AHM health insurance review

ahm is backed by Medibank, one of Australia's largest for-profit health insurers.

The fund has nine hospital plans, with five policies for the budget-conscious, and seven extras plans.

Members also have access to savings on movies, glasses, fitness programs and more, as well as discounted home and car insurance through ahm partner, Real Insurance.

ahm is on our panel, so click below to compare hundreds of policies in minutes.

Hospital cover

Nobody chooses to go to hospital.

But when you do, hospital cover will help you get the treatment you need, where and when you want it.

It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you're likely to need, in line with your budget.

If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

ahm offers one of the largest range of hospital plans, with nine in total.

There's five budget-level plans, three mid-level plans, and one Gold plan.

Starter Basic

An entry level policy if you principally want cover for accidents.

Most useful for anybody who simply wants to avoid the Medicare Levy Surcharge.

Key inclusions:

• Ambulance cover

• Avoids the Medicare Levy Surcharge

Essentials Basic Plus

A basic hospital plan with a few common hospital procedures.

Suitable for avoiding the Medicare Levy Surcharge and younger Australians on a tight budget.

Key inclusions:

• Hernia and appendix

• Dental surgeryTonsils, adenoids and grommets

Starter Bronze

ahm's budget cover for accidents and a wider range of common hospital procedures.

It's ahm's bestselling hospital cover for singles.

Key inclusions:

• Gynaecology

• Earn, nose and throat

• Digestive system

Lite Bronze Plus

A Bronze plan that's the same as Starter Bronze but with some add-ons with a variety of common hospital procedures.

Key inclusions:

• Lung and chest

• Back, neck and spine

• Chemo, radiotherapy, and immunology

Core Bronze Plus

The most comprehensive Bronze plan includes a range of common procedures, plus items such as plastic and reconstructive surgery and hearing aid implants.

Key inclusions:

• Plastic and reconstructive surgery

• Blood

• Implantation of hearing aids

Starter Silver

A medium level of cover with a range of procedures that are common to Australians of all ages and life stages.

With heart and vascular system included in this policy, it may suit older Australians on a budget.

Key inclusions:

• Heart and vascular system

• Diabetes Management (excluding insulin pumps)

• Podiatric surgery

Classic Silver Plus

An enhanced level of cover compared to Start Silver with a longer list of procedures.

Services covered include treatments for diabetes and people suffering from sleep disorders.

Key inclusions:

• Insulin pumps

• Pain management with device

• Sleep studies

Deluxe Silver Plus

A premium level of cover with a comprehensive range of procedures and medical services.

Similar to ahm's Gold cover but without pregnancy items, making it more suitable for older Australians.

Key inclusions:

• Cataracts

• Joint replacements

• Dialysis for chronic liver failure

Top Hospital Gold

ahm's top level of cover.

Includes pregnancy and birth-related services, as well assisted reproductive services making it suitable for Australians planning additions to their family.

Key inclusions:

• Pregnancy and birth

• Assisted reproductive services

• Weight loss surgery

Ambulance Cover

Unlimited emergency ambulance cover is included on all extras policies after a one-day waiting period.

Medically necessary ambulance cover is included on all hospital policies after a one-day waiting period.

Extras cover

ahm’s extras reset on July 1 every year.

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we've summarised the key points of each plan below, it's always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, has an agreement with the health fund.

Take the time to work out what you need and what you're prepared to pay.

If this feels a bit overwhelming, our experts are here to help.

ahm has 7 extras plans to choose from.

There's budget cover for the bare essentials, through to a comprehensive plan, including unlimited preventative dental and rebates of up to 100%.

There are also Choosable Extras, where you’re able to select a base bundle of teeth and emergency extras and then are able to select three more bundles. You can also receive 60% back on the cover.

This includes muscle and bone, which has physio, eyes, which is optical, and wellbeing, which has counselling, psychology, and nutrition.

Black 50 saver

Only covers the basics of general dental, physio, chiro, and osteo. You can get 50% back on included extras.

Key inclusions:

• General dental

• Physiotherapy

• Emergency ambulance services

Black 60

This budget option allows you to get 60% back on included extras, 100% back on optical and no gap dental check ups that are available at specific dentists.

Key inclusions:

• Complex and major dental

• Remedial massage

• Optical

Black 70

You can get 70% back on dental as well as therapies and 100% back on optical up to your annual limit.

Key inclusions:

• Complex and major dental

• Health improvement options, including health checks and preventive tests

• Optical

Lifestyle Extras

With this cover, there’s 100% back on optical, no two or six month waiting periods on included extras and no-gap dental check-ups available at specific dentists.

Key inclusions:

• Laser eye surgery

• Psychology, counselling and hypnotherapy

• Dietetics, nutrition and weight loss

Family Extras

A highly flexible extras policy that has cover for the whole family. No two or six month waiting periods on included extras.

Key inclusions:

• Podiatry

• Hearing aids

• Eye therapy

Black 70 Boost

This cover includes 70% back on lots of extras and offers 100% back on optical.

Key inclusions:

• Pharmacy

• Optical

• Physiotherapy, chiropractic and osteopathy

Super Extras

This cover includes unlimited routine dental, no two or six month waiting periods and offers no gap dental check-ups.

Key inclusions:

• Laser eye surgery

• Speech therapy

• Audiology

Waiting periods

To stop people signing up, claiming, then cancelling their health insurance, all insurers apply waiting periods. 

Generally, the more expensive the treatment, the longer you'll wait.

But keep an eye out for special deals with waiting periods reduced or waived.

Hospital waiting periods

• 12 months for pre-existing conditions, pregnancy, and birth

• 2 months for hospital psychiatric services, rehabilitation, and palliative care as well as all other services

• No waiting periods for accidents after joining

Extra waiting periods

• 3 years for laser eye surgery for a pre-existing condition

• 12 months for major and complex dental services, orthodontics, health appliances, and health aids

• 6 months for health management programs and hire and repair of health aids and appliances

• 2 months for all other services, including general dental, chiro, osteo, and all other services

Member benefits

As well as its comprehensive range of hospital and extra covers, ahm offers members perks.

This includes discounts for movies, fitness programs, savings at OPSM and Specsavers, tax returns, and discounts on other ahm insurance products.

How to claim

Claim on the spot through the HICAPS payment system at your provider.

You can also claim online, through the mobile app, or by email.

Hospital agreements

ahm has agreements with most hospital and day surgery providers across Australia.

When comparing policies, it's worth checking if your local hospitals and clinics are covered.

Our specialists at Compare Club can do this for you.

Customer service

ahm received 22.8% of complaints in 2021, and has a market share of 26.9%^.

FAQs

1. Is ahm a not-for-profit fund?

No, ahm is a for-profit fund.

2. Who can apply? Are there restrictions?

You’ll need to be an Australian resident with a Medicare card and over 17.

3. Is it easy to switch to ahm?

Yes, it’s easy to switch your health insurance policy and you can do this at any time. They’re on our panel, so click here to get started. You can contact our team for more details on different health insurance policies.

4. Do I need to re-serve waiting periods?

If you switch to an equivalent or lower level of cover, you won’t have to serve new waiting periods. However, you may need to serve waiting periods from your previous health fund if your new policy includes additional services or higher benefits.

5. Can I change my level of cover?

Yes, you can choose a lower or higher level of cover.

If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services/higher benefits.

6. Do I get the government rebate?

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income). To learn what you’re entitled to, read our rebate guide.

7. Do I have to pay the Lifetime Health Cover loading?

If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without hospital cover since the 1st July following your 31st birthday. You can find out more here.

8. Up to what age are children covered?

ahm allows all children to stay on family policies up to the age of 21 as a child dependant.

If they're studying full time, dependents can be covered as a student under a family policy up to the age of 31.

Adult dependants who are not married or living in a de facto relationship can be covered under Extended Family Cover. However, this type of cover is not available on all ahm policies and will add an additional premium to your cover.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

^Private Health Ombudsman, ahm, accessed 17 January 2022.