Australians with health cover are paying larger out-of-pocket costs for private treatment than ever, new data shows. The average Gap for private hospital treatment has climbed to $511.02 – an increase of 8.4% from the previous quarter, according to the latest statistics from government regulator APRA (the Australian Prudential Regulation Authority). Average Gaps for Extras Cover have increased to $65.02 – a 3.4% rise. Orthopaedic procedures remain the most expensive when it comes to out-of-pocket costs, with...
The cost of raising children continues to rise, with policies for families among the hardest hit in the latest health insurance premium increases.Analysis by health insurance comparison site healthslips.com.au found increases to Family and Single Parent policies have risen higher than policies that don’t include children.The government announced health insurance premiums would rise by an...
Senior Australians are facing a double whammy of health insurance cost rises, putting extra pressure on wallets during the cost-of-living crisis. Changes to the Private Health Insurance Rebate, coupled with high premium increases to policies that meet health needs of people over 65, mean senior Australians will be hit doubly hard by new health insurance changes. Currently the Private Health Insurance Rebate reduces premiums for people on low incomes by up to 24.288%, with reductions...
Health insurance premiums will increase by an average of 4.41% on 1 April, but some Australians are already experiencing bill shock after finding their policies will increase by as much as 10.74%. In the past few weeks policyholders have been notified by health insurers about their premium rises on 1 April 2026 and in some cases, the increases are significantly higher than 4.41%. Analysis by health insurance comparison...
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 government has approved a 4.41% average health insurance premium rise for 2026 – the highest increase in 9 years. Every year, health insurers must apply to the Minister for Health and Ageing to raise premiums. Last year’s average increase was 3.73%, while the 2017 average was 4.84%. Policyholders will be advised of their premium change over the coming weeks, with new premiums effective from 1 April. The Private Health Insurance Rebate will also be reduced from 1 April...
Increased out-of-pocket costs for specialists are leading many Australians to delay or cancel specialist care, a recent study has found. A survey of 4,000 people by Private Healthcare Australia – peak body for the health insurance industry – found that 55% of people received a higher specialist bill than expected in the past 3 years, and almost one in 3 people had delayed or cancelled specialist care due to costs. The survey – which included 2,300 people...
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...
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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,...