Do I need private health insurance?
From avoiding the Medicare Levy Surcharge to accessing private healthcare, learn when private health insurance could make sense for you.
Do you need private health insurance in Australia?
Medicare helps with the costs of essential health care for those who are eligible, but it doesn’t always cover everything. Private health insurance complements Medicare and can play an important role in helping you and your family stay on top of your health care needs.
What is private health insurance?
In Australia private health insurance helps with healthcare costs that aren’t fully covered by the public health system, Medicare. You can take out either hospital, extras or combined private health insurance.
Hospital cover helps pay towards the costs of being admitted into hospital as a private patient. Depending on your cover, you may be able to choose your specialist and elect to have your procedure at a private hospital.
Extras cover pays benefits towards the costs of services not usually covered by Medicare, like physio, chiro, dental and optical. Combined hospital and extras cover gives you the best of both.
Working alongside Medicare, private health insurance can provide greater peace of mind, more choice in how and where you receive care, and additional support for your health needs.
Why do I need private health insurance?
There are many reasons why you might need private health insurance.
- Help you skip public waiting lists if you choose to be treated in a private hospital
- Give you more choice over your treating doctor or specialist
- Help you avoid the Medicare Levy Surcharge (MLS) for higher income earners
- Help you avoid Lifetime Health Cover (LHC) loading if you take out cover before 1 July after turning 31
- Give you peace of mind knowing you’ll be covered when unexpected health issues come up
Is health insurance that pays benefits for non-hospital services and treatments like dental, physio, and eyecare; that aren’t generally covered by Medicare.
You can take out an extras-only policy, or combine extras with hospital cover. With combined cover, you can choose the hospital and extras options that best suit your needs.
Age-based discount: Eligible members aged under 30 can receive a discount of up to 10% on hospital cover premiums for 18-25 year olds. The discount can be retained until age 41, then gradually reduces by 2% each year until it's gone. The age-based discount is available on all GMHBA hospital covers.
Will I save money with private health insurance?
Private hospital cover can help reduce the cost of treatment, accommodation and services if you choose to be treated in a private hospital, helping you avoid potentially significant out-of-pocket expenses. However, because doctors can charge above the Medicare Benefits Schedule (MBS) fee, you may still have a medical gap. You can use Access Gap Cover and fee search tools (like the Government's Medical Costs Finder) to better understand potential costs.
Without hospital cover, you can access treatment through the public hospital system, but may face longer wait times for non-urgent procedures. Higher-income earners may also need to pay the Medicare Levy Surcharge (MLS).
Extras cover can help reduce and make the cost of everyday healthcare more predictable, including services like dental, physio and optical. Without extras cover, you'll generally pay the full cost of these services yourself.
Four steps to make the most of your health cover:
Selecting the right level of cover for your current health needs can help you get the most value from your policy. Reviewing your cover from time to time can ensure it continues to support your health and wellbeing.
Reduce your out-of-pocket costs, and stay on top of preventative care such as dental, optical and physio.
GMHBA is dedicated to supporting the health of members through health programs, telehealth support, and member discounts.
By choosing a cover that suits your needs, you can reduce unexpected expenses and feel more confident about the costs of your care.
Private health insurance FAQs
No, private health insurance is not tax deductible; however, private health insurnace hospital cover could help you avoid the Medicare Levy Surcharge (MLS) – an additional tax for higher income earners.
The best age to get private health insurance depends on your needs, but taking out hospital cover earlier can have its advantages. Those aged 18–29 may be eligible for age-based discounts, while delaying cover can result in Lifetime Health Cover (LHC) loading—adding 2% to your premium for each year after age 31 without cover (capped at 70% and removed after 10 continuous years).
Medicare is Australia’s universal healthcare system that makes essential health care available to Australian citizens, residents, and visitors from countries with reciprocal health care agreements. Medicare helps pay some or all of the cost of necessary health care, like visiting your GP, or the emergency room in a public hospital.
Medicare doesn’t pay for all health care services, which is where private health insurance comes in. Extras cover helps pay towards services not typically covered by Medicare, like physio, optical, and dental care. Hospital cover pays benefits towards eligible services provided by private specialists in private or public hospitals.
GMHBA is a not-for-profit, meaning we reinvest our profits into better products, services and support for our members and communities, rather than paying shareholders or overseas investors. With over 90 years of experience caring for Australians, you can feel confident knowing you're in good hands. Plus, you can join with peace of mind thanks to our 60-day money-back guarantee, provided you haven't made a claim.
Your personal circumstances, stage of life and values will be the best judge of how much private health insurance could benefit you. Here’s some more information on why private health insurance could be worth it.
Like many things in life, there's no one-size-fits-all answer.
Medicare provides access to treatment in the public hospital system, which works well for many Australians.
However, Medicare doesn't cover all healthcare services outside of hospital (such as dental, physio, and optical). That's where private health insurance can help.
You might consider extras cover if you regularly use services such as dental, physiotherapy or optical care, as it can help reduce your out-of-pocket costs for these treatments.
Hospital cover offers different benefits, including the option to be treated as a private patient and greater choice around your care. If you're a higher-income earner, having an appropriate level of hospital cover may also help you avoid the Medicare Levy Surcharge (MLS).
Yes, most Australians will pay the 2% Medicare levy at tax time. Private health insurance could help you avoid the Medicare Levy Surcharge (MLS), which is an additional tax of 1% to 1.5% for higher income earners who don’t have eligible hospital cover.