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Guides Explore our 13 Guides to find everything you need to know about the Australian Health System and private health insurance.

Australian Health System (25 articles) Health Insurance Prices (20 articles) Private Health Insurance (34 articles) Private Health Insurers (15 articles) Medicare (28 articles) Medicare Benefits Schedule (MBS) (6 articles) Pharmaceutical Benefits Scheme (PBS) (8 articles) Public Hospitals (6 articles) Private Hospitals (7 articles) Medicare Levy (7 articles) Private Health Insurance Rebate (7 articles) Age-based Discount (5 articles) Lifetime Health Cover Loading (11 articles)

Cover Understand the different types of cover – Hospital Cover, Extras Cover, Ambulance Cover and the Excluded Treatments.

Hospital Cover (9 articles) Extras Cover (6 articles) Ambulance Cover (5 articles) Excluded Treatments

Insurers Find out everything you need to know about all registered health insurers in Australia and the brands that sell health insurance.

AAMI Health Insurance

AIA Health Insurance

Allianz Care Australia

APIA Health Insurance

Astute Simplicity Health

Australian Unity

Bupa Health Insurance

CBHS International Health

Doctors’ Health

Emergency Services Health

Health Partners

Hunter Health Insurance

ING Health Insurance

Latrobe Health Services

Mildura Health Fund

Nurses & Midwives Health

Phoenix Health Fund

Priceline Health Insurance

Qantas Insurance

Queensland Country Health Fund

Real Health Insurance

Reserve Bank Health Society (RBHS)

Seniors Health Insurance

St Lukes Health

Suncorp Health Insurance

Teachers Health

Territory Health Fund

Transport Health

Westfund

News Stay up-to-date with the latest health insurance news and developments.

Gaps for hospital treatment up 7.7%, new data shows

Out-of-pocket fees for Australians with health insurance have risen, new data shows. Statistics from health insurance industry regulator APRA reveal average Gaps for hospital treatment rose by 7.7% in 2025, from an average of $437.61 to $471.29. Gaps for Extras Cover claims were up 5.6% from an average $59.53 to $62.87. Despite the increased Gaps and the cost-of-living crisis, Australians are holding onto their health insurance policies. There was no...

Health insurance premiums rise to 9-year high

The government has approved a 4.41% average health insurance premium rise for 2026 – the highest increase in 9 years. Every year, health insurers must apply to the Minister for Health and Ageing to raise premiums. Last year’s average increase was 3.73%, while the 2017 average was 4.84%. Policyholders will be advised of their premium change over the coming weeks, with new premiums effective from 1 April. The Private Health Insurance Rebate will also be reduced...

Higher Gaps forcing many people to delay care, survey finds

Increased out-of-pocket costs for specialists are leading many Australians to delay or cancel specialist care, a recent study has found. A survey of 4,000 people by Private Healthcare Australia – peak body for the health insurance industry – found that 55% of people received a higher specialist bill than expected in the past 3 years, and almost one in 3 people had delayed or cancelled specialist care due to costs. The survey – which included...

Health insurance giving Aussies less value, doctors say

The Australian Medical Association (AMA), an advocacy group for doctors, says private health insurance no longer provides value for money, and wants the government to overhaul the industry. The association’s annual Private Health Insurance Report Card, released today, found premium prices had doubled over the past 16 years, outstripping health inflation. “Australians are paying more...

Insurers paying more for hospital claims, new data shows

Increased claim costs are putting health insurers under pressure, new data shows. The latest figures from industry regulator, the Australian Prudential Regulation Authority (APRA), show $5.2 million was paid for hospital treatment claims in the September 2025 quarter – an 8.0% increase compared with the same quarter last year and much higher than the growth...

Aussies paying steep Gaps for specialist care, data shows

Specialist fees for private hospital care in Australia have increased dramatically – in some cases, by as much as 9 times, new data shows. Figures from Private Healthcare Australia, the peak body for the health insurance industry, found that average out-of-pocket fees charged for treating private patients have surged by staggering amounts between 2018-19 and...

Govt warns insurers about premium increases

The Minister of Health has warned health insurers to focus on providing value to customers when they apply to increase their premiums over the next few weeks. Private health insurers are allowed to raise premiums once a year only, subject to government approval. Insurer applications for 2026 premium increases are due in November, with approved...

ACT residents paying high Gaps, as premiums set to rise

Some ACT residents are being hit with shock bills for public hospital treatment, new figures show. Following news this week that health insurance premiums for ACT residents may rise by at least $180 next year, an analysis of billing records has revealed the high Gaps being paid for Canberra hospital treatment. Data from Private Healthcare...

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Stephen Treacey

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Sophie Bartho

Chief Operating Officer

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Loren Jaffe

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Customer Engagement Australia

Led by Chris Payne

Do you have a reference number? Resume your calculation.

In your 20s From cost to cover types, we help you decide what health insurance is right for you.

In your 30s Understand your options, compare costs and choose health insurance that fits you.

Starting a Family Everything you need to know about health insurance for childbirth and cover for your children.

Explore Overview

Guides Overview

Australian Health System (25 articles) Health Insurance Prices (20 articles) Private Health Insurance (34 articles) Private Health Insurers (15 articles) Medicare (28 articles) Medicare Benefits Schedule (MBS) (6 articles) Pharmaceutical Benefits Scheme (PBS) (8 articles) Public Hospitals (6 articles) Private Hospitals (7 articles) Medicare Levy (7 articles) Private Health Insurance Rebate (7 articles) Age-based Discount (5 articles) Lifetime Health Cover Loading (11 articles)

Hospital Cover (9 articles) Extras Cover (6 articles) Ambulance Cover (5 articles) Excluded Treatments

Insurers Overview

AAMI Health Insurance

AIA Health Insurance

Allianz Care Australia

APIA Health Insurance

Astute Simplicity Health

Australian Unity

Bupa Health Insurance

CBHS International Health

Doctors’ Health

Emergency Services Health

Health Partners

Hunter Health Insurance

ING Health Insurance

Latrobe Health Services

Mildura Health Fund

Nurses & Midwives Health

Phoenix Health Fund

Priceline Health Insurance

Qantas Insurance

Queensland Country Health Fund

Real Health Insurance

Reserve Bank Health Society (RBHS)

Seniors Health Insurance

St Lukes Health

Suncorp Health Insurance

Teachers Health

Territory Health Fund

Transport Health

Westfund

Gaps for hospital treatment up 7.7%, new data shows Health insurance premiums rise to 9-year high Higher Gaps forcing many people to delay care, survey finds Health insurance giving Aussies less value, doctors say Insurers paying more for hospital claims, new data shows Aussies paying steep Gaps for specialist care, data shows Govt warns insurers about premium increases ACT residents paying high Gaps, as premiums set to rise

Compare Overview

Calculate Cheapest Policy Search for a new policy based on your health cover needs and budget. We compare every insurer and every policy.

calculate new policy

Compare Existing Policy Compare your existing policy with similar policies to meet your current health cover needs and budget. Compare every insurer and every policy.

compare existing policy

Calculate Rebate Discount & Loading Check if your health insurance premium decreases or increases by calculating your Government Rebate, Age-based Discount and Lifetime Health Cover Loading.

About Us Overview

Our Brand Promises

Our Contributors Overview

Stephen Treacey

Sophie Bartho

Vladimir Kundrat

Trudie McConnochie

Peter Kawecki

Loren Jaffe

Loren Jaffe Customer Engagement Australia

How We Make Money

Your Contact Information

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Home Explore Guides

Guide

Pharmaceutical Benefits Scheme (PBS)

Reviewed and updated 2 December 2024

In this Guide, we outline how the Pharmaceutical Benefits Scheme (PBS) operates, as well as answer your most common questions.

The Australian government subsidises the cost of medicines for most common medical conditions.

The Pharmaceutical Benefits Scheme (PBS) is the government program that helps you pay for those medicines.

We have put together a Guide that explains:

how the Pharmaceutical Benefits Scheme (PBS) works
what medicines it covers
how to claim a refund.

What is the Pharmaceutical Benefits Scheme (PBS)?

What does the Pharmaceutical Benefits Scheme (PBS) cover?

How does the Pharmaceutical Benefits Scheme (PBS) work?

How to claim a refund through the Pharmaceutical Benefits Scheme (PBS)

What is the Pharmaceutical Benefits Scheme (PBS) Safety Net?

How does the Pharmaceutical Benefits Scheme (PBS) work for pensioners and concession card holders

What is the Repatriation Pharmaceutical Benefits Scheme (RPBS)?

How is the Pharmaceutical Benefits Scheme (PBS) funded?

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PREVIOUS Medicare Benefits Schedule (MBS)

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