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 change to the percentage of people with health cover, which remains at 45.6% of Australians with Hospital Cover and 55.3% with Extras Cover. 

The data also shows claim costs have risen. Hospital Cover claims increased by 6.9% in 2025, while Extras Cover claims were up 6%. Higher healthcare costs was one reason cited by insurers when they applied to increase premiums for 2026. The government approved an average 4.41% premium rise, which will take effect on 1 April.   

Read the APRA statistics 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.

Read more.