Medibank Private Health Insurance Review

Founded over 40 years ago, Medibank provides health insurance to more than 3.5 million members through its Medibank and ahm brands.

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by Gary Andrews

Last update 15 Apr 2021

Overview

As well as being one of Australia's largest for-profit health insurers, Medibank also offers a range of health services, including mental health and after-care support.

They offer Australians eight hospital plans, starting with a basic accident policy through to a premium Gold plan with everything included.

Four extras policies are also available.

All members have access to the Live Better rewards program that allows you to earn points for healthy actions that can be redeemed at a range of retailers.

Key Points

Gold level hospital benefits for all members in an accident.
24/7 Medibank Nurse and Mental Health phone support.
100% back on dental check-ups twice a year.

Medibank isn't on our panel but we're confident we can get you a great deal on your health insurance.

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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.

Medibank offers eight hospital plans to suit every life stage and budget.

From a no-frills accident plan, to Gold cover with all the bells and whistles, there's something for everyone.

Medibank Basic Accident and Ambulance

A basic policy for those on a tight budget and looking to avoid the Medicare Levy Surcharge.

Members get upgraded to Medibank's Gold level benefits in the event of an accident.

Key inclusions:

  • Emergency ambulance services
  • Avoids the Medicare Levy Surcharge
  • Rural and regional transport and accommodation support

Medibank Basic Plus Healthy Start

A basic hospital plan that includes a few common treatments, designed for the young and healthy.

Suitable for singles and couples on a budget.

Key inclusions:

  • Joint reconstructions
  • Hernia and appendix
  • Dental surgery

Medibank Bronze Everyday

More comprehensive cover for a broad range of common hospital procedures that also includes cancer treatment.

Key inclusions:

  • Chemotherapy
  • Gastrointestinal endoscopy
  • Gynaecology

Medibank Bronze Plus Progress

A Bronze plan that features a wide variety of procedures.

The policy has no hospital excess for kids on a family membership.

Key inclusions:

  • Back, neck and spine
  • Tonsils, adenoids and grommets
  • Implantation of hearing devices

Medibank Silver Everyday

More expensive than Bronze, this cover level has a wide range of procedures to cover singles, couples and families of all ages.

Key inclusions:

  • Heart and vascular system
  • Podiatric services
  • Plastic and reconstructive surgery

Medibank Silver Plus Assured

A more expensive higher level of cover with a long list of procedures.

It doesn't include pregnancy services, so may not be suitable for those looking to start a family.

Key inclusions:

  • Palliative care
  • Insulin pumps
  • Plastic and reconstructive surgery
  • Sleep studies

Medibank Silver Plus Security

A premium level of cover with an extensive range of procedures.

This policy includes joint replacements, cataracts and heart, but no pregnancy services, making it more suitable for older Australians.

Key inclusions:

  • Joint replacements
  • Cataracts
  • Dialysis for chronic kidney failure

Medibank Gold Complete

Medibank's top level of cover includes a private room promise.

With pregnancy and birth services, this plan is suitable if you're starting or growing your 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.

Not available to QLD & TAS residents, NSW & ACT residents who hold health insurance and WA residents if eligible for free state funded services.

Extras cover

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

Simply work out what you need and what you're prepared to pay.

Medibank offers four extras policies to suit a range of needs, from fit and healthy singles, to couples and growing families.

Healthy Start Extras

Designed for the young and healthy, it allows members to claim 60% back on basics, including general and major dental, optical and physio.

100% back on selected services at preferred providers.

Essentials Extras

Allows members to claim 75% back on dental, optical, physio, remedial massage, natural therapies and more. 100% back on selected services at preferred providers.

Growing Family Extras Only

Designed for the young and healthy, it allows members to claim 60% back on basics, including general and major dental, optical and physio.

100% back on selected services at preferred providers.

Top Extras

Medibank's top level of cover with all the extras.

This flexible plan gives you the option to claim 60%, 75% or 90% back from Members' Choice providers.

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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.

Medibank Basic Accident and Ambulance

  • 2 months -- rehabilitation, psychiatric and palliative care

Medibank Basic Plus Healthy Start Medibank Bronze Everyday Medibank Bronze Plus Progress Medibank Silver Everyday Medibank Silver Plus Assured Medibank Silver Plus Security

  • 2 months -- rehabilitation, psychiatric and palliative care
  • 2 months -- all other covered services other than pre-existing conditions
  • 12 months -- pre-existing conditions

Top Hospital Gold

  • 2 months -- rehabilitation, psychiatric and palliative care
  • 2 months -- all other covered services other than pregnancy related and pre-existing conditions
  • 12 months -- pre-existing conditions
  • 12 months -- pregnancy and birth

Member benefits

Medibank members have access to the Live Better rewards program.

Accessed through an app, it encourages you to earn points on healthy actions, to redeem for a wide range of products and services.

Points can also be earned by shopping with partners such as HelloFresh.

How to claim

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

You can also claim through the My Medibank online hub or mobile app.

Or drop your claim form into a Medibank store or in the post.

Hospital agreements

Medibank has agreements with most private hospitals and day clinics across Australia and a tool on their website to check what's near to you.

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

Customer service

In 2019 Medibank and ahm (combined) received 22% of all complaints.

Relative to their market size of 26%, this suggests their customer service may be above average.

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FAQs

Is Medibank a not-for-profit fund?

No. Medibank used to be not-for-profit but converted to a for-profit fund in 2009.

Who can apply? Are there any restrictions?

Members must be aged 16 or over to apply.

Is it easy to switch to Medibank?

Medibank is not on Compare Club’s panel but they also own ahm, who we do compare.

We’re confident we can find you a good deal from the other funds we compare.

You’ll need to contact Medibank directly if you want to move to them.

Do I need to re-serve waiting periods?

No, providing you transfer to Medibank within 30 days of leaving your old fund on an equivalent or lower cover.

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.

Do I get the government rebate?

Most Australians are eligible to receive a rebate from the government.

This will depend on your age and income. To learn what you're entitled to, see this rebate guide.

Do I have to pay the Lifetime Health Cover loading?

If you're joining for the first time and you're 31 or over, you usually need to pay 2% loading for each year you've gone without health cover since your 31st birthday.

You can find out more here.

When do extras reset?

Medibank’s extras reset on 1 January each year.

What age are children covered up to?

Medibank allows children to stay on family policies until they’re 21.

If they’re studying full time, dependents can be covered as a student under a family policy up to the age of 25.

Children must not be married or living in a de facto relationship. 

Read our guide to learn more.

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