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 in persons covered of 2.4% over this time.  

Meanwhile, separate data from industry body Private Healthcare Australia (PHA) found insurers paid a record $9.4 billion in ‘high’ claims in 2024, with $147.7 million paid for mental health hospital claims alone. More than 1,000 Aussies had hospital treatment claims for more than $100,000 each, the PHA Annual Hospital High Claims Report 2025 found. The highest benefit paid in 2024 was $697,267 to treat a heart valve replacement with complications requiring a 2.7-month hospital stay.  

With increased cost of hospital claims, health insurance prices could be significantly higher in 2026. This month, health insurers applied to raise premiums, with the Minister for Health expected to announce approved increases by March 2026.  

Read the APRA quarterly data here, and Private Healthcare Australia’s high claims report here.  

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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