How to Compare Health Insurance in Australia
Comparing health insurance in Australia is harder than it should be. There are over 62,000 products across dozens of registered funds, with different tiers, excess options, extras categories, and pricing structures. Most comparison tools show you a handful of options from a handful of funds.
Here's how to cut through the noise and find the cover that actually matches your needs and budget — backed by data, not sales pitches.
The Australian Health Insurance Market at a Glance
| Registered health funds | 30+ |
| Active health insurance products | 62,988 |
| Australians with PHI | ~13.7 million |
| Average premium increase (April 2026) | 4.41% |
| Government PHI rebate (max) | 24.608% |
Sources: APRA, PrivateHealth.gov.au, Department of Health and Aged Care.
The market breaks down as: 29,210 hospital-only products, 21,370 combined (hospital + extras) products, and 12,408 extras-only products. Silver Plus is the most common hospital tier (21,101 products), followed by Gold (10,599) and Bronze Plus (8,340).
With premiums rising 4.41% from 1 April 2026, now is an ideal time to compare. See our full breakdown of the 2026 premium increase.
Understand the Three Types of Cover
Hospital Cover
Pays for treatment as a private patient in hospital — including accommodation, theatre fees, prosthetics, and doctor charges. This is the cover that satisfies the Medicare Levy Surcharge exemption (for incomes over $97,000 singles / $194,000 families).
Extras Cover
Pays for out-of-hospital services — dental, optical, physiotherapy, psychology, chiropractic, podiatry, and more. Extras cover is not standardised into tiers, so every fund structures their extras differently, making comparison harder.
Key extras categories to compare:
- General dental (check-ups, fillings, cleans) — most commonly used
- Major dental (crowns, root canals, bridges) — high cost, often with 12-month waiting periods
- Optical (glasses, contact lenses)
- Physiotherapy
- <strong>Psychology/counselling</strong> — check Medicare's Better Access scheme first (10 subsidised sessions/year)
- Orthodontics — important for families with children
Combined Cover (Hospital + Extras)
Most Australians buy a combined policy that bundles hospital and extras together. This is often (but not always) cheaper than buying hospital and extras separately. For help choosing between these cover types, see our hospital, extras, and combined cover guide.
Hospital Tier Comparison
Hospital cover is divided into standardised tiers set by the Australian Government. The tier is the single largest driver of your premium.
| Tier | What It Covers | Who It Suits |
|---|---|---|
| Gold | All hospital procedures (obstetrics, joint replacements, IVF, everything) | Families planning children, older Australians, those wanting maximum coverage |
| Silver Plus | Most procedures, may exclude some Gold items | Established families, mid-life Australians |
| Silver | Solid range — excludes obstetrics, joint replacements, cataracts | Younger adults, couples without children |
| Bronze Plus | Essentials plus additional categories (insulin pumps, pain management) | Health-conscious adults who want more than basics |
| Bronze | Accidents, emergencies, dental surgery, common procedures | Young, healthy adults wanting baseline cover |
| Basic Plus / Basic | Minimum cover — limited procedures | MLS avoidance, very healthy individuals |
For a detailed breakdown of what each tier covers, see our guide to downgrading health insurance.
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What Each Tier Actually Costs
Moving down one tier can save $30 to $100+ per month. Here are actual premiums across all 62,988 active products for singles before rebate.
| Tier (Singles, before rebate) | Average $/mth | Cheapest $/mth | Most Expensive $/mth |
|---|---|---|---|
| Gold | $313 | $80 | $717 |
| Silver Plus | $264 | $68 | $621 |
| Silver | $188 | $86 | $319 |
| Bronze Plus | $172 | $56 | $338 |
| Bronze | $170 | $63 | $326 |
| Basic Plus | $146 | $48 | $289 |
| Basic | $122 | $39 | $239 |
Actual premiums from 62,988 active products. Singles, national pricing, before PHI rebate. Source: analysis of all registered health fund products, March 2026.
Gold hospital cover for singles ranges from $80 to $717 per month — nearly a 9x difference for the same tier label. Two funds offering the same hospital tier, same excess, and similar extras can differ by $500 to $1,500+ per year. The only way to find out is to compare.
How Your Excess Affects Your Premium
Your excess is what you pay out of pocket per hospital admission before your fund covers the rest. Higher excess means a lower premium.
| Excess | Typical Premium Impact |
|---|---|
| $0 | Highest premium |
| $250 | ~10-15% lower |
| $500 | ~20-30% lower |
| $750 | ~25-35% lower |
For a healthy person who doesn't expect hospitalisation, a $500 excess is often the sweet spot — meaningful premium savings, manageable risk. The maximum permitted excess is $750 for singles and $1,500 for families.
Step-by-Step Comparison Process
Decide what type of cover you need
Do you need hospital cover, extras cover, or both? If your primary goal is avoiding the Medicare Levy Surcharge, you need hospital cover. If you mainly want dental and optical, extras may be sufficient. Most Australians with private health insurance hold combined cover.
Choose your hospital tier
Hospital cover is categorised into four tiers: Basic, Bronze, Silver, and Gold. Gold covers all clinical categories. Lower tiers may exclude or restrict certain treatments such as hip and knee replacements, cardiac surgery, or pregnancy. Consider which treatments you are likely to need in the coming years.
Set your excess level
The excess is the upfront amount you pay per hospital admission. Common options for singles are $0, $250, $500, and $750. A higher excess means lower monthly premiums but more out of pocket if you go to hospital. To avoid the MLS, your excess cannot exceed $750 (singles) or $1,500 (families).
Check clinical category inclusions
Look beyond the tier label. Within the same tier, different funds may have different inclusions. Check whether specific categories you care about (e.g., pregnancy, joint replacements, mental health, rehabilitation) are fully included or restricted. A restricted category means the fund pays a limited benefit and you may face large out-of-pocket costs.
Review extras limits and sub-limits
Extras policies have annual limits per service category. Check not just the total annual limit, but also per-visit limits (e.g., $60 per dental visit) and item caps. A policy with a $1,000 dental limit sounds generous, but if the per-visit limit is $40 for a check-up, you may not get great value.
Check waiting periods
All new policies have waiting periods before you can claim. General hospital services typically have a 2-month wait. Pre-existing conditions, pregnancy, and certain mental health services have a 12-month wait. Dental check-ups usually have a 2-month wait, while major dental can be 12 months. These periods are standard but worth confirming.
Check gap cover arrangements
Does the fund have agreements with hospitals and specialists to reduce or eliminate out-of-pocket gaps? Funds with gap cover schemes have agreements with doctors to limit these costs. Check how extensive the doctor network is, especially for specialists in your area.
Compare the final premium after rebate
After accounting for the government rebate (based on your income and age), compare the actual premium you will pay. Premiums are typically quoted fortnightly, monthly, or annually. Make sure you are comparing the same payment frequency and the same state, as premiums vary by state. Also check whether the fund offers any discounts for paying annually upfront.
The Must-Check Comparison List
When looking at two or more products side by side, make sure you are checking these eight factors:
- Hospital tier — ensure you are comparing the same tier (Gold vs Gold, not Gold vs Silver)
- Excess — same excess level ($500 vs $500)
- State — premiums vary by state
- Waiting periods — standard by law for new products (2 months general, 12 months pre-existing, 12 months obstetrics). But if switching, waiting periods transfer for equivalent cover.
- Restricted vs unrestricted — some products mark certain procedures as restricted (limited benefit, shared room only). Unrestricted gives you full cover.
- Extras limits — compare annual claim limits for the categories you actually use
- Gap cover arrangements — does the fund have agreements with hospitals and specialists to reduce or eliminate out-of-pocket gaps?
- Net premium after rebate — compare the price you actually pay, after the PHI rebate is applied
Common Traps to Watch For
The cheapest policy often has the most restrictions. A $90/month Basic policy may exclude dozens of clinical categories. If you are admitted for a restricted treatment, you could face thousands in out-of-pocket costs. Always check what is included, not just the price tag.
Some funds have agreements with specific hospitals. If you go to a non-agreement hospital, you may need to pay the full cost of accommodation and theatre fees. Check whether your preferred hospitals are in the fund's network, especially if you live in a regional area.
Even with hospital cover, you can face "gaps" between what the fund pays and what the doctor charges. Funds with gap cover arrangements have agreements with doctors to limit or eliminate these out-of-pocket costs. Check whether the fund has a gap cover scheme and how extensive its doctor network is.
The government rebate can significantly reduce your premium. Make sure you are comparing after-rebate prices. A policy that looks expensive at the listed rate may be quite affordable once the rebate is applied. Your rebate percentage depends on your income and age.
Health insurance premiums increase each year (typically in April). Your needs also change over time. It is worth reviewing your policy annually to ensure you are still getting good value. Switching funds is straightforward, and waiting periods transfer for equivalent or lower cover.
Read the clinical categories and check for restrictions. A product labelled "comprehensive" by a fund may still restrict certain high-cost procedures. Always verify the specific inclusions against what you might need.
Switching is easy, waiting periods transfer, and the savings compound every year. Two funds offering the same tier, same excess, and similar extras can differ by $500 to $1,500+ per year. Loyalty to a fund does not reduce your premium.
A lower premium with a $750 excess may cost more overall if you are hospitalised. If you expect to need hospital treatment in the coming year, a lower excess may be more cost-effective despite the higher monthly premium.
Government Incentives That Affect Your Costs
PHI Rebate Quick Reference
The government pays a portion of your premium based on your income. In 2025-26:
| Income (Singles) | Income (Families) | Rebate (Under 65) |
|---|---|---|
| < $97,000 | < $194,000 | 24.288% |
| $97,001 - $113,000 | $194,001 - $226,000 | 16.192% |
| $113,001 - $151,000 | $226,001 - $302,000 | 8.095% |
| > $151,000 | > $302,000 | 0% |
Higher rebates apply for ages 65-69 (28.337% base) and 70+ (32.385% base). Source: PrivateHealth.gov.au, 2025-26 financial year.
On the average Gold singles policy ($313/mth), the base rebate is worth approximately $914 per year. For a detailed breakdown, see our PHI rebate tiers guide.
Medicare Levy Surcharge (MLS)
If your income exceeds $97,000 (singles) or $194,000 (families) and you do not have hospital cover, you pay an additional 1% to 1.5% tax surcharge.
| Income (Singles) | MLS Rate | MLS at This Income |
|---|---|---|
| $97,001 - $113,000 | 1.0% | $970 - $1,130/yr |
| $113,001 - $151,000 | 1.25% | $1,413 - $1,888/yr |
| > $151,000 | 1.5% | $2,265+/yr |
Compare this to a Basic hospital policy at ~$80 to $120/month ($960 to $1,440/year). For incomes above ~$113,000, the insurance is almost always cheaper than the surcharge.
Lifetime Health Cover (LHC) Loading
If you do not have hospital cover by 1 July following your 31st birthday, you accrue a 2% loading per year without cover, up to 70%. This makes insurance permanently more expensive if you delay. For the full picture, see our Lifetime Health Cover loading guide.
How to Switch Funds Without Losing Cover
Switching health funds in Australia is straightforward. Under portability rules:
- Equivalent cover: If you switch to the same tier or lower, all waiting periods transfer. No re-serving.
- Higher cover: If you upgrade (e.g., Bronze to Gold), you serve new waiting periods only for the additional benefits.
- No break in cover: Ensure your new policy starts the day your old one ends. A gap can trigger LHC loading and restart waiting periods.
- <strong>Pre-existing conditions:</strong> If you've served the 12-month pre-existing condition waiting period with your old fund, it transfers to your new fund for equivalent cover.
Step-by-Step Switching Process
Compare and choose your new fund and product
Sign up with the new fund and specify the start date
Call your old fund and cancel, effective the same date
Confirm both dates match — no gap in cover
Update your rebate tier with the new fund
Check your first statement to ensure waiting periods are correctly recognised
The whole process can be done in a day. There are no exit fees, no lock-in contracts, and no penalties for switching health funds in Australia.
How Much Should You Be Paying?
There's no single "right" price — it depends on your age, state, tier, excess, and extras. But here are rough benchmarks.
Singles (Before Rebate / After Base Rebate at 24.288%)
| Cover Type | Avg Before Rebate | Avg After Rebate | Cheapest Available |
|---|---|---|---|
| Basic hospital only | $122/mth | $92/mth | From $39/mth |
| Bronze/Bronze+ hospital only | $171/mth | $129/mth | From $56/mth |
| Silver/Silver+ hospital only | $264/mth | $200/mth | From $68/mth |
| Gold hospital only | $313/mth | $237/mth | From $80/mth |
| Extras only | $83/mth | $63/mth | From $4/mth |
| Combined (hospital + extras) | $289/mth | $219/mth | Varies |
Families (Couples, Gold Hospital — By State)
| State | Avg Gold $/mth | After Base Rebate | Cheapest Gold |
|---|---|---|---|
| NT | $523 | $396 | $159/mth |
| WA | $662 | $501 | $319/mth |
| SA | $717 | $543 | $362/mth |
| NSW | $734 | $556 | $362/mth |
| TAS | $737 | $558 | $362/mth |
| QLD | $776 | $588 | $362/mth |
| VIC | $781 | $591 | $362/mth |
Actual averages from 62,988 active products, March 2026. Rebate calculated at base tier (24.288%, income <$97K singles / <$194K families, under 65).
If you're paying above these ranges, it's worth comparing — you may find equivalent cover at a lower price.
Where to Compare
- PrivateHealth.gov.au — the government's official comparison tool. Covers all funds, unbiased. Start here.
- internest.com.au/insurance/compare — compare across 62,988 products with filtering by tier, excess, and budget.
- Individual fund websites — useful for detailed product information once you have narrowed your shortlist.
- Avoid comparison sites that only show a subset of funds (they may earn commissions from featured funds).
Frequently Asked Questions
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General information only. This is not personal financial advice. Health insurance policies, premiums, and features vary by fund and change over time. Consider your own circumstances or consult a qualified adviser. Data sourced from APRA, PrivateHealth.gov.au, and Health.gov.au. Information reflects publicly available data as of March 2026.