How can private health insurance support me and my family after transition?
Private health insurance sits alongside Medicare and, where applicable, DVA support. It does not replace Medicare.
It can cover both 'hospital' and 'extras' treatment. These insurances help fill financial gaps in treatment costs, as well as provide cover where Medicare doesn't.
Private health insurance generally includes:
- hospital cover, which helps with hospital-related costs if you’re admitted; and / or
- extras cover, which can help with services Medicare doesn’t usually cover, such as dental and physiotherapy
Waiting periods and out-of-pocket costs may apply. Whether private health insurance is right for you will depend on your life stage, health needs and family circumstances.
Waiting periods
Waiting periods are a set time during which you can’t claim certain benefits. Depending on the insurer, waiting periods may be avoided if you take out cover from your transition date. If you take out cover later, waiting periods may apply.
How does private health insurance fit alongside Medicare and DVA?
Medicare and DVA provide important support. Private health insurance helps fill the gaps and provides additional choice.
Private health insurance generally includes two types of cover.
Medicare does a great job. But patients are treated in public hospitals according to the urgency of their clinical need. That means you could have to wait longer than you'd like for elective treatment.
And it's not just a case of 'join the queue'. As emergencies and more critical patients come along, their clinical needs take priority and you get bumped down the list. Private hospital cover can give you access to a network of hundreds of private hospitals. So you'll get more timely treatment.
It also covers a minimum of 25% of the MBS fee when your specialist treats you in a private hospital - and Medicare will pay the other 75%. Most funds will also have some form of 'gap cover' which, if participated in by your doctor, will cap or remove your out-of-pocket medical expenses.
Out-of-pocket costs in hospital
Even with hospital cover, you may still have out-of-pocket costs. Doctors and specialists can charge more than the MBS fee, and any amount above what Medicare and your insurer pay becomes your responsibility.
To manage costs:
- ask about fees before treatment
- check what your insurer covers
- ask whether your doctor will participate in gap cover if it’s available on your cover.
Gap cover
Some doctors participate in gap arrangements (which is a feature of many private health insurance hospital covers, but not all of them):
No gap: no out-of-pocket cost
Known gap: you pay an agreed amount
No agreement: costs may be higher and less predictable.
Extras cover reduces the cost of the everyday health care services that help keep you well and out of hospital.
It helps with everyday services that Medicare doesn’t usually cover, such as:
- dental
- optical
- physiotherapy
- psychology and other allied health services
The level of benefits depends on your cover.
DVA and private health insurance
- Gold Card holders may not need hospital cover for themselves, but family members may still benefit
- White Card holders may consider private cover for conditions not accepted by DVA
The treatment covered varies from a handful of categories for budget cover, up to a wide range of substantial health and wellness benefits for higher cover.
Transition Newsletter
Our monthly Transition Newsletter shares practical information about health care after service, aligned to where you are in the transition journey.