Is Private Health Insurance in Australia Worth It?

Is Private Health Insurance in Australia Worth It? When it comes to healthcare in Australia, many people are faced with the decision of whether or not to invest in private health insurance. With the rising cost of health care, it can be difficult to determine whether the investment in private health insurance is worth it. In this blog post, we take a closer look at private health insurance in Australia and examine the pros and cons of investing in a policy.

What Is Private Health Insurance?

Private health insurance is an arrangement that exists to help individuals and families cover the costs of health care. While all eligible Australians are guaranteed access to a range of health and hospital services through our publicly funded Medicare system, private health insurance exists that covers things that Medicare does not. It may also provide benefits beyond those of Medicare. It is optional and can be purchased from various private health funds.

Health insurance premiums vary in price, depending on the policy.

What does private health insurance cover?

Private health insurance is divided into two components: hospital coverage and additional coverage. Depending on your needs, you can choose a policy that covers one or both. Ambulance coverage is also available as a third component in some states (but not in Queensland or Tasmania, where this service is covered by Medicare).

The hospital portion of private health insurance covers the cost of hospital treatment by a doctor or specialist, but may also cover costs such as accommodation in a private room. Health insurance that includes hospital coverage generally allows you to choose your doctor, choose to be treated in a private hospital (or as a private patient in a public hospital), and have more flexibility in scheduling appointments and procedures.

The additional component of private health insurance covers the cost of services not covered by Medicare. This may include general and major dental treatments, optical products such as eyeglasses and frames, and physiotherapy.

Pros And Cons Of Private Health Insurance Australia

Pros – Why take out private health insurance in Australia?

1. Skip the waiting list

An important advantage of private insurance is that you can often skip public waiting lists for certain treatments, such as elective surgery. The public waiting list for surgeries such as hip or knee replacements can stretch for years and you don’t have much say in when it happens or who performs the surgery. With private health insurance, you can often decide when to make your appointment, which surgeon will perform the surgery, and even where to stay afterwards (more on that later).

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Another advantage of going private is that you record your appointment yourself. If you’re going through the public system, prioritizing patients may mean delaying your surgery so the surgeon can operate on a more critical patient. Since your doctor is in private practice, this usually won’t happen.

2. Choose your doctor

As we said, you can choose which doctor or surgeon will perform your surgery. If this is someone you already have an existing relationship with, it can make you feel more comfortable with surgery. When it is made public, the doctor or surgeon on duty at the time is the one who will operate.

3. Private hospital rooms

If you are going to be hospitalized, with private health insurance, you can usually opt for a private room. Staying in a public hospital usually gets you stuck with other people in your room, which can be uncomfortable or even annoying (what if they snore?). While it’s not always guaranteed, you generally have a much better chance than a public patient.

4. Avoid the Medicare tax penalty

Private health insurers with adequate hospital coverage are exempt from paying the Medicare Tax Surcharge. Most Australians pay Medicare tax of 2% of their taxable income as part of their taxes, but if you have income over $90,000 as a single person or $180,000 for families, you may be subject to a surcharge of at least 1 %. of your income in addition to the Medicare base rate. If you have a higher income, it is often cheaper to purchase private health insurance than to pay the extra premium.

4. Covered extras can be dental work

Unfortunately, even the most basic dental work (such as a checkup or general cleaning) is not covered by Medicare. Private health insurance allows you to fully or partially reimburse certain dental work. So if you need some fillers because you eat too much candy, it won’t burn a hole in your pocket either.

While state dental clinics exist, access to them is often strictly limited and criteria apply. Waiting lists can also be very long.

5. Claim for other non-Medicare health services

Several other health services are not covered by Medicare. For example, while some optical services are covered, others are not. The annual eye test is reimbursed, but the costs of glasses or other products are not. You can also add pregnancy (obstetrics) to your hospital or supplemental coverage, which may mean accessing certain pregnancy-related services not otherwise available through Medicare.

Cons – Why not take out private health insurance in Australia?

While there are many benefits to consider, you should also weigh the potential downsides of private health insurance.

1. The costs

The main drawback of private health insurance is that it can be expensive. Depending on your policy, you could be paying thousands of dollars in premiums each year. The costs will generally also increase annually. For example, the federal government recently announced that private insurance will increase by 2.7% in 2022, the lowest premium change in 21 years. Some providers have also postponed their price increases.

2. It doesn’t always cover everything

Private health insurance often only covers part of the cost of your treatment/procedure. This means you may still have a bill at the end, albeit less than what you would have paid had you not had insurance. This is called out-of-pocket cost or gap. Depending on how much you still have to cover and the cost of your insurance premium each year, you may not be much better off.

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3. Excluded Treatments

Your health insurer may not have some treatments listed on your policy. Sometimes even the most comprehensive policy does not cover all types of treatments or procedures.

4. It can be complicated

The variety and complexity of the products offered can be overwhelming for some people to understand. That is why the government has recently introduced reforms to private health insurance to simplify the products offered. This includes a tiered rating system, with tiered bronze, silver and gold ratings designed to take the complexity out of choosing a policy.

When is private health insurance right for you?

There are several situations where buying private health insurance may be right for you. For example, if you plan to start a family if you think you might benefit from supplemental coverage, if you earn more than $90,000 a year as a single person or $180,000 as a couple, if you are over age 31 and no more want to pay in the future, or If you just want peace of mind as you get older, private health insurance may be right for you.

1. You’re thinking about getting pregnant:

You can have a baby through the public system, it’s free and you’ll be well looked after. But going through the private system has its advantages; that is, the fact that you have access to a private room and can choose your midwife. You may also need to stay in the hospital longer to recover.

2. You have a chronic illness:

If you live with a chronic illness like diabetes or heart disease, private health insurance may be worth it since you’ll likely be in and out of the hospital for quite some time.

3. You are older:

It is a sad fact, but the older you are, the more health problems and complications you will encounter. Purchasing private health insurance in your later years can be a wise decision, especially when you consider that there are government rebates to keep people 65 and older an affordable option.

4. You need help with dental bills:

If you know you have major dental work to do (like wisdom teeth removal or a root canal), Medicare won’t cover the cost. Dental bills can be a huge source of financial pain for families, so additional coverage may be a wise investment. Make sure your policy covers major dental work.

5. You want to avoid long waiting lists for elective surgery:

If you have elective surgery (such as a hip replacement) coming up, waiting times in the public system are often much longer than for patients with private health insurance.

6. You want to choose your doctor:

Picky who you open it with? That seems fine to me. Private health coverage allows you to choose your doctor and hospital.

7. You want a possible tax refund:

If your income exceeds $90,000 and you don’t have private health insurance, the Medicare tax penalty applies. Depending on your income, you may have to pay an additional 1.5% of your annual income to the ATO each year because you are not covered.

8. You want ambulance coverage:

If you’re lucky enough to live in Queensland or Tasmania, ambulance services are free. For everyone else, it’s an out-of-pocket cost and it’s not always cheap. Fortunately, many health insurers have included ambulance coverage in their policies.

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When is private health insurance not right for you?

While there are situations where private health insurance may be worth it, there are also some cases where it may not be worth its weight in gold.

1. You are young and healthy:

If you are young and generally healthy, private health insurance probably isn’t worth it right now. That said, there may be some instances where private health insurance is worth considering.

2. You trust the public system:

If you are satisfied with the level of care you already receive through the public health system, private health insurance may be an unnecessary expense.

3. The cost of supplemental coverage exceeds the annual benefits you receive:

Do you spend more than $500 a year on supplemental coverage, but barely claim more than $100 in benefits? Eliminating the extras from your policy may be a wise move.

4. You feel pressured to remove a cover you don’t need:

You should never remove a cover “just like that”. Do not forget that in case of an emergency, you should receive excellent care at the nearest hospital for free.

10 Factors to consider when deciding whether or not to invest in private health insurance in Australia

  1. Personal Needs and Circumstances: The first factor to consider when deciding whether or not to invest in private health insurance is your personal needs and circumstances. Factors such as your age, health and lifestyle can influence your decision.
  2. Cost and Coverage: The cost of private health insurance and policy coverage are also important factors to consider. It’s important to review the policy details and compare costs between different insurers to make sure you’re getting the best bang for your buck.
  3. Quality of the public health system: The quality of the public health system in Australia should also be considered when deciding whether to invest in private health insurance. It is important to research and compare the services and coverage of the public health system with private health insurance coverage.
  4. Pre-existing conditions – If you have pre-existing conditions, it is important to review the policy details carefully to ensure that your condition is covered and that you are not restricted in any way.
  5. Waiting Times – Some private health insurance plans have waiting times before certain treatments or procedures are covered. It’s important to keep these waiting times in mind when comparing policies and deciding whether they match your needs.
  6. Out-of-pocket Costs: Some private health insurance plans have out-of-pocket costs, it’s important to consider whether you can afford them and whether it’s worth it to you.
  7. Exclusions and Limitations: It is important to read the details of the policy carefully to understand what is and what is not covered by the policy and to understand the limitations of the cover.
  8. Service Providers: Some private health insurance plans only cover services provided by certain healthcare providers. It’s important to consider whether the policy allows access to your preferred providers.
  9. Policy Flexibility – Some private health insurance policies offer more flexibility, such as the ability to change the level of coverage or upgrade the policy; it is important to consider whether the policy meets your long-term needs.
  10. Compare policies – It’s important to compare policies from different insurers to ensure you’re getting the best value for money and that the policy suits your personal needs and circumstances.

Conclusion – Is Private Health Insurance in Australia Worth It?

Is Private Health Insurance in Australia Worth It? In conclusion, private health insurance in Australia can be a worthwhile investment, especially if you are looking for more control and flexibility over your health care. However, it is important to think carefully about the costs and what the policy covers before making a decision. It is also important to weigh the benefits of private health insurance against the quality of the public health system. Ultimately, the decision of whether or not to invest in private health insurance is a personal decision and should be based on your own specific needs and circumstances.