Guide to Private Health Insurance in Western Australia

Here’s what Western Australian residents need to know to help them narrow down their search for great value health insurance.

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by Gary Andrews

Last update 15 Apr 2021

Overview

Health insurance can be confusing.

That’s why we’ve put together this guide to help you navigate the world of health cover for Western Australian residents.

While Western Australians are fiercely loyal to local fund HBF, there’s also a great range of national funds to choose from.

Here’s what you need to know, whether you’re living in Perth or in a remote part of WA.

Key Points

Western Australian fund HBF dominates the market – 90.4% of HBF members are local
If you’re under 65, the fee for an emergency ambulance is $1,006 in metro areas
In 2019-20, around 90% of WA public patients were admitted for elective surgery within 201 days
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What are the largest health funds available to WA residents?

Western Australians are loyal to HBF, with nearly half the state’s private health policies held by the Perth-based insurer.

Based on market share, the top four providers are:

  1. HBF (49.9%)

  2. Medibank (21.0%)

  3. Bupa (12.1%). Also operates overseas.

  4. HCF (5.0%)

HIF is Western Australia’s other locally based health fund, with a 3.4% market share in the state.

Why is it important to look at market share?

While a larger insurer will generally have a wider network of practitioners and member benefits, some funds may have better coverage for regional WA, while others may not have agreements in place with as many local hospital providers.

For example, smaller health funds based in other states may have fewer agreements with private hospitals in WA, which means there’s more chance of getting hit with a gap fee if they’re your insurer.

Overall, it’s still worth comparing with smaller providers, especially if you’re based in regional WA.

Once you determine your specific needs, you’ll be in a good place to weigh up which fund is best for you.

What types of cover can I get in Western Australia?

All health funds offer a range of policies.

There's hospital cover offered as Basic, Bronze, Silver and Gold tiers, based on your specific needs.

Taking up hospital cover could also help you avoid paying the Medicare Levy Surcharge at tax time.

The majority of Australians opt for a combined package with hospital cover and extras, which gives you benefits on everyday treatments like dental, optical and chiro.

These policies tend to give you the best value.

You can also choose ambulance-only cover to avoid paying a hefty bill in an emergency.

Are there regional health insurers based outside of Perth?

No, but most funds offer health insurance to Western Australian residents.

What do I need to consider for health cover in Western Australia?

With a wide choice of funds, it helps to start working out the inclusions you need along with your budget.

Do you want to see your regular practitioners or are you happy to use the fund’s dental and eyecare centres? Do you want access to reward programs?

Check the fund’s hospital agreement includes your local hospital, particularly if you live outside Perth.

There’s no point having great cover if you have to drive for hours to receive full coverage for your hospital costs.

Extras providers are also important. Does the health fund offer its highest rebates for treatments at your local dentist or optometrist?

Weigh up the pros and cons of the big names and smaller funds. And make sure you’re not going to get hit with hidden costs or excessive gap fees.

Medicare doesn’t cover ambulance call outs for people under 65 years of age in Western Australia, so take that into account as well.

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How much does ambulance cover cost in Western Australia?

Ambulance fees in WA are $1,003 for emergencies and $541 for non-urgent services for people under 65 years of age in metro areas.

All services are free for pensioners over 65, and half price for non-pensioners over 65.

Either way, it’s worth considering ambulance cover.

In Western Australia, even a Basic hospital policy will usually include ambulance cover with a one-day waiting period.

It could also help you avoid paying the Medicare Levy Surcharge.

While a hospital policy will give you better value, some of the larger health funds also offer ambulance-only insurance.

Are there any rebates for Western Australian residents?

Yes. From 1 April 2021, rebates for Australians under 65 years range from 8.202% for a single earning $105,001-$140,000 (and couples/families earning $210,001-$280,000), to 24.608% for singles earning $90,000 or less (and couples/families earning $180,000 or less)

How long do I have to wait for elective surgery in Western Australia?

It will come as no surprise that COVID-19 has had a big impact on waiting times for elective surgery.

In 2019-20, around 90% of public (Medicare) patients in WA were admitted within 201 days.

How do I find the best health insurance in Western Australia?

The best way to find good value health cover is to compare health insurance providers.

Compare Club does all the hard work for you.

We’ll evaluate hundreds of policies from our panel of trusted insurers, taking into account inclusions, benefits, premiums, waiting periods and more.

We’ll even take care of the paperwork.

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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.

References

Private Health Insurance Ombudsman, 2020 State of The Health Funds Report. St. John WA, Metro Ambulance Fees Australian Institute of Health and Welfare, Elective Surgery Statistics. Australian Tax Office, Income Thresholds and Rates For The Private Health Insurance Rebate.