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...
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...
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The Australian government funds the Pharmaceutical Benefits Scheme (PBS).During 2024-25, the PBS cost $19.4 billion and 243.4 million PBS services were processed.
The Repatriation Pharmaceutical Benefits Scheme (RPBS) is an Australian government initiative that offers eligible people a wide range of medicines and wound care items at a concessional rate.Who is eligible for the RPBS?You may get prescribed medicines and wound care items at a concessional rate through the RPBS if you have an assessed clinical need...
The Pharmaceutical Benefits Scheme (PBS) Safety Net provides extra discounts on the price of medicines for pensioners and concession card holders. You are eligible for an extra discount under the PBS if you hold a Medicare Card and one of these cards:The further discount means you pay only up to $7.70 for PBS medicines.
The Pharmaceutical Benefits Scheme (PBS) Safety Net is designed to protect patients and families who require many PBS items. How the PBS Safety Net works for general patientsFrom 1 January 2026, the safety net for general patients is $1,748.00 in the calendar year. If your and/or your family’s total co-payments reach $1,748.00, you can apply for a...
How do I claim a PBS refund if I have my Medicare Card?If you have your Medicare Card, you can claim your PBS refund when you collect your medicines from the pharmacy with the prescriptions from your general practitioner (GP).How do I get a PBS refund if I don’t have my Medicare Card?You can claim...
Who is eligible for the Pharmaceutical Benefits Scheme (PBS)?Australian residentsYou are eligible for subsidised medicines under the PBS if you are an Australian resident and have a Medicare Card.Aboriginal and Torres Strait Islander AustraliansYou can get more help to buy medicine under the PBS if you are an Aboriginal or Torres Strait Islander Australian.Veterans and...
The Pharmaceutical Benefits Scheme (PBS) covers medicines for most medical conditions.If you have a medical condition and need medicine, the PBS will likely subsidise the cost of that medicine.The PBS does not cover the cost of over-the-counter medicines unless available on a prescription.The decision on which medicines to include in the PBS is based on...
The Pharmaceutical Benefits Scheme (PBS) is an Australian government program that subsidises medicines to offer all Australians prompt, reliable and affordable access to medicines.It is a vital part of Australia’s health system.The PBS is part of the Australian government’s broader National Medicines Policy. It means you can access a wide range of prescribed medicines without...