Is extras cover worth it in Australia?
Last updated: September 2026
Author: GMHBA Health Insurance
The short answer
It depends on how you use it. Extras cover can be worth it if you regularly claim on services such as dental, optical, physiotherapy or chiropractic care, and the benefits (what your health insurer pays) outweigh what you pay in premiums. For many Australians, extras cover can help reduce out-of-pocket healthcare costs, make expenses easier to budget for, and provide peace of mind knowing support is available when it's needed.
Are Australians getting value from extras cover?
According to APRA (Australian Prudential Regulation Authority) data from the Quarterly private health insurance membership and benefits summary (March 2026) shows that, on average, many Australians receive less in extras benefits than they pay in premiums. That does not mean extras cover lacks value for everyone. For regular users, the right policy may help reduce out-of-pocket costs and make routine healthcare services more predictable.
Depending on the policy, members may also access value through provider networks like GMHBA’s health practices, flexible limits, and member benefits. For some people, extras cover is also about peace of mind — knowing they have support for eligible everyday healthcare costs if their needs change.
While everyone's health needs are different, extras cover is often most valuable for people who regularly use healthcare services not typically covered by Medicare, such as dental, optical, physiotherapy, and chiropractic care.
When is extras cover worth it? (By life stage)
Extras cover may be more important at some life stages than others, depending on the services you expect to use and the reassurance you want if your health needs change.
GMHBA SmartCare Extras options may suit members who want flexible limits across commonly used services, while ClassicCare options may suit members looking for a more traditional extras structure. The right choice depends on your budget, claiming habits, life stage and the services you expect to use, so it is worth comparing the policy details before deciding which cover offers better value for your needs.
| Life stage | Typically worth it if... | Cover features to consider |
|---|---|---|
| Under 30s or young singles | You visit the dentist 1–2 times a year or want support for occasional physio after sport or exercise. | Lower-cost extras with dental and physio support. |
| Young families |
You need higher limits for growing kids, such as regular dental check-ups, orthodontics, or podiatry claims. |
Flexible limits across common family services. |
| Adults aged 45-60 | Major dental, optical*, ongoing physio management, or regular chiro visits become a priority. | Higher limits for dental and regular allied health. |
| 60+ pre-retirement | You need support for hearing devices, complex dental work, ongoing physio or other allied health services. | Cover for medical aids and devices, dental and ongoing allied health needs. |
*Optical available on SmartCare Boost products with combined hospital cover or ClassicCare Extras.
Why extras cover may or may not be worth it
A useful way to assess the value of extras cover is to ask: am I likely to claim more benefits than I pay in premiums? The answer depends on your health needs, how often you use included services, your annual limits, and the benefits paid by your fund.
According to APRA (March 2026) data, the average Australian with general treatment (Extras) cover pays approximately $538^ per year in extras premiums and receives approximately $505 in benefits.
But averages only tell part of the story. The value of extras cover varies widely depending on how often members claim, which services they use, the benefits paid by their policy and whether their annual limits match their real healthcare needs.
So why does this happen?
Many people hold extras cover but forget to use it – skipping dental check-ups or regular physio sessions.
Some policies have sub-limits that cap benefits for certain services. If these aren’t the ones you actually use, this could leave value tied up in services you don’t need.
The result can be cover that is useful in theory but not delivering enough value in practice. That’s why the question is less about whether extras cover is always worth it, and more about whether your policy suits the way you claim. Strong value usually comes from cover that matches the services you use most, offers limits you can realistically use, and helps reduce out-of-pocket costs over time.
^Source: Calculated using APRA General treatment premium revenue Quarterly private health insurance performance statistics (June 2025- March 2026) and APRA (March 2026) general treatment membership data
What national APRA data shows about extras cover
According to APRA (March 2026) data, 55.5% of Australians had general treatment cover, commonly known as extras cover, at 31 March 2026. The national data shows that a large share of benefits is paid through a small number of high-use services.
Most claimed extras services nationally:
| Service | Average annual claims per member |
|---|---|
| Dental (general and preventative dental, major dental and orthodontics) | 3.69 |
| Optical |
0.85 |
| Physiotherapy | 0.84 |
|
Chiropractic |
0.61 |
Estimated annualised utilisation per member based on APRA Quarterly private health insurance membership and benefits summary (March 2026) Figures are indicative only.
The services most commonly associated with extras value are practical, repeatable and easy to plan for — like dental, optical, physiotherapy and chiropractic care.
What GMHBA claims data shows about extras cover value
To better understand how members use extras cover, we analysed GMHBA extras claims data from FY25–26. The findings highlight the services members claim most often and the areas where members who regularly use their cover are most likely to receive value from their benefits.
Most claimed GMHBA extras services nationally:
| Service | Average annual claims per member |
|---|---|
| Dental (general and preventative dental, major dental and orthodontics) | 2.57 |
| Physiotherapy/Hydrotherapy |
1.58 |
| Chiropractic | 1.05 |
| Optical | 0.75 |
Source: GMHBA extras claim data, FY25–26. Claims data reflects GMHBA member activity made by members who hold an extras policy and does not represent all Australian extras policyholders. Not all extras policies include services like major dental or orthodontics.
In practical terms, the data suggests extras cover is most likely to deliver value when it supports services you expect to use regularly. Whether it is worth it will still depend on your life stage, claiming habits and how well your level of cover matches your needs.
How extras value can look in real life
100% back on preventative dental
60% back on other services
No annual limit rollover or optical
Annual premiums paid: $323.95^
Total services claimed: $620
- Preventative dental: $220
- 2 x physio sessions: $240
- 2 x chiro sessions: $160
Total benefits received: $456
- Preventative dental: $220
- 2 x physio sessions: $144
- 2 x chiro sessions: $96
Jade claims preventative dental, chiropractic and a few physio visits each year. Extras may be worthwhile if her annual benefits reduce recurring out-of-pocket costs and match the services she actually uses.
^ Price based on Single, aged 28 living in VIC, earning $105,000 or less (Base Tier Australian Government Rebate). Excludes any Lifetime Health Cover loading. Premiums and benefits are indicative only and may vary depending on individual circumstances and claiming patterns.
100% back on preventative dental
60% back on other services
No annual limit rollover or optical
Annual premiums paid: $585.20^
Total services claimed
- Preventative dental: $220
Total benefits received: $220
Michael only claims one dental check-up and doesn’t use other included services. Extras may be less valuable unless he wants reassurance, or he combines extras cover with hospital cover to unlock annual limit rollover features.
^ Price based on Single, aged 42 living in VIC, earning $105,000 or less (Base Tier Australian Government Rebate). Excludes any Lifetime Health Cover loading. Premiums and benefits are indicative only and may vary depending on individual circumstances and claiming patterns.
100% back on preventative dental
60% back on other services
No annual limit rollover or optical
Annual premiums paid: $1463.65^
Total services claimed: $1,900
- Preventative dental x 4: $880
- 5 x physio sessions: $600
- 4 x podiatry sessions: $420
Total benefits received: $1,492
- Preventative dental x 4: $880
- 5 x physio sessions: $360
- 4 x podiatry sessions: $252
The Nguyen’s claim preventative dental for the Mum, Dad and two kids, podiatry for one child, and occasional physio for Dad. Extras may provide stronger value when per person limits support repeat family healthcare needs.
^ Price based on Family, aged 38 & 35 living in VIC, earning $210,000 or less (Base Tier Australian Government Rebate). Excludes any Lifetime Health Cover loading. Premiums and benefits are indicative only and may vary depending on individual circumstances and claiming patterns.
How GMHBA approaches providing extras value
As a not-for-profit health insurer with no shareholders, GMHBA focuses on members and the communities it serves.
In 2026, GMHBA delivered the lowest average premium increase of 1.98%, compared to the industry average of 4.41%. GMHBA was also recognised in the 2026 WeMoney Health Insurance Awards for flexibility.
In GMHBA’s February 2026 premium announcement, former CEO David Greig said, “As a not-for-profit health insurer, every decision GMHBA makes is guided by the best interests of our members and the communities we serve, not shareholders. Our SmartCare extras and low premium increases reflect GMHBA’s commitment to providing members with great value health insurance that genuinely meets their needs.”
Delivering member value as a not-for-profit
During the COVID-19 pandemic, GMHBA returned value to members through premium freezes and a range of support initiatives, including:
- Freezing premium increases for six months in 2020, 2022 and 2023.
- Returning claims savings to active members in 2022, and to suspended and former members in 2023.
- Returning further COVID-19 savings to eligible members in 2024.
As a regionally based health fund, we are committed to supporting our members and the community during difficult times.
Support is available for eligible GMHBA members affected by natural disasters. Impacted members can suspend their membership for up to 12 months.
Official sources: APRA Quarterly Private Health Insurance Membership and Benefits Summary, March 2026; APRA Quarterly Private Health Insurance Performance Statistics, June 2025 - March 2026; GMHBA extras claims data, FY25–26; GMHBA premium increase announcement, February 2026; Canstar and WeMoney health insurance awards references.
This information is general in nature and does not take into account your personal circumstances.
Extras cover FAQs
Yes, extras cover can be worth it in Australia if you regularly receive more in benefits than you pay in premiums. It is less likely to offer value if you rarely use included services or choose a policy with limits that do not match your needs.
It may also be worthwhile if you value having support for eligible everyday healthcare costs, even when you do not claim often.
The amount Australians get back on extras cover varies by service, policy and claiming behaviour. APRA (March 2026) data shows dental, optical, physiotherapy and chiropractic account for a large share of general treatment benefits, which means people who regularly use those services may be more likely to see value from their cover.
Yes. Extras-only cover is available without hospital cover. It can help with everyday health services that aren’t typically covered by Medicare, such as dental, physiotherapy, and more.
This standalone choice is ideal if you:
- Don’t need hospital cover right now
- Mainly want support for routine or preventative care
- Prefer a lower premium focused on day-to-day health expenses
With GMHBA, you can choose extras-only cover as a separate policy or combine it with hospital cover later if your needs change.
Extras cover can help with a range of everyday healthcare services, such as dental, optical, physiotherapy, chiropractic, podiatry, osteopathy and mental health support. The exact inclusions and benefit levels vary by policy, so choose a level of cover that aligns with your health needs and how often you plan to claim.
It can be worth having both hospital and extras cover if you want support for both private hospital treatment and everyday healthcare services. Hospital cover may also help some higher-income earners avoid the Medicare Levy Surcharge (MLS), while taking it out earlier in life before 1 July following your 31st birthday may help avoid Lifetime Health Cover (LHC) loading. Eligible members who take out hospital cover before age 30 may also qualify for an age-based discount of up to 10% on their hospital cover premiums. The discount can be retained until age 41 before gradually reducing each year.
Explore GMHBA’s combined hospital and extras options
Yes, most extras covers have annual limits that reset on 1 January each year, meaning any unused benefits are typically lost.
However, with GMHBA’s SmartCare Boost Extras (available with combined hospital and extras cover), you may be able to carry forward unused limits into the next year after a 12-month qualifying period. This annual limit rollover can help you get more value from your cover over time, rather than losing what you don’t use in a single calendar year.
There is no single best extras cover for everyone. Value depends on the services you use, the benefits paid, annual limits, provider fees and your premiums.
GMHBA has been recognised by Canstar for Outstanding Value in 2025, including awards for Hospital & Extras Insurance across five states (NSW, QLD, SA, WA, and VIC). Awards can be a useful comparison point, but members should still check whether a policy suits their own health needs and budget.
SmartCare Extras offers a single flexible annual limit helping members claim across the services they use most.
Before choosing cover, check the policy factsheet, waiting periods, annual limits and sub-limits, and provider fees.