Compare Health Insurance for ACT

Updated 19/12/2023
Compare Health Insurance for ACT

Compare Health Insurance for ACT

A proper private health insurance comparison for QLD will need to compare health insurance rebates and benefits to discover which policy offers you the best value. You might also want to look at a health insurance comparison for Brisbane, versus other towns in Queensland as a metro location can make a difference to whether or not you can easily access the healthcare providers working within your health fund’s network.

Key Points

  • Many health services in the ACT are provided by Canberra Health Services.

  • Ambulance services are not free in the ACT, but you can get them covered with private hospital insurance.

  • Extras-only private health cover does not always include ambulance services.

Public and private healthcare systems in the ACT:

There are both public and private healthcare systems in the ACT, just like the rest of Australia. Each system has its own health services and hospitals.

Even though the ACT sits geographically within the state of New South Wales (NSW). NSW Health runs the state of NSW, but Canberra Health Services oversees the ACT’s health systems. **

COMPARE & SAVE

How to find the best health insurance in the ACT:

  1. Decide who needs cover in your household; you, you and your partner, or your whole family. This will help you choose between separate single policies, a couples policy, or a family policy.

  2. Decide what type of cover you want: hospital, extras or a combination of both.

  3. Consider your location: the ACT does not have free ambulance trips for residents, so bear this in mind when selecting your policy. Ambulance services are covered under a hospital policy and some extras policies.

  4. Compare multiple quotes. Get prices from a range of funds and look at their benefits and inclusions – and exclusions.

Expert tip: Rather than spend ages trawling through different health insurers' websites, you can compare them here, for free.

Which fund offers the best hospital cover for the ACT?

The best hospital cover is the one that suits your specific needs and circumstances. It will be different for everyone. 

Expert tip: Basic hospital policies let you avoid the MLS but they're often poor value. Basic plus cover or bronze hospital insurance gives you more value for your money.

Private health insurance in the ACT:

You can buy private health insurance in the ACT so you and your family can use health services that Medicare does not pay for, like:

  • private hospital services.

  • private dentists.

  • alternative therapies, including Chinese medicines and treatments.

  • ambulance services.

Your health fund may charge you a hospital excess payment, but this is usually a lot less than the full cost of your hospital treatment. As a private patient, you’re responsible for checking that your health fund covers the treatment you’re receiving.

Outpatient treatment also isn’t typically covered by Medicare or your private hospital cover. Unless you have extras cover, you’ll have to pay for any services and equipment you use, including your consultation with your attending health professional.

You can end up paying more tax in Australia if you don’t have appropriate private health insurance and earn above the MLS income threshold.

What's the best private health insurance for ACT families?

Each family’s health needs are unique, but it’s never worth paying for extras or hospital benefits you don’t use. For example, depending on your circumstances, you may want to get pregnancy cover if you plan to have kids or look for a policy that covers your teenager for free.

Tips for families in the ACT:

  • Look for a fund that doesn’t charge you an excess for kids’ hospital care.

  • Some funds will cover adult children on their parents' policy until 31 years of age. This can save you all some dollars.

  • Seek out funds that rebate you a percent of a consultation/treatment charge, rather than a fixed dollar amount. This insulates you somewhat from fee inflation when, for example, your kid’s dentist increases their charges.

What's the best health insurance for visitors to the ACT?

Most visitors and temporary workers aren't eligible for the same health insurance policies as Australians. Instead, you will need overseas visitor health cover (OVHC). This is a type of health insurance designed specifically for non-Australian residents. These policies start from around $64.50 a month and at the very least should cover hospital care and repatriation. Some can also help pay for doctor's appointments, prescription medicine and out-of-hospital treatment such as dental.

Which health insurance insurers cover ACT?

There are 38 health funds registered to operate in Australia. Of these, 12 are restricted funds. This means they only service a specific demographic (for example, members of the police force have a Police Health Fund). 

There are no health funds that operate exclusively in the ACT only, and no funds that will not insure you there.

However, if you want to avoid as many out of pocket costs as possible, it’s a good idea to select an insurer with a practitioner network you can access. For example, Queensland Country is a health fund servicing most of regional QLD. You can take out a policy with them, but most of their preferred providers are unlikely to be located in the ACT. Their members are almost entirely based in QLD and NT.

How much does health insurance cost for ACT?

Different private health funds offer different kinds of insurance for different prices. If you buy private health insurance, you can choose what kind and level of private health insurance you buy, and which private health insurance company you buy it from.

The most expensive Gold tier cover in the country is based in the ACT and NSW and has an annual premium of $3570. The range in premiums can be over $1000 dollars for the same level of cover, so it pays to shop around.

Average monthly premium costs across ACT for a single person taking out hospital cover in 2023*:

Basic

Bronze

Silver

Gold

$84.84

$98.88

$147.60

$217.00

Expert tip: Plus policies are like 'half tiers'. They cover more treatments than the tier below but less than the one above. If you don't need all the procedures listed in the tier above, but a few more than the tier below, they're often better value for your wallet.

Health Insurance Statistics for ACT:

How much do people on average pay for health insurance in the ACT?

Health insurance premiums for the ACT range from $100 for ambulance-only cover, to over $3,000+ a year for the most expensive gold hospital policy. On average though, ACT residents manage around $90 a month for singles hospital cover.

Extras average $23 a month, so combined, a single person living in the ACT can look to pay around $113 per month for a combined policy.

This depends a lot on your insurer, your general health, and your lifestyle. The premium will also be higher for a policy that covers more people, like couples or family cover.

What are the most popular insurers in Australia? 

The most popular health funds in Australia, based on the lower levels of customer service complaints, include:

  • HBF (only 4.0% of complaints versus their 7.3% market share).

  • Medibank (22.8% of complaints versus 26.9% market share).

  • Bupa (21.5% of complaints, versus 25.4% market share).

  • nib (8.1% of complaints versus 9.2% market share).

What do ACT residents claim on their health cover most?

Based on APRA’s September quarterly data, dental claims were by far the highest extras service used in 2023. Over 230,000 people took care of their teeth in the last quarter and claimed this back on their extras with little to no gap. Coming in second at over 54,000, is physiotherapy services. This doesn’t include hospital cover, where the most common reason for admission was a heart attack^^.

Ambulance costs in the Australian Capital Territory

The costs of paying for an ambulance in the ACT can seem daunting. You can arrange to pay by instalments, and there are some fee exemptions for concession card holders. Of course, if you hold private hospital cover at any level, your ambulance fee is covered.

Paying for your medical care in the ACT:

Some doctors will bulk bill if you have a Medicare card. Bulk billing means their services are free to the patient because Medicare pays the doctor on your behalf. This also means the doctor is only charging the Medicare benefits rebate.

When a doctor charges more than the Medicare rebate amount, you’ll be asked to cover the difference. 

It can be difficult to find a doctor that bulk bills in the ACT. Ask about bulk billing when you make your appointment. 

 

There are five Medicare offices in the ACT. They can help you with any problems to do with Medicare and your entitlements. You’ll find them located in:

  • Belconnen

  • Braddon,

  • Gungahlin

  • Tuggeranong

  • Woden

Health services may have different rules for giving free or discounted services to people

with a Medicare card. You will not have to pay for your treatment or hospital stay in the ACT if you’re receiving treatment in a public hospital as a public patient, and:

  • you have a Medicare card, DVA card.

  • you’re an asylum seeker.

  • your treatment is clinically necessary.

  • you’re an inpatient for under 35 days.

  • you’re receiving treatment under the Mental Health Act 2015.

Frequently Asked Questions:

How much does an ambulance cost in the ACT?

Medicare does not cover the cost of ambulance services in the ACT. Canberra Health Services directs that the payment obligation for the ambulance service falls on the person receiving it. Ambulance services are divided into:

  • Emergency ambulance services.

  • Non-emergency ambulance services.

Any care you receive from the ACT Ambulance Service means that you’re legally required to pay for it, regardless of whether it’s Emergency Ambulance Services or any Non-Emergency patient transport.

​​What's the difference between emergency and non-emergency ambulances in the ACT?

Emergency ambulance services are accessed by calling 000, and the costs are as follows^:

Services

Cost

Emergency ambulance service (treatment and transport)

$1070 (+$14/km for every km travelled outside the ACT)

Emergency ambulance service (treatment not including transport)

$741

Emergency ambulance services includes the following treatments:

  • Onsite undertaking a medical examination and assessment.

  • Giving medical advice.

  • Administering first aid.

  • Undertaking a medical procedure.

  • Administering medication onsite.

Non-Emergency Ambulance Services

Non-emergency services usually require a referral from a health service provider, and can be booked in advance. The invoice is usually sent to the patient, though it can be sent via your treating hospital as well. Approximate costs for this service in the ACT^:

Services

Cost

Non-emergency ambulance service (treatment and transport) by an Ambulance Paramedic or an Intensive Care Paramedic

$764 (+$14/km for every km travelled outside the ACT)

Non-emergency ambulance service (treatment and transport) by Patient Transport Service resource

$249 (+$5.10/km for every km travelled outside the ACT)

Am I covered for ambulance services in the ACT?

If you have one of the following concession cards, you can access ambulance services for free in the ACT:

  • ACT Services Access Card.

  • Centrelink Health Care Card.

  • Pensioner Concession Card.

If you’re not eligible for one of these concession cards, ambulance trips aren’t free for you in the ACT - unless you take out private health cover. 

Expert Tip: Ambulance cover is included with your hospital cover but only included in some extras policies. If you take out extras-only cover, and you need an ambulance in the ACT, you may not be insured for this and you may be expected to foot the entire bill, including your callout fee.

Can I get ‘ambulance only’ cover in the ACT?

You can get this cover in the ACT. Ambulance-only cover is cheaper than basic hospital insurance, but it only pays for your ambulance services. Ambulance-only cover can cost around $100 per year.

Do overseas visitors need private health cover in the ACT?

Some visitors to Australia must buy private health insurance as a component of their visa approval. Even if private health cover isn’t a visa requirement for your stay in the ACT, temporary residents and visitors are wise to consider private health cover anyway, otherwise any healthcare they need while travelling in Australia is entirely at their cost. 

If you don’t have private health cover, or your policy doesn’t cover the treatment you need, Canberra Health Services may require an upfront payment. This may include costs for attending the emergency department, surgery and some diagnostic services. 

What is the best way to save money on health insurance in the ACT?

Comparing features and benefits of the type of cover you decide best suits you is the best way to save on health cover. This can take quite a lot of your time. This is why outsourcing it to a comparison service# makes sense.

Sources

2022 State of the Health Funds Report

2021 State of the Health Funds Report

Australian Medical Association: The AMA Repeat Prescription for Private Health Insurance

Data source: Private Health Insurance Ombudsman

APRA: Private Health Insurance Annual Coverage Survey

https://health.act.gov.au/sites/default/files/2018-10/Using%20Health%20Services%20in%20the%20ACT%20.pdfhttps://www.health.act.gov.au/about-our-health-system/organisation-structure#:~:text=The%20ACT%20Health%20Directorate%20oversees,leading%20health%20and%20medical%20research. ^^https://www.apra.gov.au/quarterly-private-health-insurance-statistics **https://www.canberrahealthservices.act.gov.au/before,-during-and-after-your-care/staying-at-canberra-hospital/before-you-arrive/will-i-have-to-pay-for-my-care

^https://esa.act.gov.au/about-esa-emergency-services/ambulance/fees-and-charges

#Compare Club compares selected products from a panel of trusted insurers. We do not compare all products in the market.




Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

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Chris Stanley

Sales & Operations Manager for Health Insurance