Ways to get the most out of your private health insurance

Are you over 50 and paying for private health insurance? If you haven’t reviewed your health insurance policy recently, you may find this helpful. 

As you progress through life, your needs and priorities can change. For many older Australians, navigating new health conditions, chronic illnesses, or additional health challenges can be common, so your existing health insurance policy may no longer be suited to your current life stage and health needs.  

While paying for pregnancy-related services makes sense as a young parent, you’ll may get more value out of health insurance for seniors that covers things like joint replacements (like hip or knee replacement surgery) and cardiovascular health.  

We want to help you learn things to look for in your policy, ways to compare your health insurance options and ways to maximise your private health cover.  

Why private health insurance may be important for Australians over 50? 

Private health insurance can offer a valuable financial safety net, helping to cover certain healthcare costs. For Australians over 50, particularly those navigating health conditions, private health cover may be valuable. 

The Australian Seniors Cost of Health Report 2023 reveals that 61% of older Australians are most concerned about affording unexpected healthcare costs given the rising cost of living.  

Private health insurance can offer a number of benefits to Australians over 50, including: 

• Cover for things that Medicare don’t cover: Dental, optical and physio are among the many Extras you could have cover for. Learn more here. 
• A private hospital room: While it isn’t guaranteed, private hospital cover can increase your chance of having your own room during your hospital stay. 
• Your choice of doctor: Where possible, you gain the ability to choose a doctor you are comfortable with. 
• Reducing your hospital wait time: The wait time in the public hospital can be weeks, even months. Here are the median hospital wait times for commons procedures: 
• Knee Replacement – 308 days^  
• Hip Replacement – 179 days^  
• Tonsils Removal – 174 days^  
• Coronary Bypass – 19 days^ 

Some considerations to keep in mind when comparing private health insurance policies 

A practical way to find the right policy for you is to compare your private health insurance options. When comparing policies, you may consider comparing their potential considerations as well:  

• Premiums: This is the amount you’ll pay each month for your private health insurance. Your health insurance premiums tend to be more expensive if you’ve picked a higher level of cover. 
• Waiting periods: A waiting period refers to how long you’ll need to wait before you can make a claim on certain medical or health services. 
• Pre-existing conditions: When switching to a new insurer or upgrading your policy with your current insurer, you may need to wait up to 12 months before you can claim benefits for hospital treatments related to a pre-existing condition. 
• Excess: This is the amount of money you’ll need to pay before your health insurance benefits kick in, such as when receiving hospital treatment. 
• Out-of-pocket costs: There may be exclusions that apply to your policy for specific conditions or services. Plus, there may be limits on how much you can claim over a certain period of time, which means you’ll need to understand what out-of-pocket costs you’ll need to budget for.  

Australian Seniors Tip: An easy way to compare private health insurance policies is to use the Australian Government’s free comparison tool, helping you assess the appropriate health fund and coverage for your personal circumstances whether you need Hospital cover, ambulance cover, Extras cover for of the above. 

[H2] How to understand your private health insurance policy  

The first step to maximising your private health insurance is to understand what is and isn’t covered by your current policy.  

Your insurer will have created a Private Health Information Statement (PHIS) for your policy. This document will explain what services are covered, how the policy works, and any exclusions or annual limits that apply.  

Maximising your private health insurance: tips and tricks for over 50s 

Now that you know what policy you’re paying for, it’s time to learn ways to maximise your private health insurance. 

Assess your current and future health needs 

Are you currently navigating chronic health issues? Do you have any important procedures or treatments on the horizon? What health concerns are you likely to encounter in the next chapter of your life? 

You may ask yourself these questions to gain a better understanding of your current and future health needs. This can help you when you review your current policy to ensure you’re only paying for services and benefits that you’ll actually use.  

 You can switch insurers or simply adjust your current cover to better suit your needs.  

Check if your insurer uses in-network providers  

Some insurers may give you access to in-network providers, which are a handpicked selection of doctors and healthcare providers. By using in-network providers, you may be able to access these healthcare services at a better rate.  

Under this arrangement, some key services you may be able to access include dentists, optical retail outlets, chiropractors, physiotherapists, and podiatrists.  

While every policy is different, looking for an insurer that offers in-network providers may mean you gain access to capped prices, discounts at healthcare retailers, lower out-of-pocket costs, and even a percentage back on certain services.  

When it comes to getting the most out of your private health insurance later in life, proactively reviewing your policy and comparing insurers is key to making an informed decision. The sooner you review what you are and aren’t covered for, the sooner you can move to a policy that best aligns with your current and future health insurance needs.  

Download the Australian Seniors Cost of Health Report 2023, exploring the challenges Australia’s over 50s are facing with the rising cost of living and the growing cost of healthcare. 

^Median elective surgery waiting times sourced from Australian Institute of Health and Welfare data, Public Hospital wait time for public patients (days) 2022 - 2023. Actual wait times vary by hospital and severity of the condition. Category wait times are used where specific procedure wait times are not available.