Originally published by TJ Ryan, September 23, 2016
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.
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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