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 Brain and Nervous System?Hospital Cover for Brain and Nervous System is for hospital treatment to investigate and treat:Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Some treatments you might expect to be in the Brain and Nervous System clinical category are under other clinical categories. For...
What is covered under Breast Surgery (medically necessary)?Hospital Cover for Breast Surgery (medically necessary) covers hospital treatment to:Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).You should be aware that this category does not cover Cosmetic Surgery or Cosmetic Breast Surgery that is not medically necessary.Some treatments you might expect...
What is covered under Cataracts?Hospital Cover for Cataracts includes hospital treatment for a specific eye problem known as a cataract. This condition causes clouding of the lens that makes it difficult for people to read, drive at night or see true colours.This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). Examples include:Some treatments...
What is covered under Chemotherapy, Radiotherapy and Immunotherapy for Cancer?Hospital Cover for Chemotherapy, Radiotherapy and Immunotherapy for Cancer includes hospital treatment of cancer or benign tumours.Treatments include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Some treatments you might expect to be in the Chemotherapy, Radiotherapy and Immunotherapy for cancer clinical category...
What is covered under Dental Surgery?Hospital Cover for Dental Surgery includes hospital treatment for surgery to the teeth, gums and jaw.Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Which Hospital Cover tiers include Dental Surgery? Tier Clinical category covered? Can insurers offer restricted cover? Basic Optional Yes Bronze Optional No...
What is covered under Diabetes Management?Hospital Cover for Diabetes Management includes hospital treatment to investigate and manage diabetes. Examples include:There is only one treatment for this clinical category listed in the Medicare Benefits Schedule (MBS). This is liposuction for skin contour problems because of repeated insulin injections. It does not include insulin pumps.Some treatments you might expect...
What is covered under Assisted Reproductive Services?Hospital Cover for Assisted Reproductive Services includes hospital treatment for fertility treatments or procedures. Examples are:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Some treatments you might expect to be in the Assisted Reproductive Services clinical category are in other clinical categories. For example, treatments for:Which...
What is covered under Digestive System?Hospital Cover for Digestive System includes hospital treatment to investigate and treat the digestive system, including the:Examples include:This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).Examples include:Some treatments you might expect to be in the Digestive System clinical category are in other clinical categories. For example,...