Gold Tier Health Insurance

Australia's health insurance landscape underwent significant changes with reforms in April 2019, introducing a tier system to simplify policy comparisons. Each tier includes a minimum standard for cover. Gold health insurance is the highest tier, offering the most comprehensive level of hospital cover

Gold health insurance comparison:

When you compare health insurance, Gold health insurance is the most comprehensive but it’s also the most expensive tier. The average premium for a Singles policy is $219.35 a month, but it’s possible to find gold cover for less.

If you’re young, healthy, and have no immediate plans to start a family, you may find the lower tiers better suit your budget. Typically, gold tier cover may suit you if you’re:

• A senior: Comprehensive coverage for age-related health complications.

• Planning a Family: Gold is the only tier that must include pregnancy care,  including pre- and post-natal services, and assisted reproductive services.

• Needing a high level of medical support for complex medical condition/s such as diabetes, cancer, kidney disease, etc.

you may want to look at downgrading your cover as a Silver or Silver Plus policy may cover your health care requirements.

Some health funds offer product half-tiers with additional features, (Basic Plus, Bronze Plus, Silver Plus), there is no Gold Plus.

What is the new health insurance tier system?

Health insurance in Australia can be complicated.

The tier system was designed to allow Australians to easily compare different health funds.

Note this tier system only applies to hospital policies, not extras cover.

The new system breaks hospital policies into four tiers: Basic, Bronze, Silver, and Gold.

Every policy e a minimum coverage standard they must meet to fall into one of the tiers.

Some health insurance policies may offer additional features to attract customers, bumping them into value-added product tiers: Basic Plus, Bronze Plus, and Silver Plus.

You might find a Silver Plus health insurance policy, for instance, that covers a procedure or service that is usually reserved for the Gold tier.

Apart from these cases, the products from different funds will become more standardised.

What does gold health insurance cover?

Gold is the highest tier, offering the most extensive cover for procedures not covered, or offered only with restricted cover, in the tiers below. These procedures include… but are not limited to: 

• cataracts, 

• joint replacements, 

• dialysis, 

• pregnancy and birth, 

• assisted reproductive services, 

• weight loss surgery, 

• insulin pumps, 

• pain management devices,

• and sleep studies.

Additionally, Gold policies encompass all the other categories of care included in Silver, Bronze, and Basic tiers.

Gold health insurance offers the highest level of hospital cover, making it a smart choice if you have extensive healthcare needs. 

While not essential for everyone, it can be a good fit for if you’re a senior Australian, planning a family, or dealing with complex medical condition/s. 

Making the right choice for your health insurance ensures both adequate protection and value for money.

Pros and cons of gold health insurance

Who is gold tier health insurance suited to?

Gold-level health insurance is the most comprehensive tier, but it's also the most expensive.

Young, healthy, single Australians probably don't need to purchase Gold hospital cover, and can instead opt for a lower tier.

There are a few groups who Gold health insurance will benefit, though.

Here are a few people who might want to consider purchasing a Gold health insurance policy.

Ageing Australians

It's an unfortunate reality that getting older comes with health complications.

Those who are ageing need comprehensive coverage to make sure they can get timely and affordable treatment for their ailments.

Procedures like cataract surgery, joint replacement, and dialysis are only required with Gold insurance policies.

These problems, especially those regarding eyes and joints, disproportionately affect older Australians.

Those who are getting a bit older and want to make sure they have the most comprehensive cover might want to take a look at upgrading to the Gold tier.

Those who want to start a family

Australians who plan on starting a family might also want to consider Gold hospital cover.

Gold health insurance is the only tier guaranteed to include pregnancy and birth-related services, as well as assisted reproductive services.

While Basic, Bronze, and Silver policies are not required to include cover for pregnancy, birth, or assisted reproductive services, health funds can choose to include these categories in Plus levels of cover.

Keep in mind that these procedures will come with a 12-month waiting period after you sign up, so it's important to act sooner rather than later if you and your partner are considering having kids.

Those who struggle with their weight

Gold health insurance is also an attractive option for people struggling with obesity.

This level of health insurance is the only one that requires coverage for weight loss surgery, which can be an essential tool for some.

When diet and exercise aren't effective, weight loss surgery can make a difference and possibly prolong your life.

This level of health insurance also includes the categories of insulin pumps and sleep studies.

Those who are obese have a greater risk of developing diabetes and conditions like sleep apnea.

Gold tier health insurance provides benefits for accompanying procedures and services.

Below are 3 relevant Gold policies for a Family, living in VIC, aged 50 with an annual income of $151,000 or more (Tier 3)

*Policies accurate as of 07-08-2024

Should you consider gold tier health insurance?

Gold health insurance isn't for everyone, so young and healthy Australians may not need to spend the extra money.

If you fall into one of the categories above, you might want to consider upgrading to a Gold policy.

Want to get started comparing health insurance for the upcoming changes? Get started below.

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.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).