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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The Members Health Fund Alliance is the industry body for health insurers that are not-for-profit or part of a member-owned group.It differs from industry body Private Healthcare Australia, because it claims its members all share a common objective – putting members’ health and wellbeing before profits.It currently represents 24 private health insurers that provide more...
Private Healthcare Australia is an industry body representing private health insurers.It currently represents 22 private health insurers that cover 98% (14.8 million) of people in Australia who hold private health insurance: No. Insurer 1. AIA Health Insurance 2. Australian Unity 3. Bupa Health Insurance 4. CBHS Corporate 5. CBHS Health 6. Defence Health 7. GMHBA...
The Private Health Insurance Ombudsman (PHIO) is part of the Office of the Commonwealth Ombudsman.The Commonwealth Ombudsman protects the community when dealing with the Australian government, particularly resolving complaints about the Australian government.The Commonwealth Ombudsman also oversees some private sector organisations, including private health insurers.The Commonwealth Ombudsman protects private health insurance consumers by:
No. In Australia, private health insurers cannot increase their premiums whenever they choose.Instead, they have to apply to the Australian government for permission to increase premiums and must provide supporting evidence explaining why the increase is necessary.Insurers can apply to increase premiums for their private health insurance policies only once a year.The process works like...
The Australian government regulates private health insurers in Australia.The government regulates:Private health insurance laws also cover what your insurer must let you know about your policy:
In Australia, many private health insurers are mutuals.A mutual is a member-owned organisation where people come together to help achieve their shared purposes. Its objective is to help members and/or the community by providing goods or services rather than returning profits to investors.The underlying concept behind a mutual is that a group of people acting together...
About not-for-profit insurers A not-for-profit health insurer uses its revenue to:In Australia, not-for-profit health insurers are mutual organisations rather than corporations.Most not-for-profits claim to be focused on people rather than profits.Most of the restricted insurers are not-for-profit insurers.How many not-for-profit health insurers are there in Australia? In Australia, 22 private health insurers operate on a not-for-profit basis....
About for-profit insurersA for-profit insurer focuses on returning profits to shareholders from premiums paid by members after it has:How many for-profit health insurers are there in Australia? In Australia, there are 8 private health insurers that operate on a for-profit basis. Insurer Status ahm (a subsidiary of Medibank) Open 1. AIA Health Insurance Open 2. Australian...