Seniors & Pensioners Private Health Insurance

As we age, health insurance becomes increasingly significant, especially for seniors who typically face more medical costs and require ongoing healthcare services. Australia's public healthcare system, Medicare, covers a wide range of medical services, but for seniors who want additional peace of mind, shorter waiting times, and more treatment options, private health insurance is an essential consideration.

This guide will walk you through everything you need to know about health insurance for seniors in Australia, including the types of cover available, common costs, and tips for finding a plan that suits your unique circumstances. Additionally, we’ll provide insights on how to future-proof your plan as your healthcare needs evolve.

Why Should Seniors Consider Private Health Insurance?

For many seniors, relying solely on Medicare might not meet all their needs. While Medicare does cover a wide range of services, it often falls short in areas such as elective surgeries, access to private hospitals, and some forms of specialist care. Moreover, the Medicare system can expose you to long waiting times for non-essential procedures, which becomes more troubling as health needs increase in later years.

Private health insurance can bridge these gaps by offering:

• Faster access to elective surgeries and specialists

• Private hospital choices: Select which hospital you want to be treated in, allowing you more autonomy in your healthcare decisions.

• Choice of doctor: With private health insurance, you often have the ability to choose specialists and surgeons, offering more personalised care.

• Financial peace of mind: Private health insurance helps cover out-of-pocket costs for surgery, hospital stays, and certain treatments unavailable through Medicare.

Types of Health Insurance for Seniors

Private health insurance typically comes in two forms: hospital cover and extras cover . Seniors often opt for a combination of both, depending on individual healthcare needs and financial situations.

1. Hospital Cover

Hospital cover is designed to cover your medical expenses if you're admitted to a hospital for treatment. Depending on the level of cover you choose, it will pay for part or all of the costs associated with:

• Treatment by a specialist or surgeon

• Hospital accommodation in a private or public hospital

• Operating theatre or surgery fees

• Rehabilitation or follow-up services

Depending on the level of hospital cover, you can access treatments for a wide range of major health issues. For seniors, common services include heart surgeries , joint replacements , and cataract removal .

Levels of Hospital Cover:

Basic Hospital Cover: Suitable if you’re looking for the most affordable, fundamental level of hospital insurance, but keep in mind it may not cover procedures like cardiac surgery, hip and knee replacements, or cataract surgery. This level may also confine you to a public hospital.

Bronze and Silver Hospital Cover: These provide coverage for an increasing number of essential services. Most seniors opt for Silver as it covers a good range of treatments, including some heart treatments, joint reconstructions, and general surgeries.

Gold Hospital Cover: Comprehensive cover that typically includes all treatment options like joint replacements, cataracts, dialysis, and heart surgeries. It’s the best option for seniors facing complex health conditions or those wanting access to the widest range of treatments.

2. Extras Cover

While hospital cover assists with procedures requiring hospital admission, extras cover addresses health-related services that you usually use more frequently, such as:

• Dental

• Physiotherapy

• Optical services (like glasses and eye exams)

• Hearing aids

These are big considerations for seniors. Dental and vision care, in particular, become crucial as we age, since Medicare does not cover routine dental or optical treatments.

Do you know what health cover you need?

As we age, the likelihood of needing specific treatments and surgeries increases. For example, in 2020-21, nearly 40% of elective surgeries, including hip and knee replacements, were for Australians aged 65 and over (i.e. seniors). 

To ensure you have cover for certain treatments, choose the appropriate tier. The specific procedures covered by each tier are detailed in the following table - but always check with your insurer.

Source: https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients

While lower-tier policies might offer some cover, this can be restricted. If you opt for a Silver Plus policy, monitor it closely to ensure it continues to meet your needs. 

Important Note: Upgrading your cover often comes with a 12-month waiting period for previously uncovered pre-existing conditions. Downgrading your cover does not typically require you to serve additional waiting periods.

Downgrading your cover post-treatment:

After undergoing your necessary treatments, consider downgrading your cover to reduce ongoing premium costs. 

Top-level Gold policies can cost nearly twice as much as the cheapest Silver policies from the same provider. By downgrading, you can avoid paying extra for services you no longer need, such as pregnancy cover.

What's covered by Medicare vs Private Health Cover for Australian seniors.

Important Health Insurance Considerations for Seniors

As you consider the right health insurance plan, here are some key points worth keeping in mind:

1. Focus on Cover for Common Senior Treatments

As you get older, your medical needs change. Treatments commonly claimed by seniors include:

• Joint replacements (hips, knees)

• Cardiovascular treatments , including heart surgeries and pacemaker insertion

• Cataract surgery

• Chronic disease management

When comparing plans, ensure the services you’re likely to need are included in your cover.

2. Check Pre-Existing Conditions

Seniors generally have more pre-existing conditions that may influence their cover options. Most insurers have waiting periods (commonly 12 months) for services related to a pre-existing condition, meaning you’ll have to hold your policy for some time before being eligible to claim.

3. Access to Private Specialists

With the public system wait times for non-urgent treatments potentially running into months or even years, private health insurance offers senior Australians the ability to skip the queue. Services like knee or hip replacements , sorely needed by many seniors, are often handled much faster in the private system.

Tips for Seniors Choosing Health Insurance

Tailor Cover to Your Medical Needs: Avoid paying for cover you don’t need (like pregnancy and birth-related services) and focus on treatments and extras relevant to seniors such as joint replacements, heart surgery, and eye or dental care.

Review Waiting Periods: If you have a pre-existing condition, check how long you’ll need to wait before you can claim certain treatment benefits.

Make Full Use of Government Rebates: Maximise your savings by taking advantage of the Private Health Insurance Rebate and avoiding the Medicare Levy Surcharge .

Regularly Compare Plans: Health insurance isn’t a "set and forget" service—plans and premiums can change from year to year. Use our comparison tool to see whether you can get a better deal or different services tailored to your needs.

Renew or Change at the Right Time: Consider reviewing your policy before the April health insurance premium hikes each year, when insurers often raise their prices. Adjusting your plan before this deadline can ensure you lock in savings.

Conclusion: Peace of Mind in Your Golden Years

With rising medical needs and the importance of ongoing care, choosing the right health insurance plan for seniors is critical to ensure you receive the care you need—without long waiting times or hefty out-of-pocket expenses. Whether you're looking for faster treatment, access to a private hospital, or specialist care, the right plan will give you peace of mind and control over your health choices.

To explore the best health insurance options for seniors and get tailored advice based on your needs and budget, use our health insurance comparison tool .

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).