The Medicare system, which is funded by the government, is the basis for Australia's healthcare system, which gives everyone access to public health services. But adding private health insurance to this is a big financial and personal decision. One essential step for residents navigating the private market is to compare health care options carefully and frequently in order to get the most value and avoid surprise costs.
Why it's important to compare
There are hundreds of different private health insurance plans available, divided into different levels (Basic, Bronze, Silver, Gold). The services covered, waiting times, and out-of-pocket costs of these policies are very different from each other. It's not enough to just have a policy. A policy that was good five years ago may not be good enough now because of changes in your life, changes to the policy, or higher premiums.
You can avoid paying for services you don't need or, worse yet, not having coverage for services you need by regularly taking the time to compare health care plans. It makes you think about the trade-off between the yearly premium and the possible "excess" at the hospital, which is the fee you pay when you get there.
Things to Compare
Pay attention to these important factors when you Compare Health Care Policies, especially the Hospital Cover part:
Clinical Categories: Australian policies must clearly group services into categories, such as cataracts, joint replacements, and heart and circulatory system issues. Make sure the policy you choose covers the procedures you might need. For example, a Bronze-level policy might not cover things like joint replacements, which are usually covered by Silver or Gold policies.
Waiting Periods: All new private policies have waiting periods before you can get benefits. For pre-existing conditions and obstetrics, these are usually 12 months. For other services, they are shorter. Your insurance company might not make you wait for services you were already covered for if you switch funds, but you should check this.
Out-of-Pocket Costs (The "Gap"): This is usually the part that confuses people the most. If the doctor or specialist charges more than what Medicare and your private insurance cover, you may still have to pay a gap payment. Always make sure that your policy has a "no-gap" or "known-gap" agreement with the doctors you want to see.
Rebate vs. Premium Increases: Premiums usually go up every year. The Australian Government's Private Health Insurance Rebate, which helps pay for your premium, is based on your income and can change. To make sure the net cost remains reasonable compared to the benefits, you must compare health care costs every year.
What Extras Cover Does
When you Compare health care for day-to-day services (Extras Cover), the focus shifts to maximizing annual limits. Look for a policy with high maximum annual limits for the specific treatments you need, like major dental work, physiotherapy, or optical items, if you rely on them a lot.
Many funds offer a combination policy, but it is often possible—and sometimes cheaper—to buy Hospital Cover from one company and Extras Cover from another to make a combination that works best for you. This calls for careful comparison.
In a system where incentives like the Lifetime Health Cover (LHC) loading and the Medicare Levy Surcharge (MLS) encourage continuous cover, the only way to make sure that compliance doesn't turn into financial complacency is to take the time to Compare health care options.