Health Insurance for Over 65s in Australia
Navigating life’s uncertainties becomes more crucial as we age. While a balanced diet and regular exercise contribute to good health, the risk of certain health conditions still rises with time.
Seniors’ health insurance steps in to alleviate the financial burden in times of illness or injury, allowing you to cherish the life you’ve built.
Below, we’ll help you understand the different health insurance options for older Australians over 65, making sure you live a healthier and more fulfilling life in your golden years.
What is Health Insurance for Seniors?
While there isn’t a specific product labelled ‘seniors’ health insurance’ or’ ‘health insurance for over 65s’, many health insurance providers offer tailored coverage to meet the unique healthcare needs of older Australians.
Your ideal policy will depend on your individual health and financial circumstances.
Typically, health insurance options for seniors encompass hospital, extras, and combined cover policies for both singles and couples. Meanwhile, extras insurance provides coverage for treatments outside of hospitals that are not covered by Medicare.
On the other hand, private hospital insurance covers treatments in private hospitals listed on the Medicare Benefits Schedule (MBS).
Considering the benefits of both types of health insurance as you age, a combined cover policy might be worth considering, depending on your financial situation.
Health Insurance Options for Seniors Over 65
Thanks to the 2019 government reforms, all health cover in Australia must cover specific treatments. While there is no specific seniors health insurance policy, certain levels of cover are more appropriate for seniors than others.
- Cost: Around $160 per month for a single policy.
- Coverage: Includes all 38 treatments outlined by the Australian government, such as joint replacements, insulin pumps, and cataracts.
- Suitable for seniors with health issues or those seeking total peace of mind.
- Cost: Often around $115 per month.
- Coverage: Covers a minimum of 26 treatments but does not include joint replacements, insulin pumps, and cataracts.
- Suitable for services like implantation of hearing devices, podiatric surgery, heart, and vascular treatments.
- Cost: Policies start from around $80 per month.
- Coverage: Offers basic cover, including joint reconstructions, kidney and bladder treatments, and chemotherapy.
- May be suitable for seniors who want shorter waiting times and basic coverage.
- Cost: Around $75 per month.
- Coverage: Provides restricted cover for rehabilitation, hospital psychiatric services, and palliative care.
- Suitable for those who want to avoid an expensive ambulance bill or are still working and wish to be exempt from Medicare Levy Surcharge and Lifetime Health Cover Loading.
- Look for Silver Plus, Bronze Plus, and Basic Plus policies.
- These policies cover at least one service more than the standard tiered policies.
- Often tailored to seniors who want top cover without including pregnancy services.
What Does Health Insurance for Seniors Cover?
Hospital cover opens the door to private hospital treatment as a private patient, granting you the freedom to choose your own doctor and enjoy a private room (subject to availability). With greater flexibility in scheduling procedures, you can rest assured knowing you’re in control of your healthcare journey.
- Typical hospital services covered by these plans include:
- Accommodation as a private patient in either a private or public hospital
- Operating theatre fees
- Intensive care costs
- MRIs, X-rays, CAT scans, and pathology for in-patients
- Eye surgeries
- A wide range of other surgeries and procedures such as hip and knee replacements, back surgery, colonoscopies, dental surgery, hernia repair, renal dialysis, and more
- Cardiothoracic surgery (related to the heart, lungs, and chest)
- Cancer and stroke treatments
- In-patient pharmaceuticals
- Rehabilitation services
- Organ transplants
- In-patient psychiatric treatments
- Gap cover for GP visits
- Emergency ambulance services
- Palliative care
On the other hand, extras insurance comes to the rescue for out-of-hospital treatments not typically covered by Medicare. This includes various services such as dental, physiotherapy, chiropractic care, optical needs, and more. Additionally, many policies also cover ambulance fees – something the public system does not pay for unless you reside in Queensland or Tasmania.
- Typical extras services covered include:
- Ambulance cover (often covered by hospital cover as well)
- Optical services
- Dental treatments
- Chiropractic services
- Physiotherapy sessions
- Hearing aids
- Remedial massage
- Non-Pharmaceutical Benefits Scheme (PBS) pharmaceuticals
- Blood pressure monitors
- Occupational therapy
- Podiatry services
- Psychology consultations
- Preventative tests like bowel screening and bone density testing
With a comprehensive hospital and extras insurance plan, you can ensure you’re well-equipped to handle both in-hospital and out-of-hospital medical needs, providing you with peace of mind and holistic healthcare coverage.
How Much Does Health Insurance Cost for Seniors?
Health insurance premiums for seniors follow a community-rated system, where individuals of all ages pay the same premium for the same level of cover. This means whether you’re 18 or 88, you’ll be charged equally for the insurance plan you choose.
For seniors looking for comprehensive coverage, a single hospital + extras policy in New South Wales can range from $67.15 to $277.41 per month for females. The actual cost will depend on various factors, such as the level of hospital cover, the insurance provider, the individual’s age, location, and specific healthcare needs.
Keep in mind that the cost of health insurance can vary based on the type of health insurance cover you select.
“A hospital-only policy may be more affordable than a combined hospital + extras plan, but it might not provide the same comprehensive coverage for treatments and services.”
When considering health insurance for seniors, it’s essential to assess your individual healthcare requirements, budget, and preferences. Comparing various policies from different insurers can help you find the most suitable and cost-effective plan to meet your specific needs as you age.
Additionally, the Australian Government provides a private health insurance rebate for eligible policyholders, which can further reduce the overall cost of health insurance for seniors. The government rebate amount depends on factors like your age and income.
Why is Private Health Insurance for Seniors Necessary?
While Australia boasts an excellent public healthcare system with Medicare, dealing with long waiting lists for crucial surgeries can be a genuine challenge. Fortunately, there’s a solution that can save the day – private hospital cover.
For example: If you need hip replacement surgery, and are on a public waiting list, you could be waiting a month for your surgery– sometimes longer.
But with the right level of private hospital cover, those never-ending waits become a thing of the past. Private waiting times are significantly shorter, meaning you can get that much-needed surgery done much quicker.
So, while you can access most of the healthcare you need with Medicare, private health insurance will have you back on your feet and living life to the fullest – all without the long waits.
Pros & Cons of Health Insurance for Over 65s
As with anything, there are pros and cons. Before taking out private health insurance, here are some of the benefits and drawbacks to consider:
- Shorter wait times.
- Freedom to choose your own hospital and doctor.
- More flexibility in scheduling appointments.
- Medicare levy surcharge exemption for those with an income.
- Basic policies covering emergency ambulances.
- Higher rebate entitlement at age 65.
- Potentially high cost, starting from around $80 per month.
- Tolerance for longer wait times on the public health system.
- Lifetime health cover loading (70% additional charge) for those without prior health insurance.
What Isn’t Covered by Health Insurance that Might Affect Seniors?
Before diving into a private health insurance policy, it’s crucial to be aware of certain restrictions and exclusions that might apply.
- Exclusions refer to medical services your health fund won’t provide benefits for if you receive treatment as a private patient.
- Restrictions limit the extent to which your health fund covers specific services. For instance, they might only cover treatment as a private patient in a public hospital or contribute only a portion of the cost for treatment in a private hospital.
For hospital cover, the government regulates restrictions and exclusions based on your health insurance tier. However, with extras cover, excluded services are determined at your health fund’s discretion. Additionally, some natural therapies may not be covered by health funds.
For seniors, certain services might be commonly excluded or restricted, such as:
- Hip and knee replacements
- Cardiac-related treatments
- Cataracts and eye lens procedures
- Rehabilitation and psychiatric services
However, it’s essential to note that these exclusions and restrictions can vary across policies. Therefore, shopping around and checking the full list of inclusions and exclusions in your policy brochure is essential. Consult with your health fund to understand the precise coverage details and make an informed decision.
Will I have to serve waiting periods?
Yes, waiting periods typically apply for most treatments and services when you take out a new health insurance policy. For most treatments, the waiting period is usually 2 months, while for pre-existing conditions, it’s generally 12 months. However, if you previously held a policy that covered the same treatment, you won’t have to re-serve waiting periods for those specific items. Keep in mind that if you switch to a policy with higher benefit limits or additional treatments not covered by your previous policy, you may need to serve waiting periods for those new items.
Why should I consider seniors health insurance?
Seniors health insurance can provide access to a broader range of services and treatments, including private hospital rooms, elective surgeries, and certain treatments not covered by Medicare. It also offers more choices of doctors and hospitals, and can help you avoid long waiting lists for non-urgent procedures. Before making a decision, it’s essential to evaluate your healthcare needs, budget, and existing Medicare coverage.
How does the Commonwealth Seniors Health Card (CSHC) work?
Once you turn 65, you may be eligible for the Commonwealth Seniors Health Card (CSHC). This concession card provides access to cheaper pharmaceuticals and government-funded medical services for older Australians. The eligibility requirements and benefits associated with the card are outlined below:
What if I have a pre-existing condition?
Health insurers are required to cover pre-existing conditions; however, there is usually a waiting period of 12 months from the policy’s start date before you can submit a claim related to that pre-existing condition.
What isn’t covered by seniors health insurance products?
Like any health insurance policy, seniors health insurance has some common exclusions. Treatments such as laser eye surgery and specialist appointments outside of hospitals are typically not covered. Additionally, non-medically necessary surgeries, such as surgical face-lifts or tattoo removal, are often excluded.
Are seniors eligible for a health insurance rebate?
Yes, seniors over the age of 65 are eligible for a private health insurance rebate. The rebate amount increases based on your age, and it is provided you’re not classified as a high-income earner (earning $144,001 or more for singles and $288,001 or more for families, single parents, and couples).
Do seniors need to pay the Lifetime Health Cover (LHC) loading?
In most cases, seniors are subject to the Lifetime Health Cover (LHC) loading. There are some exceptions, such as if you were born on or before 1 July 1934.
How much is the Lifetime Health Cover (LHC) loading?
If you’ve never had health insurance before and are subject to LHC, the loading is typically 70% of your premium. However, if you were born before 1 July 1934, you may be exempt from LHC. To have the loading removed, you must hold continuous cover for 10 years. For example, if your annual premium for seniors health insurance is $1,800, you would need to pay an extra $1,260 per year due to the LHC loading, excluding any eligible rebates.
Let CHI Find You the Right Over 65s Health Insurance Policy
While there are no policies specifically designed for seniors or over 65s, our easy online lets you compare health insurance policies side by side and get personalised quotes within minutes.
Enjoy better health care and peace of mind when you sign up for private health care today.