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 for their...
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...
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 2023-24. Average...
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 prices...
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 Australia...
With public hospitals under strain, health insurers are paying out greater sums for private patient treatment, new data shows. Quarterly health insurance statistics released by the Australian Prudential Regulation Authority, which regulates the industry, showed a significant increase in the amount paid for Hospital Cover claims in the June 2025 quarter. Health insurers paid $4.98 billion...
New data from the Australian Tax Office shows that the number of people being charged the Medicare Levy Surcharge (MLS) has almost quadrupled over 6 years. Data found 768,537 Aussies paid the MLS in the 2022-23 financial year, up from 196,807 in 2017. An article in The Australian says the increase is due to rising wages. The...
Australians treated with natural therapies may soon be able to claim rebates on Extras Cover. Following a review completed last year, the government has reinstated 7 of the 16 natural therapies that were removed from private health insurance cover in 2019. The health insurance industry is now developing framework to cover: Private Healthcare Australia, the peak body for...
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What is covered under Pain Management?Hospital Cover for Pain Management includes hospital treatment for pain management that does not require the insertion or surgical management of a device. Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). Some treatments you might expect to be in the Pain Management clinical category are under...
What is covered under Pain Management with Device?Hospital Cover for Pain Management with Device includes hospital treatment to implant, replace or surgically manage a device needed to manage pain.Examples include implanting:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). Some treatments you might expect to be in the Pain Management with Device...
What is covered under Palliative Care?Hospital Cover for Palliative Care includes hospital treatment to provide quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Treatments covered under the Palliative Care category are meetings with your doctor...
What is covered under Plastic and Reconstructive Surgery (medically necessary)?Hospital Cover for Plastic and Reconstructive Surgery (medically necessary) includes hospital treatment to investigate and treat any physical deformity, whether acquired as a result of illness, accident or from birth.Examples include:It does not include Cosmetic Surgery.This clinical category includes these treatments listed in the Medicare Benefits...
What is covered under Podiatric Surgery?Hospital Cover for Podiatric Surgery includes hospital treatment for foot and ankle surgery when performed by an accredited podiatric surgeon.Examples include:Treatments for this clinical category are not covered in the Medicare Benefits Schedule (MBS).This means your health insurer does not have to pay fees for your podiatric surgeon or anaesthetist....
What is covered under Pregnancy and Birth?Hospital Cover for Pregnancy and Birth includes hospital treatment to investigate and treat conditions associated with pregnancy and childbirth.Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). Some treatments you might expect to be in the Pregnancy and Birth clinical category are under different clinical...
What is covered under Rehabilitation?Hospital Cover for Rehabilitation includes hospital treatment to help people recover from surgery, illness or injury.Examples include:Treatments for this clinical category are not covered in the Medicare Benefits Schedule (MBS).Which Hospital Cover tiers include Rehabilitation? Tier Clinical category covered? Can insurers offer restricted cover? Basic Yes Yes Bronze Yes Yes Silver...
What is covered under Skin Conditions?Hospital Cover for Skin Conditions includes hospital treatment to:Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). Some treatments you might expect to be in the Skin Conditions clinical category are under other clinical categories. For example: Which Hospital Cover tiers include Skin Conditions? Tier Clinical category...