be treated as a private patient. This may include selecting your doctor, staying in a private room (if available), and receiving faster access to elective procedures. It can also help cover the cost of certain ‘extras’ services that Medicare may not cover, such as dental, physiotherapy, or chiropractic treatment.
You can purchase private health cover from a registered health insurance provider by paying regular premiums. Most policies fall into three categories:
- Hospital cover: Helps pay for treatment as a private patient in either a public or private hospital.
- Extras cover: Covers out-of-hospital services not paid for by Medicare, such as dental, physio, and optical.
- Combined policy: You can also purchase a policy that combines both hospital and extras cover under one policy.
How to compare health insurance policies in Western Australia
When comparing health insurance options in WA:
- Compare your options carefully, paying close attention to premiums, included services, and how different funds support members across Western Australia, particularly if you live outside Perth.
- Review your policy regularly to ensure it still aligns with your healthcare needs and budget, especially as the availability of local specialists and hospitals in WA can influence the value you get from your cover.
- Choose a suitable level of coverage that reflects the type of care you’re most likely to need, from hospital treatment to extras such as dental, optical, and physio.
- Select a policy excess that fits your financial comfort level. Many WA policyholders opt for higher excesses to reduce premiums, but it’s important to choose one you can comfortably afford if you need hospital treatment.
- Check waiting periods for specific treatments, including services that may have longer local wait times in WA. If you switch to a policy on the same tier (for example, from a Silver to another Silver policy), you generally won’t need to re-serve waiting periods.
- Look at current health insurance deals and sign-up offers, but weigh them against long-term value. A short-term discount is only helpful if the policy provides the coverage and provider access you need in WA.
What are the benefits of private health cover in WA?
Health insurance in WA offers greater flexibility and financial protection across a wide range of healthcare services. While Australia’s public health system is comprehensive, private cover can give you more control over when and where you receive treatment.
Choice and flexibility
One of the main advantages of private health insurance is the ability to be treated as a private patient. This means you can choose your preferred doctor and receive care in a private hospital. Depending on availability, you may also access a private room.
Another key benefit is the potential to reduce waiting times for non-emergency procedures, which can be significantly longer in the public system.
Broader healthcare coverage
Health insurance can also cover services not included under Medicare. Extras cover, depending on your policy, may include dental check-ups, optical care, podiatry services and more. The services and benefit limits vary depending on the level of cover you choose.
Ambulance Cover
In Western Australia, ambulance services are not covered by Medicare. According to St John WA, an emergency ambulance trip under 200km costs $1,253, while a non-urgent trip is $673 (2025 rates). Many private health insurance policies offer ambulance cover as an optional extra, helping reduce or avoid these out-of-pocket costs.
Tax and financial incentives
Having an appropriate level of private insurance coverage may have some tax benefits. If you earn more than $101,000 as a single or $202,000 as a couple or family, holding an eligible hospital policy can help you avoid the Medicare Levy Surcharge (MLS)—an extra 1.0% to 1.5% of your taxable income, in addition to the standard Medicare levy.
You may also qualify for the Private Health Insurance Rebate, which is income-tested and varies by age and earnings. This rebate can be applied directly to your premiums or claimed at tax time.
Do I need private health insurance in Western Australia?
No, purchasing private health insurance is not mandatory in WA or anywhere in Australia. However, it may be worth considering based on your personal circumstances, such as your income, healthcare needs, and lifestyle.
Is taking out private health insurance in WA worth it?
In Western Australia, private health insurance can offer benefits beyond Medicare, such as choice of doctor, access to private hospitals, and reduced waiting times. Extras cover can include services like dental or physiotherapy. You may also want to look into any current deals or sign-up offers that could provide added value.
WA has fewer private hospital options in regional areas compared to Perth, so consider location when selecting a policy. Costs, waiting periods, and exclusions vary, so reading policy documents carefully is essential. Government incentives such as the Medicare Levy Surcharge and Lifetime Health Cover loading may also make private cover more worthwhile.
