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Reviewed and updated 25 April 2023

What are the health insurance options for seniors?

As a senior, you have 2 options for your health insurance.

Step 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.

Step 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
  • receive help to pay for treatments that Medicare does not cover, including:

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
  • the treatment you receive
  • 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
  • Physiotherapy.

Do seniors receive additional healthcare support from the Australian Government?

Yes. If you are eligible for a Commonwealth Seniors Health Card, you are eligible for additional discounts.

If you are eligible for a state or territory Seniors Card, you may receive further discounts.

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.

It is worth taking advantage of these offers and discounts.


Commonwealth Seniors Health Card

When do I become a senior and what does it mean?

You become a senior and eligible for a Commonwealth Seniors Health Card if you:

  • are Age Pension age (or older):
    • 66 years and 6 months, if you were born between 1 July 1955 and 31 December 1956 
    • 67 years, if you were born after 1 July 1957 
  • are not receiving income support from Centrelink or the Department of Veterans’ Affairs
  • meet the income test, which means you earn:
    • less than $90,000 a year for singles
    • $144,000 a year for couples
    • $180,000 for couples separated by illness, respite care or prison.

There is no asset test.

What benefits will I receive if I have a Commonwealth Seniors Health Card?

The Commonwealth Seniors Health Card is a concession card for cheaper healthcare and a range of discounts, including:

  • 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 eye care
    • public transport.

Option 2: Seniors Private Health Insurance

In Australia, seniors health insurance is private health cover for a senior single or couple.

You have the option of taking out:

There are no specific private health insurance products for seniors as there are for a Single, Couple, Family or Single Parent. However, some insurers offer Hospital Cover or Extras Cover policies that are tailored to seniors.


How much does health insurance cost for seniors?

Prices

For singles:

  • Hospital Cover starts at around $100 per month
  • Extras Cover starts at around $15 per month
  • Combined Hospital and Extras Cover starts at around $115 per month.

For couples:

  • Hospital Cover starts at around $200 per month
  • Extras Cover starts at around $30 per month
  • Combined Hospital and Extras Cover starts at around $230 per month.

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, your age, income, where you live, excess payable and any co-payments:

  • The tier of Hospital Cover:
    • Basic Cover
    • Bronze Cover
    • Silver Cover
    • Gold Cover.
  • Extent of Extras Cover
  • If you have not taken out Hospital Cove before the age of 31, you may have to pay the Lifetime Health Cover Loading, which is 2% per year for every year you have not taken out cover. 
  • Your income: if your income is $140,000 or less, you may be eligible for the Private Health Insurance Rebate, which will give you a discount on:
    • Hospital Cover
    • Extras Cover
    • Ambulance Cover.

If you earn over $90,000 per year and do not have Hospital Cover, you may have to pay the Medicare Levy Surcharge.

  • Where you live because you will pay more if:
    • you live in an area where there is a higher rate of claims
    • your state or territory charges more for hospital services.
  • Higher excess: applies if you want to pay this in exchange for a lower premium
  • Co-payment: applies if you want to make a contribution for every day you are in hospital in exchange for a lower premium.

What is the best seniors private health insurance for seniors?

To find the best seniors health insurance for you, ask yourself these questions:

Q1: 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?
Q2: What type of health insurance do you need?
Q3: If you want Hospital Cover, what Hospital Cover tier do you need?

Hospital cover tiers:

  • Basic
  • Bronze
  • Silver
  • Gold.

You may want a higher level of cover because your health needs are increasing as you get older.

Q4: If you want Extras Cover, what treatments do you need and are likely to use? 

There is no point taking out Extras Cover if you are not going to use it.

Q5: For Extras Cover, what are the limits on the policy?

Check the policy for:

  • claim limits: how many claims you can make for a particular treatment?
  • annual limits: how much you can claim each year?
  • lifetime limits: how many claims you can make for a particular treatment over the life of the policy?
Q6: For Extras Cover, what is your budget?
  • Does the cover you have selected fit within your budget?
  • Are you eligible for the Private Health Insurance Rebate?
  • Do you have to pay the Lifetime Health Cover Loading?
Q7: 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?
Q8: Will you have to make a co-payment if you make a claim on your Hospital Cover policy?
  • How much is the co-payment?
  • Will you be able to afford the co-payment if you make a claim?
Q9: Does the policy have waiting periods?

Check the policy to find out:

  • What is the waiting period before you can make a claim for a particular Hospital Cover clinical category?
  • What is the waiting period before you can make a claim for a particular Extras Cover treatment?

How can I compare health insurance for seniors?

Use our Calculator to find the best and cheapest health insurance for you.

We compare every insurer and policy.

We can also give you a personalised price on your health insurance because our Calculator helps you calculate whether you:

  • can save on your health insurance because you are eligible for the Private Health Insurance Rebate and/or the Age-based Discount
  • have to pay the Lifetime Health Cover Loading.

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