NewsDo You Need Private Health Insurance

Do You Need Private Health Insurance

70.9% of Australians that have private health insurance say “that above all else, private health insurance is about knowing that you will be able to cover the cost of big medical expenses if they arise”. That’s according to Roy Morgan’s Single Survey (Australia).

While attitudes regarding private health insurance decline and premiums continue to rise each year, many are often scratching their head and asking: Do I need private health insurance?

If you don’t mind waiting lists for surgery, here are a few stats, facts and figures that could help you decide if you want private health insurance (PHI):

  • Elective surgery waiting times has increased to 40 days.
  • 90% of emergency department visits were completed in 7 hours and 14 minutes.
  • You can choose your own doctor or specialist.
  • Extras such as dental, glasses/contacts and a range of other therapies are covered by PHI.
  • Covers some or all costs of ambulances depending on your state.
  • Covers the cost of hearing aids.
  • Covers elective surgeries

Those are just to name a few. There are 100 more reasons why you should have private health insurance and the exact amount of reasons why you shouldn’t too.

While having just private health insurance won’t keep you healthy, having it could give you peace of mind and 83.8% of Pre-Boomers surveyed by Roy Morgan say that having private health insurance because they know they are able to cover the cost of medical expenses.

Ultimately that answer can only be answered by you.


Any advice contained in this article is general in nature and does not take account of your particular objectives, personal circumstances or needs. If in doubt about your own situation you should seek appropriate advice.

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Do You Need Private Health Insurance

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Joyce from NSW commented:

My husband and I have PH, no extras as we worked out it is cheaper to pay for them ourselves than to pay extra in the cover. With the new PHI coming in, we are tossing up as to whether to maintain or pull out, as our current policy covers hip and knee replacements plus cataracts, I believe that will now put us into the Gold category that will cost us more and as pensioners, we are waiting on a letter from our fund, as to where we stand with the new policies and if any, how much extra it will cost us. If the policy will cost us more, there will be an extra two people relying on the public system. 

Judy from NSW commented:

Hi all, Everyone who has health insurance needs to look carefully at the changes being made to the PHI reforms starting April 2019, on my current policy I was covered for renal dialysis, joint replacements and cataract surgery as from April if I want these covers I have to upgrade to top hospital cover. I recently dropped by extras cover because it is more economical to save what you would pay in premiums and use that money to pay your extras like dental and optical, I am now putting away $2000 a year and paying out of that. At this point I am considering opting out of Hospital Cover before April. 

Katherine from NSW replied to Judy:

Thanks for the info, I didn't know there were reforms starting. May I ask which fund you are with? 

Anonymous from VIC commented:

This article is poorly written and neglects the two most important issues. The first is ‘the gap’. If you go public you may have to wait for elective surgery but urgent matters are dealt with immediately. Public means no charge. Private leaves the patient in the hands of the unregulated doctors. They can charge what they like. The Government pay the relevant percentage of the schedule fee, but limits the health fund to paying only the difference between the Medicare rebate and the scheduled fee. The sometimes substantial gap between the scheduled fee and what the Doctor charges is the gap for which you are responsible. The second is the insurance rebate. Initially members were entited to a 30% rebate on their premium. Five or six years ago the Government decided to limit the annual increase in rebate to not more than CPI. Premiums increase at much more than this rate. The result is that the standard rebate has now dropped to just over 25%.Eventually it will disappear. So we poor members are hit when we buy insurance and when we claim! The only way i can see around it is to always go Public without any extra costs even if you have health insurance,and save the insurance for elective surgery! Since we dont pay a membership fee to belong to Fifty Up I have to assume that the organisation is funded by those programs it offers. Not a recipe for sound independent advice! 

Diane from VIC commented:

I haven't been in a Health Fund for many years, and have aged in that time to pensioner time! This is the time when I feel Health Funds should be considered as with age creeping on the body begins to break down. As I wasn't in a fund, and found myself suddenly going through the agonies of a spinal canal stenosis which still has to be operated on, I have had to pay the 70% "penalty" rate now for the upcoming 10 years! I think this should be outlawed. Why should anyone be made suffer simply for not electing to take cover when younger, and especially at an age when they no longer can get employment to pay for the cost, but also battle with their health breaking down? I thought Health Funds were raised to HELP, not punish and rake in millions more in 'penalty rates'. 

Robert from NSW commented:

We are both pretty healthy and have PH as a risk management tool. We don't claim much or often. One of my biggest gripes is that the funds only allow a certain number of dollars per annum for each category. No one ever uses the full amount for all of them, but there is always a gap to pay for any individual item.. Why not allocate a total number of dollars to use as and where you need to ? 

Robert from NSW commented:

I'm old enough to remember when there was no gap. Medicare fixed that. One of my neighbours had to have both knees replaced a couple of years ago . No private health cover. Had to wait in much pain and discomfort for over a year.. 

Carolyn from VIC commented:

If your kids are grown up and you own your home, you probably don't want to keep paying for private cover. As you age, the limits on what you can claim for increase (just when you need it most). And, your less likely to be able to afford to pay the premiums as your super dwindles down (if your lucky enough to have any). Put an amount, equivalent to any premiums you pay, into an account and leave it there until you need it instead. Better than paying premiums for ever only to find you can't claim when you need to or that you have to let the policy go due to cost. The you have paid premiums for nothing. 

Ron from NSW commented:

Your article was so unhelpful someone wasted their time tapping on the keyboard. Find them something more meaningful to do 

Anonymous from QLD commented:

I had a bi-lateral mastectomy 3 years ago and was out of pocket $6000 overall even though I have the highest hospital & extras. Part of the problem was that the government only recompensed me half the cost of the second breast. My husband now has prostate cancer and I can see that being about $5000 out of pocket. When you insure, you expect to have all your expenses paid. 

Anonymous from NSW commented:

my health fund told me this week that hearing aids are not covered by private health funds 

Katherine from NSW commented:

exactly - mine aren't covered either. 

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