Time to read : 4 Minutes

Private health premiums are going up – yes again – on April 1… by an average 3.73%.

Let’s take a quick look at some numbers. If for example your premiums are currently $500 a month, and you are hit with the average increase, they will go up around $19 a month. But… if your premiums go up by more than the average increase, you’ll be paying a whole lot more. 

So, I want to share the $42,500 reason I am so grateful I have kept mine.

Because when my world turned on its head four years ago that’s what private health saved me.

This was my treatment experience when, with no family history and aged only 45, I heard the word nobody wants to: “cancer”.

What happened when I was diagnosed

There’s a thing I describe as the cancer ‘head tilt’.

I first saw it when I was swiftly called in to see my wonderful GP, after a core biopsy on a lump I found in my right breast just after COVID-19.

Me: How are you?

Her: Good – (with distinct sidewards sympathy head loll) how are you?

Me: I’m guessing not very good!

That conversation set in motion a whirlwind journey through a private health system that is incredible when it comes to cancer.

I had specialist appointments and further scans within days. I had a treatment plan within a week. I had my first of two surgeries within three weeks. And three weeks after that, I had a simultaneous double mastectomy and reconstruction, a painstaking (and yes painful) surgery.

That second surgery was a choice… a very personal one.

Everyone’s cancer is different so this is by no means medical advice. Not only did that choice reduce my risk of recurrence to just 1%, in my case it also meant I could skip radiation and avoid 10 years of hormone blockers, which probably would have put me into early menopause. (Mercifully, my type of cancer would not have responded to chemotherapy so that was unnecessary.)

A further – and significant – part of the reason I took that decision was the confronting cancer experience of two close friends. Both had no private health insurance and were treated in the public hospital system.

What happened when my friends were diagnosed with cancer – and what it cost them

Let me preface this by saying our public hospital system is generally excellent. But it’s also overstretched with waiting lists that have blown out even more since the pandemic.

Sadly, a dear, uninsured friend of mine found a malignant tumour when she was just 32.

She wanted a mastectomy for peace of mind that the cancer wouldn’t come back, but in the public system she was offered only a lumpectomy, where they remove just the tumour with a margin of cancer-free cells.

And five years later, she was scarily diagnosed with a different type of cancer in that same breast.

By then, she desperately wanted a double mastectomy. But in the public system, she could only get a single.  

This beautiful young woman was put on a waiting list for a breast reconstruction. This list saw her flat chested and lopsided for nine years. Not just structurally but psychologically, you can imagine how difficult that would be.

And now she lives in fear, having already had cancer twice, of contracting it in her remaining breast.

Then there was my 39-year-old friend. She had private health insurance but the radiation was problematic.

As a slight woman – very much like me – it burned through to her back and she now endures constant muscular-skeletal pain.

There’s also a cost consideration to radiation which is usually an outpatient treatment. Now, outpatient treatments of any kind are mostly not covered by private health.

You can have it in a public hospital, but you will probably get short notice of the variable times of treatment that may be daily for weeks and weeks – this makes it almost impossible to work… or to work around the needs of children.

As such, my friend ended up borrowing almost $10,000 to pay the out-of-pocket, after-Medicare cost of private treatment, so that she could continue her career and care for her child.

Both of these wonderful women – who are now thankfully healthy – encouraged and cheered my decision to use my private health cover for a double mastectomy to reduce the risk of the cancer returning and avoiding the need for radiation.

But you may be thinking: I just won’t be able to afford private cover anymore.

Here’s how my family makes private health pay for itself

Private health is expensive. And – in a double cost whammy – the rebate for having it goes down again slightly on April 1.

💡 Note: besides premiums going up on 1 April, an annual rebate factor is applied which means the government pays a little less towards private health insurance rebates. Your out-of-pocket costs could be approximately 0.5% more.

But I work the system in such a way that I get payouts equal to my premiums. Here’s how: 

Step 1: Interrogate and tailor your policy to cut the cost

It’s very possible your insurer charges over-the-odds. 

It’s also very possible you are paying for services you do not need. 

And it's probable you could slash your premiums by restructuring your payouts: increasing the hospital’s excess that you would pay once a year and/or agreeing to a co-payment per night in hospital – though I’m not a big fan of the latter as it can work out quite expensive.

But what I would say: ask those questions.

Step 2: Prepay your premium

You should have the option to pre-pay a year, and often a few months more than that. By doing so, you lock in this year’s rate for that much longer.

If you can at all afford it, and if your insurer is about to levy a steeper-than-average price rise, it may be well worth it.

Step 3: Claim everything you can

The fact is that most people with private health leave a whole bunch of the compensation for it on the table.

Here are the main claims members miss:

• Free dental checks and cleans twice a year for the whole family.

• Subsidised glasses, probably at least once a year (my whole family wears them so this is huge for us).

• If you’re even a little bit injured, group exercise classes supervised by a physiotherapist may well be covered. 

• Some funds or policies may even subsidise gym memberships up to $200 a year per person.

• If you have children, some insurers will pay $200 a year each for swimming lessons, too.

A quick skim of the health insurance fine print may find you quite a bit of money!

Bottom line 

When I was diagnosed with breast cancer, I counted myself lucky.

My young son, who was 11 years old at the time, would respond when I said that: “But you’ve got cancer, Mama.”

However, I had cancer in the best possible situation: with the right private health cover for me.

That meant I was in the very privileged position of being able to stop it in its tracks within months.

My hospital stays alone – more than a week thanks to complications – cost $33,000. I paid just one excess of $500.

And remember that radiation is typically not covered by private health.

Having private health and the option of a mastectomy that avoided radiation, meant I saved around a further $10,000.

In other words, though there are always some payment shortfalls with specialists when you have private health (my out-of-pocket was roughly $10,000 all up), I came out at least $42,500 ahead.

But, for me, it wasn’t about the cost. It was about getting the treatment that gave me the best possible health outcome, with no wait. I shudder to think about the alternative. 

Four years later, I’m delighted to report I’m still cancer-clear.

Sure, private health premiums are going up by an average 3.73% on 1 April, but there are circumstances – far too common ones – when private health insurance is priceless.

Go deeper:

Financial toxicity: what’s the cost of surviving breast cancer?

Financial disclaimer

The information contained on this web page is of general nature only and has been prepared without taking into consideration your objectives, needs and financial situation. You should check with a financial professional before making any decisions. Any opinions expressed within an article are those of the author and do not specifically reflect the views of Compare Club Australia Pty Ltd.