Seniors & Pensioners Private Health Insurance

As you get older, your health needs evolve, making it important to ensure you have the best health insurance for seniors. You may need procedures covered by higher - and more expensive - tiers of cover, or you may not. Knowing more about private health insurance for seniors over 60 can help you take better care of your health while watching your budget as well.

What is seniors health insurance?

Health insurance isn't a one-size-fits-all approach, which is why insurers often create specific policies for older Australians, built around different lifestyles, ages, health needs and more.

Seniors health cover are policies that have been designed to cater to singles and couples of a particular age.

Some providers offer specific policies and packages for those aged 50 and above, while others have policies more suited to retirees and pensioners aged 65 and older.

The right seniors health insurance policy can help pay for your healthcare expenses as you age.

Each policy will cater for differing needs depending on your current circumstances and your anticipated future needs.

What are the four tiers of health insurance?

Hospital insurance policies in Australia are categorised into four tiers: Basic: Minimal to no cover in a private hospital. Bronze: Low level of cover. Silver: Medium level of cover. Gold: Comprehensive or top-level cover. In addition to these main tiers, there are Plus policies (e.g., Silver Plus, Bronze Plus, etc.). Plus policies offer at least one additional service beyond the standard tier and can often be the best health insurance for seniors in Australia from an affordability standpoint. For instance, a Silver Plus policy might cover joint replacement and cataract surgery, which are usually exclusive to Gold policies, but they won't cover all of the treatments and procedures covered by a Gold tier hospital policy.

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.

Evaluating Pregnancy Cover:

For seniors, downgrading from policies that cover pregnancy and fertility can be complex. While these services are included in top-tier Gold and some Silver Plus policies, they also cover surgeries most commonly required later in life. 

Some health funds offer Silver Plus policies without pregnancy cover, but check that they really are cheaper than the Gold policies and don’t exclude any critical treatments you might need - like hip replacements or rehabilitation therapies.

What does health insurance offer that Medicare doesn't?

There are a number of items and procedures for seniors that Medicare doesn't cover but are included in private health insurance.

Private health insurance can also cut your waiting times for elective surgery, which is especially useful if you have a long-standing problem that's affecting your quality of life.

You can also choose your own doctor.

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

Using extras smartly -- such as getting a good deal back on glasses -- is a way to get better value from your health fund.

It means you don't have to rely solely on Medicare, and you can get peace of mind that you'll be adequately covered as you age.

What doesn't seniors health insurance cover?

No matter what seniors health insurance you take out, you won't be covered for aged-care services.

Beyond that, any further exclusions will depend on your health insurance provider and the policy you choose.

Medicare subsidises eye tests, GP visits and consultations with a hearing specialist.

Eye tests are covered by Medicare, while general GP visits are often partially covered -- although a Commonwealth Seniors Health Card can cover your doctor visits under bulk billing (this is at the discretion of the doctor).

How does seniors health insurance work with elective surgery?

Appropriate private health insurance can speed up waiting times for older Australians who require elective (non-emergency) surgery, such as hip replacements or cataract surgery.

Without private health insurance you may have to endure a long wait to be treated publicly.

Do seniors still need health insurance in aged care?

Private health insurance for seniors doesn't cover the costs of aged care, but most aged-care services are partially subsidised by the government for eligible Australians.

Some of your health needs will be tended to by your aged-care provider, but it's still worth keeping private health insurance.

You may need it for elective surgeries and to give you greater choices in your health care.

Because moving into aged care is such a big lifestyle change, it's important to review your seniors health insurance and see whether you need to adjust your level of cover.

This may help you save money while still getting the healthcare you need.

Consider paying a higher excess to lower your premiums

Since the 2019 health insurance reforms, you can opt for a higher excess (up to $750 per person or $1500 per family) to reduce your premiums. However, if you anticipate needing surgery soon, a lower excess might be more cost-effective despite the higher premiums, as this reduces your out-of-pocket expenses for hospital visits.

Check how often you can change your excess within your 12 month policy term.

Day surgery and excess waivers:

If day surgery is likely, you can select a policy that waives your excess for same-day procedures. Insurers like GMHBA, HCF, Medibank, RT Health, and Health Care Insurance (HCI) offer such policies.

Should you drop health insurance entirely?

The best insurance for elderly Australians in terms of care is usually private. Despite the robust public healthcare system, long waiting times for elective surgeries make retaining private health insurance advisable if you can afford to do so. 

Seniors benefit significantly from health insurance, as they use hospital insurance more than any other age group. This often makes private health cover the best health insurance for senior citizens. Another point that can help with affordability is knowing that your private health insurance rebates increase with your age:

• At 65, your rebate increases to 28.7% for singles earning up to $93,000 and couples and families earning up to $186,000. Note that your higher rebate applies to your entire family or couples cover, even if only one policyholder is 65 or older.

• At 70 years old, your rebate rises to 32.8%, often making the choice of private health cover the best health insurance for seniors over 70.

By thoroughly evaluating your health insurance needs and options, you can secure appropriate and cost-effective coverage that meets your health needs as you age.

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).