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What are the health insurance options for seniors?
As a senior, you have 2 options for your health insurance.
Option 1
Medicare
Rely on the public health system (Medicare). This is cost-effective but you have less choice about your healthcare and have to pay out of your own pocket for treatments not covered by Medicare.
Option 2
Seniors private health insurance
Take out private health insurance so you can:
choose your doctor or specialist
avoid long waiting lists in the public health system for elective surgery
get your own room in hospital if one is available
get cover for treatments that Medicare does not cover, including:
Chiropractic
Optical
Physiotherapy.
Remember, higher levels of cover can be quite expensive, and there can be out-of-pocket costs. While some surgeons may waive out-of-pocket fees for seniors, this is not guaranteed, so it is important to research health insurance policies carefully.
Option 1: Medicare
As a senior, you can rely on the public health system Medicare for your health needs.
You are entitled to a wide range of medical treatments for free or at a lower cost.
However, if you rely on Medicare, you cannot choose:
the doctor who treats you in a public hospital
when you receive that treatment.
You also have less choice about the treatments you receive and may have to go on long waiting lists for elective surgery.
You have to pay out of your own pocket for treatments not covered by Medicare, including:
Chiropractic
Optical
Dental.
Do seniors receive additional healthcare support from the Australian government?
If you are eligible for a state or territory Seniors Card, you may benefit from lower costs for state, territory or local council services.
Am I a senior?
In Australia, the age when you become a ‘senior’ and are eligible to receive a Seniors Card (which entitles you to concessions) varies depending on whether it is commonwealth, state or territory.
Commonwealth Seniors Health Card
67 years or older
ACT Seniors Card
60 years or older
NSW Seniors Card
60 years or older
NT Seniors Card
60 years or older
QLD Seniors Card
60 years or older
SA Seniors Card
60 years or older
TAS Seniors Card
60 years or older
VIC Seniors Card
60 years or older
WA Seniors Card
65 years or older
It is worth taking advantage of these offers and discounts.
As well as age, other criteria will apply, so check the eligibility requirements for your state or territory’s Seniors Card.
Commonwealth Seniors Health Card
When can get a Commonwealth Senior Health Card and what does it mean?
cheaper medicine under the Pharmaceutical Benefits Scheme (PBS)
bulk-billed doctor visits, which is up to your doctor
a refund for medical costs when you reach the Medicare Safety Net
lower state or territory government costs:
electricity and gas bills
property and water rates
healthcare costs, including ambulance, dental and eyecare
public transport.
Option 2: Seniors private health insurance
There are no specific private health insurance products for seniors. However, some insurers offer Hospital Cover or Extras Cover policies that are tailored to seniors.
The lowest Hospital Cover starts at around $39.30 in the NT ranging up to around $102.99 in Qld
Extras Cover ranges from around $14.95 in the NT up to around $22.73 in Qld and SA for cover that includes General Dental, Optical and Physiotherapy
Combined Hospital and Extras Cover starts from around $56.65 in the NT up to around $119.55 in NSW and the ACT for Basic Hospital Cover plus Extras Cover that includes General Dental, Optical and Physiotherapy.
For 2 adults (per month):
The cheapest Hospital Cover starts at around $78.60 in the NT ranging up to around $205.98 in Qld
Extras Cover starts at around $25.12 in the NT up to around $32 in most other states and territories for cover that includes General Dental, Optical and Physiotherapy
Combined Hospital and Extras Cover starts at around $113.30 in the NT, ranging up to $228.85 for Qld for Basic Hospital Cover plus Extras Cover that includes General Dental, Optical and Physiotherapy.
Key factors affecting the cost of private health insurance for seniors
Ultimately, the cost of private health insurance for seniors depends on the tier of Hospital Cover/or extent of Extras Cover, where you live, excess payable and any co-payments:
if you did not take out Hospital Cover before the age of 31, you have to pay the Lifetime Health Cover Loading, which means you pay 2% per year for every year you have not taken out cover, up to a maximum of 70%.
Your combined income:
if you’re single and your income is less than $164,000 or living with a partner and your combined income is $328,000 or less, you may be eligible for the Private Health Insurance Rebate, which gives you a premium reduction on:
Hospital Cover
Extras Cover
Ambulance Cover.
Different premium reductions apply depending on your age and income bracket, so check your eligibility.
If you’re single and your income is more than $105,000 or living with a partner and your combined income is more than $210,000 per year, and you do not have Hospital Cover, you may have to pay the Medicare Levy Surcharge.
Can seniors include adult children on health insurance cover?
You cannot include adult children (referred to as adult dependants by insurers) on your health insurance policy if they are over the age of 31, unless they have a disability.
If your adult child is participating in the National Disability Insurance Scheme (NDIS), they are eligible to be included on your policy as ‘dependants with a disability’, regardless of their relationship status or where they live. Some insurers will allow you to include dependants with a disability on your cover even if they are not participating in the NDIS, so check with your insurer about their conditions and how this will affect your premium.
What is the best private health insurance for seniors?
To find the best seniors health insurance for you, ask yourself these 10 questions:
Q 1:
What do you want from your health insurance?
Do you want more choice than Medicare provides?
Are your health needs increasing so you want a higher level of cover?
Do you want health insurance to reduce your tax bill only?
Will you have to pay an excess if you make a claim on Hospital Cover?
How much is the excess?
Will you be able to afford the excess if you make a claim?
Q 8:
Will you have to make a co-payment if you make a claim on your Hospital Cover and, if so, can you afford it?
Q 9:
Will you have to pay out-of-pocket fees, such as Medical and Hospital Gaps, and if so, can you afford this?
Q 10:
Check the waiting periods before you can make a claim for any policy you are considering.
How can I compare health insurance for seniors?
Use our free calculator to find the best and cheapest health insurance policy for you. You can also compare your existing policy against other relevant policies currently in the market.
We compare every insurer and every policy, with no commercial bias, and guarantee you the cheapest policy.
You can also personalise your premium by calculating whether you:
can save on your health insurance because you are eligible for the Private Health Insurance Rebate
have to pay more due to the Lifetime Health Cover Loading.
