• Health insurance premiums rise each year, so it’s a good time to check your cover and make sure you’re getting the best bang for your buck.
  • Seniors health insurance can help cover you for hearing aids, hip replacements, joint replacement occupational therapy and private hospital cover when you need it most
  • Seniors health insurance may not cover you for aged care-related services

As we grow older, our bodies tend to need a bit of extra love care (and more regular consultations and check-ups with your doctor!)

As such, it’s really important to make sure our health insurance is up-to-date and fits your changing needs. For pensioners, there are certain procedures and hospital treatments that you might need more frequently, and these are often covered by the more premium policies, like the Gold and Silver health insurance cover.

Now, with health insurance premiums going up, it’s the perfect time to take a step back and have a closer look at your policy.


Why not compare what’s out there and see if you can find a deal that’s better suited to you? It’s all about ensuring you’re covered, and comfortable, and can enjoy your golden years with peace of mind.

The Four Levels of Hospital Cover

Private health insurance in Australia falls into four tiers:

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

The level of hospital cover and the treatments insured increase as you move up from Basic to Gold.

Intermediate tiers like Silver Plus, Bronze Plus, and Basic Plus provide more coverage than their standard counterparts.

As we age, we’re more susceptible to certain health conditions, making hospital cover more important than ever. Did you know about 40% of all elective surgeries in Australia, including hip and knee replacements, were conducted on individuals aged 65 and over in 2020-21?

So, the question is, what level of cover do you need for these common treatments?

  • Heart surgery: Silver or Gold
  • Joint replacements: Gold
  • Cataracts: Gold
  • Dialysis: Gold
  • Rehabilitation: Gold
  • Palliative care: Gold

Do You Have the Right Level of Cover?

As a senior, having a comprehensive health insurance policy is not just about peace of mind; it’s a crucial part of managing your health needs.

While lower-tier policies like Silver Plus may offer cover for conditions typical to your age, they aren’t guaranteed. A

Always keep a close eye on your policy’s specifics. And remember, if you’re upgrading your cover, a 12-month waiting period applies for conditions not covered under your old policy.

Should You Cancel Your Private Health Insurance As a Pensioner?

There’s no denying Australia’s public hospitals are excellent, especially when you’re dealing with serious or urgent health conditions. However, they do have their downsides, such as long waiting times for planned surgeries, like cataract operations or hip and knee replacements. If you’re currently covered by health insurance and can manage the cost, our advice is to keep it.

Here’s why:

  1. Getting more bang for your buck: Folks between 60 and 79 years old actually use their hospital insurance more than anyone else.
  2. Bigger government rebates: Once you celebrate your 65th birthday, you’re entitled to a larger government rebate. This is the part the government chips in to help lower your insurance cost. If you’re single and earning up to $90,000 or part of a couple or family earning up to $180,000, your rebate will jump from 24.6% to 28.7%. And guess what? This goes up to 32.8% when you turn 75, starting from 1 April 2021.
  3. Good news for partners and families: If you’re part of a family or couple where one of you is 65 or over, this increased government rebate applies to your whole policy. That’s a win for everyone!

You Could Potentially Drop Extras Cover

It might be worth thinking about whether you need extras cover for services like dental, optical, chiropractic, podiatry, psychiatric services, remedial massage and physiotherapy.

Our research shows that the average annual extras premium for a single person in Australia is around $630, but you’re only likely to get about $435 back in benefits.

However, if managing money isn’t your strong suit, and you’d prefer to pay your insurer each month rather than shell out big bucks all at once for a hefty dentist bill, keeping your extras cover might be a good plan.

Be aware that you might end up paying more in premiums than you’ll ever get back in benefits. We’d advise you to check out standalone hospital and extras policies to compare, rather than automatically going for a combined policy.


Do I need health insurance as a pensioner in Australia?

Although the Australian Government provides world-class public health care, private health insurance can give you quicker access to elective surgeries and may cover treatments not available under Medicare.

Should I consider dropping my extras cover?

It might be worth considering if you’re paying more in premiums than you’re receiving in benefits. However, it ultimately depends on your personal health needs and financial situation.

Are there any changes in the government rebate for pensioners?

Yes, once you hit 65, you’re entitled to a higher private health insurance rebate, which further increases at 75.

What is Lifetime Health Cover Loading (LHC)

Lifetime Health Cover (LHC loading) is an Australian government initiative that encourages individuals to take out and maintain private hospital insurance earlier in life. If you don’t have hospital cover by July 1st following your 31st birthday, you may have to pay a 2% loading on top of your premium for every year you are aged over 30.

How is the Medicare Levy Surcharge (MLS) different from the Medicare Levy?

The Medicare Levy is a tax that most Australians pay to fund our public healthcare system, Medicare. The Medicare Levy Surcharge (MLS) is an additional tax, on top of the Medicare Levy, that applies to individuals and families on higher incomes if they don’t have private hospital cover.

How does health insurance handle pre-existing conditions?

A pre-existing condition is any ailment or illness that you had signs or symptoms of during the 6 months before you joined a health fund or upgraded to a higher level of cover. Most funds apply a 12-month waiting period for these conditions. This means you might not be covered for hospital or medical costs associated with treatment for these conditions for the first 12 months of your policy.

What are the eligibility criteria for health insurance policies?

Eligibility for health insurance policies depends on the specific policy and the insurance provider. However, common factors include age, residency status, and in some cases, health status.

What are policy exclusions in health insurance?

Exclusions in health insurance are specific services or treatments that aren’t covered by your policy. These could include things like elective surgeries, certain therapies, or treatment for pre-existing conditions during the waiting period.

How do out-of-pocket expenses work with health insurance?

Out-of-pocket expenses, also known as ‘gap expenses’, are costs that you need to pay yourself because they aren’t covered by Medicare or your private health insurance. These can include costs for specialists, surgeries, or pharmaceuticals.

Let CHI Help Get You Covered in Your Golden Years

With a clear understanding of your health needs, as an older Australian you can tailor a health insurance policy to provide the most benefits.

Remember, the best health insurance for you is one that offers value for money, adequately covers your health conditions, and aligns with your financial situation.

If you’re 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 insurance providers in minutes!