Private Health Cover for Seniors

It seems that the older we get, the more we value our health. Regardless of how healthy you were as a young or even middle-aged adult, your senior years can present a new range of health concerns.

Though Medicare is still a viable option for many older Australians, private health insurance often becomes much more appealing, and for good reason.

Health Consideration for Seniors

As you grow older, it becomes more likely that you will experience a health condition, whether it is a chronic disease or an injury. Seniors often find themselves in hospital without warning, even if they normally have a clean bill of health.

When this occurs, it can be reassuring to know that you’re covered by private health insurance. Medicare acts as a safety net for many patients, but it simply isn’t able to cover the range of treatments and therapies that private health insurance can.

Senior Health



Medicare for Seniors

If you’ve used Medicare before, you’re probably familiar with its advantages and limitations. Medicare covers costs incurred as a public patient in a public hospital. It can also cover some of the costs incurred for out-of-hospital services and other medical treatments.

Medicare benefits are based on the Medicare Benefit Schedule, or MBS. This is a schedule of fees for medical services. Medicare generally covers:

  • 100% of the MBS fee for GP services
  • 85% of the MBS fee for a specialist

However, doctors can choose to charge more than the fee laid out by the MBS. In this case, you are responsible for covering the gap out of pocket.

Medicare does not cover a range of services that many seniors rely on, such as:

  • Glasses
  • Hearing aids
  • ‘Extras’ like dental, chiro, or physio

It will also not cover you as a private patient in a public or private hospital. This means that if you are hospitalised, you will be seen by whichever doctor is available at the time. You may see a range of doctors during your visit, and will most likely share your room with other patients. If you need non-urgent surgery, there’s a good chance you’ll be put on a waiting list.

However, if you have private health insurance, you can access a wider range of benefits. This is often appreciated by seniors who need frequent medical care or who wish to have a higher degree of comfort and control over their treatment.

Commonwealth Seniors Health Card

You may be eligible for the Seniors Health Card, which can provide some benefits, including:

  • Bulk-billed doctor visits (at your doctor’s discretion)
  • Reduced rates for certain health care costs
  • Lower-cost medicine through the Pharmaceutical Benefits Scheme

You will still need to show your Medicare card to obtain Medicare services.

Eligibility for the Commonwealth Seniors Health Card is based on four factors. You must meet all of the following conditions:

  • Have reached your pension age
  • Pass the income test
  • Be an Australian resident living in Australia
  • Not qualify for a payment from the Department of Human Services or Department of Veterans Affairs

While the card helps ease cost concerns, it unfortunately cannot help you skip waiting lists, choose your doctor, or get a private room in a hospital.

Pharmaceutical Benefits Scheme (PBS)

Studies show that almost half of Australians aged 50 and older take at least five drugs or supplements each day. If you take regular medications, it can impact your out-of-pocket healthcare costs.

The government does subsidise certain medications under the Pharmaceutical Benefits Scheme. The PBS is available to Medicare card holders, and you can access a concessional benefit if you hold an eligible concession card. The PBS significantly lowers pharmaceutical costs for seniors, but keep in mind that not all medications are covered under the scheme.


Private Health Cover for Seniors

Private health insurance covers a range of medical treatments and services that Medicare does not. There are three types of cover you should be aware of: hospital, extras, and ambulance cover. Most funds offer varying levels of cover to suit different budgets, and the coverage types can be mixed and matched.

Hospital Cover

Hospital policies cover you as a private patient in a private or public hospital. This includes in-hospital accommodation, treatment fees, and surgeon fees. Depending on your level of cover, you can also claim back on elective surgeries like joint replacements.

Hospital cover lets you choose your doctor, skip lengthy public hospital waiting lists, and can give you access to a private room. This can be important, especially when you are enduring pain as you wait to be treated or during recovery.


Extras Cover

Extras cover, also called general or ancillary cover, lets you claim benefits on the health services you use regularly. You can get coverage for dental exams, mobility aids, physio, occupational therapy, prosthetics, glasses, hearing aids, remedial massage, fitness classes, and even natural therapies. These services are not only essential for some, but they can supplement an overall healthy lifestyle.

Ambulance Cover

Medicare does not cover ambulance services, which can be very costly if you don’t have private health insurance. The good news is that many hospital policies include ambulance cover, and you also have the option of taking out a standalone policy. Certain concession card holders may be able to access free ambulance services, as do residents of Queensland and Tasmania.


Making Private Health Cover Affordable

If you haven’t had personal experience with the benefits of private health cover, the thought of the extra cost might put you off. You may be surprised to learn that health care doesn’t necessarily cost as much as you think, especially if you take advantage of money-saving measures.

Health Insurance Rebate

The government offers a rebate to encourage people to take out private health cover, and it’s seniors who stand to benefit the most. The rebate is income-tested, so older, low-income earners are eligible for the highest rebate percentage. You have the option of claiming the rebate as a premium reduction or as a tax offset.



Shop around for health cover

The key to saving on health cover is not signing up with the first fund that offers you a policy. Shop around for your health cover to find a policy that offers the features you want at a competitive price. Great private health cover meets your needs and suits your budget. Comparing policies is a quick, easy way to find a good deal on health insurance.

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