Australian Health Insurance Statistics

19 March 2018

Originally published by TJ Ryan, September 23, 2016

Private health insurance statistics show that more Australians have extras cover than hospital cover, but that coverage rates remain reasonably healthy for both.

According to APRA, as at December 2017, 45.6% of Australians have private health insurance cover in terms of a policy covering hospital treatment. This is down just slightly on September 2017’s near 46% of Australians (because of an increasing population, it equates to around 12,000 fewer people covered).

In addition, 54.6% of the population are covered for general treatment (extras) with an additional 3,000 people covered between September and December alone.

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More than 87.5% of Australians with health insurance have lifetime health cover (LHC). This means they aren’t paying more than they need to for their premiums – good onya, Aussies!

Source: APRA, Quarterly Private Health Insurance Statistics (February 2018)

If you don’t already have health insurance and you sign up when you are older than 30, your premium is made more expensive by a government penalty (2% loading for every year of your age over 30). You can use the Government’s Lifetime Health Cover calculators to find out if the loading would be or is being applied to you.

The following table displays a snapshot of health insurance policies on Canstar’s database sorted by Star Rating (highest to lowest). The Star Ratings and products listed below are based on couples under 35 in NSW.

Health Insurance State by State

When it comes to geography, Canberrans and Western Australians are the most likely to have both hospital and general cover, while residents of the Northern Territory are the least likely to have cover, as follows:

Region Proportion of population with cover
Hospital Extras
Australia 45.6% 54.6%
New South Wales 46.9% 56.8%
Victoria 42.1% 48.9%
Queensland 42.8% 48.9%
South Australia 45.3% 59.3%
Western Australia 55.2% 69.4%
Tasmania 44.0% 51.1%
ACT 55.7% 66.8%
Northern Territory 40.5% 44.4%

Source: Private Health Insurance Administration Council, Membership Coverage December 2017

What age has health insurance?

When it comes to having health insurance in place, the proportions of those that do approximately reflect Australian demographics.

Health insurance by age – December 2017

Age Group Dec 2017  
Female Male Total
0–4             292,884             313,229             606,113
5–9             346,314             367,685             713,999
10–14             336,157             355,627             691,784
15–19             318,651             336,647             655,298
20–24             273,264             267,872             541,136
25–29             266,003             223,667             489,670
30–34             416,479             361,071             777,550
35–39             428,519             391,991             820,510
40–44             409,990             381,535             791,525
45–49             435,133             400,028             835,161
50–54             406,661             376,372             783,033
55–59             421,350             388,932             810,282
60–64             391,758             358,999             750,757
65–69             354,977             325,464             680,441
70–74             286,616             262,466             549,082
75–79             187,982             172,412             360,394
80–84             128,348             107,553             235,901
85–89              82,881              62,479             145,360
90–94              35,671              20,329              56,000
95+                9,463                2,835              12,298
Total          5,829,101          5,477,193        11,306,294

Source: APRA & ABS

Do we claim on our health insurance?

The short answer is yes, we certainly do.

Hospital use

According to the APRA statistics, December 2017 quarter alone, insurers paid benefits for more than three million days in hospital, arising from 1.18 million hospital episodes of care.

Hospital utilisation is distributed over four categories of hospital—public, private, day only facilities and hospital-substitute. During the December 2017 quarter, hospital episodes were distributed as follows:

  • Public hospitals 200,624 episodes
  • Private hospitals 769,534 episodes
  • Day hospital facilities 158,389 episodes
  • Hospital substitute 47,704 episodes.

The average out-of-pocket (gap) payment for a hospital episode was $291.5 in the December quarter. This included out-of-pocket payments for medical services, in addition to any excess or co-payment amounts relating to hospital accommodation. The out-of-pocket payments for hospital episodes increased by 6.1% compared to the same quarter for the previous year.

General treatment


We also love using our general treatment (or extras) policies and during the December 2017 quarter, insurers paid $1,287 million in general treatment (ancillary) benefits. The main ancillary benefits during this time included the major categories of:

  • Dental: $676 million
  • Optical: $255 million
  • Physiotherapy: $95 million
  • Chiropractic: $63 million.

How to find health insurance

Canstar’s Health Insurance Star Ratings is the largest of our suite of ratings and awards. That is based on the sheer size of the rating. We have 497 consumer profiles which cover various demographics across the states and territories in Australia. The number of profiles is boggling not to mention the 23,000+ premium quotes or the millions of extras claims scenarios that we calculate.

This whole process has provided us an appreciation for the process that we all go through when trying to choose the right health insurance policy for our individual needs. It is not only about finding a policy that will meet our budget, but also finding one that will provide the cover we need. With the large range of options available from multiple health fund providers, this process can be difficult. We’ve tried to make it as easy for you as possible!


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