Senior Health Insurance in Australia

We all know that healthcare is paramount, so finding the best health insurance policy for your elderly parents can seem daunting, given the large number of insurance products in the market.

Whether it’s for regular check-ups, hospital treatments, joint replacements, or managing pre-existing conditions, having the right level of cover can provide peace of mind and make a significant difference in your parents’ quality of life.

In this article, we’ll explore the best health insurance for over 65s so you can find the right senior health insurance policy to help keep your senior parents healthy throughout their golden years.

What Does Senior Health Insurance Cover?

Health insurance refers to different types of health care cover like hospital cover, extras cover, the combo of both, and ambulance cover. The best fit for your elderly parents? Well, that depends on what your personal health needs are.

Health insurance policies are categorised into four tiers:

  • Basic – very little cover in a private hospital
  • Bronze – low cover
  • Silver – medium cover
  • Gold – full or top cover.

In between these main tiers, there are also Silver Plus, Bronze Plus and Basic Plus policies that cover at least one service more than the normal Silver, Bronze or Basic policies.

Hospital Cover

Think of private hospital insurance as your VIP pass when you need treatment. You get to pick your doctor, maybe get your own room in the hospital (if there’s one free), and you’ve got a better shot at picking when you have your medical procedures.

What you get out of it will depend on your level of cover, but here’s a quick look at some of the services that could be super helpful for elderly parents:

  • Heart surgery, like bypass surgery, angiograms, and stents
  • Joint replacement, for surgeries and replacing joints
  • Major eye surgery, like cataract surgery
  • Tests and scans when you’re an inpatient (for example, x-rays)
  • Cancer treatments when you’re an inpatient
  • Palliative care
  • Renal dialysis

Extras Cover

Extras cover is your ticket to getting help with out-of-hospital care that Medicare might not chip in for, like dental work, glasses, and physio appointments. An extras policy can help with:

  • Eye care, like prescribed glasses and contacts
  • Physiotherapy and occupational therapy, including exercise programs, hands-on therapies, and electrotherapy techniques
  • Remedial massage to help with injuries and speed up recovery
  • Chiropractic treatments for nerve, muscle, and skeleton-related health issues
  • Foot care (podiatry) and orthotics
  • Non-PBS prescription medicines
  • Speech therapy (which might include post-stroke treatment)
  • Hearing aids, including the design, fixing, and replacement of aids
  • Major dental work (like dentures and partial plates)
  • Health aids and appliances, like glucose monitors, crutches, and blood pressure monitors.

What Isn’t Covered by Health Insurance?

So, what’s not covered by health insurance that seniors might need to keep an eye on? When you snag a private health insurance policy, you might bump into a few restrictions and exclusions.

  • Exclusions are the medical services that your health fund won’t chip in for if you’re treated as a private patient.
  • Restrictions limit how much your health fund will cover certain services. This could mean they only pay for treatment as a private patient in a public hospital or they cover only part of the cost for treatment in a private hospital.

When it comes to hospital cover, the government lays down the law on restrictions and exclusions, and these depend on your health insurance tier. But with extras cover, the excluded services are up to your health fund. Plus, there are some natural therapies that health funds just can’t cover.

Here’s a quick run-down of some services that are often excluded or restricted that might impact seniors:

  • Hip and knee replacements
  • Heart-related services
  • Cataracts and eye lens procedures
  • Rehabilitation and psychiatric services (these can be offered as restricted benefits on all policies except Gold).

But don’t worry, these services aren’t excluded on all policies, so it’s worth doing a bit of window shopping. To get the full picture on exclusions and restrictions, have a chat with your health fund and take a good read of the policy brochure.

Selecting the Right Health Insurance Plan for Your Senior Parents

When looking at health insurance providers, it’s essential to compare the level of cover each offers, considering your parents’ health conditions, their financial situation, and their preferences for private hospital or public hospital care.

1. Waiting Periods and Pre-existing Conditions:

Most health insurance policies have a waiting period for pre-existing conditions. This period could be up to 12 months, depending on the insurance company and the health fund’s rules.

2. Hospital Cover and Extras Cover:

Hospital cover helps pay for in-patient hospital treatments like knee replacements, palliative care, or eye surgery. Extras cover, on the other hand, can assist with out-of-hospital services such as physiotherapy, podiatry, consultations with specialists, and the cost of hearing aids. When deciding on a policy, consider both hospital cover and extras policy based on your parents’ needs.

3. Understanding the Level of Cover:

Health insurance policies in Australia are categorised into four tiers: Basic, Bronze, Silver, and Gold, with ‘Plus’ options offering additional services at each level. Bronze policies typically cover treatments like joint replacements, while Silver Plus policies might cover inpatient psychiatric services or dialysis.

Private Health Insurance Rebate & Medicare Levy Surcharge

The Australian government provides a private health insurance rebate to policyholders, the amount of which is determined by factors such as income, age, and family composition. This government rebate essentially serves as a discount on health insurance premiums.

The eligibility and scale of this rebate are contingent on your financial and personal circumstances. Higher income earners may receive a smaller rebate or none at all, while seniors or families may qualify for a larger rebate.

In addition to this, there’s the Medicare Levy Surcharge (MLS), an additional tax applied to high-income earners without private hospital cover. By maintaining appropriate private health insurance, you can avoid the MLS, potentially saving money.

Private Health Insurance Vs Medicare

Australia’s healthcare landscape blends public (Medicare) and private sectors. Medicare lays the groundwork, offering treatment in public hospitals and subsidised medication via the PBS (Pharmaceutical Benefits Scheme).

However, a private health insurance policy steps up the game, providing reduced waiting times, the luxury of choosing your doctor, and coverage for additional services that Medicare doesn’t extend to.

Why Should Seniors Consider Private Health Insurance?

When it comes to public waiting lists for crucial surgeries in Australia, there’s no shortcut. However, the picture changes considerably with private hospital cover. The waiting times are typically shorter in private settings.

Let’s say you’re in line for hip replacement surgery without health insurance. You’d be in a public waiting list that might stretch out for months. To put it in perspective, half the folks who got a total hip replacement in 2021 had to wait for 153 days or more.

But with a suitable level of private hospital cover (and after serving your waiting periods), you could be looking at a wait of just a few days or weeks. This means you get back to your usual lifestyle quicker.

To sum it up, private health insurance can fast-track your return to daily activities.


Are there exclusions in health insurance policies for senior citizens?

Yes, exclusions depend on the insurance company and the policy chosen. Always read the policy terms carefully before deciding.

What are waiting lists and how do they affect my parents’ healthcare?

Waiting lists refer to the time patients need to wait to receive certain medical treatments in public hospitals. Having private health insurance can reduce these waiting times significantly.

Are ambulance services covered in private health insurance policies?

Some policies include ambulance services, but it varies between insurance providers. It’s important to check this when selecting a policy.

What is the lifetime health cover loading and does it affect seniors?

Lifetime Health Cover (LHC) loading is an initiative by the Australian government to encourage individuals to take out and maintain private hospital insurance from a young age. The rule is pretty simple: if you don’t have private hospital insurance by the time you turn 31, you’ll pay a 2% loading on top of your premium for every year you’re aged over 30.

So how does this affect seniors, you ask? Well, if you’re a senior who’s considering getting private health insurance for the first time, and you didn’t have a private hospital cover after you turned 31, the LHC loading may apply. This could mean your health insurance premiums might be more expensive than for those who took out cover earlier in life.

Let CHI Help You Find the Right Health Insurance Policy for Your Senior Parents

If you’re searching for private health cover for your elderly parents but are overwhelmed by all the choices available, don’t worry, we can help!

Simply use our free online tool below to get personalised health cover quotes from Australia’s leading health fund providers like Bupa, HCF, nib and more in minutes!