Silver Plus Health Insurance: Is It Right for Seniors?

As we get older, having the right private health insurance is one way to plan ahead for the care we’re more likely to need. With longer wait times in the public system and rising medical costs, many Australian seniors are turning to hospital cover that gives them access to private hospitals, specialist care, and a little more peace of mind.

One option that’s getting a lot of attention is Silver Plus health insurance for seniors. It’s not the most basic cover, and it’s not the most expensive either—but it often hits the sweet spot between what’s covered and what you pay. So, is Silver Plus right for you? In this article, we’ll break down exactly what Silver Plus hospital cover includes, how it compares to other levels of private health insurance, and why it might be a smart choice for older Australians who want reliable protection – without paying for things they don’t need.

Let’s take a closer look at how Silver Plus works, and whether it could be the right fit for your health and budget.

Health Insurance Options for Seniors

As we age, our health needs tend to shift, and often become more frequent or more complex. Many older Australians start to look at private health insurance not just as a nice-to-have, but as a way to access care when they need it, with more control over how and where they're treated

Some of the more common hospital treatments for seniors include:

Joint replacements (like hips and knees)
Cataract surgery to improve vision
Heart procedures and circulatory system care
Rehabilitation after surgery or illness
Management of chronic conditions like kidney disease

Choosing a policy that covers these areas well can mean shorter waiting times, your choice of specialist, and treatment in a private hospital, all of which can make a big difference in your care and recovery experience.

Understanding the Australian Health Insurance Tiers

Private hospital cover in Australia is divided into four standard tiers:

Basic – Covers only limited hospital services, mainly in public hospitals.
Bronze – Offers cover for more categories, but still excludes high-cost treatments.
Silver – Includes a wider range of hospital treatments, such as heart, lung, and digestive conditions.
Gold – Covers all 38 clinical categories, including pregnancy, psychiatric care, and weight loss surgery.

So where does Silver Plus fit?

Silver Plus is a step up from standard Silver, offering additional cover for some treatments that aren’t normally included, without the higher premiums of Gold. Every Silver Plus policy is slightly different, because each fund decides which extra services to include. That means you can often find a Silver Plus policy that covers the hospital treatments most relevant to seniors, without paying for services you may not need (like pregnancy or fertility treatments).

Choosing the Right Plan

When it comes to private health insurance, there’s no “best” policy for everyone – just the best one for you. Seniors should look for cover that aligns with both their current needs and what they may need a few years down the line.

Ask yourself:

Does this policy cover the treatments I’m most likely to need?
Will I be able to access private hospitals and choose my specialist?
Am I comfortable with the excess and any potential out-of-pocket costs?

Taking the time to compare different Silver Plus options can help you find a plan that’s practical, affordable, and gives you real peace of mind, now and in the future.

What is Silver Plus Health Insurance?

Silver Plus (sometimes listed as Silver Hospital Plus) is a type of hospital cover that sits between the standard Silver and Gold tiers in Australia’s private health insurance system. It’s designed to give you more protection than a regular Silver policy, without the higher premium of full Gold cover.

All Silver hospital cover policies must include a set list of hospital treatments. These include care for things like:

Heart and vascular system
Lung and chest conditions
Digestive system treatments
Bone, joint and muscle procedures (some exclusions may apply)
Chemotherapy, radiotherapy and immunotherapy
Kidney and bladder conditions

But Silver Plus takes things a step further. It adds cover for one or more extra clinical categories that aren’t required in a standard Silver policy. Each fund chooses which extra services they include in their Silver Plus product – so it can vary between providers.

This is where Silver Plus can be a great option for seniors. Some Silver Plus policies include joint replacements, cataract surgery, and rehabilitation, which are typically only found in Gold-level cover. If you don’t need services like pregnancy or IVF (which are part of Gold but often not relevant for seniors) Silver Plus may give you nearly the same level of protection, at a lower premium.

Key Differences Between Silver and Silver Plus Plans

The main difference between Silver and Silver Plus hospital cover comes down to what’s included. While all Silver plans must cover the same 26 core clinical categories (like heart and lung treatments, chemotherapy, and bone and joint conditions) Silver Plus policies go a step further by adding one or more extra services that are typically found in Gold cover.

These additions vary by fund but often include treatments like joint replacements, cataracts hospital treatment, pain management with a device, or in-hospital psychiatric care. For seniors, these extra inclusions can make a big difference – especially if you're looking for cover that’s more comprehensive than standard Silver, but more affordable than Gold.

In simple terms, Silver gives you solid mid-tier protection, while Silver Plus offers a custom upgrade that can cover exactly what you need in later life (without paying for services you won’t use).

Because every Silver Plus policy is slightly different, it’s important to read the details or use a comparison tool like the one offered by Health Deal to see exactly what’s included.

Feature	Silver	Silver Plus
Minimum categories covered	26 (set by government)	26 + additional categories (usually from Gold)
Joint replacements	Not included	Often included
Cataracts hospital treatment	Not included	Often included
In-hospital psychiatric care	Not included	Rarely included (usually Gold only)
Weight loss surgery	Not included	Rarely included
Pain management (with a device)	Not included	Sometimes included
Pregnancy and birth services	Not included	Rarely included (usually Gold only)
Premium cost	Mid-range	Slightly higher than Silver, lower than Gold
Customisation	Standard across all funds	Varies by fund (custom inclusions based on policy design)
Suitable for seniors	Sometimes – depends on needs	Often ideal for seniors needing specific extra cover

Why Choose Silver Plus for Seniors?

For many older Australians, Silver Plus health insurance offers a practical solution: it provides cover for the hospital treatments that matter most in later life, without the cost of a full Gold policy.

If you don’t need services like pregnancy, assisted reproduction or weight loss surgery, Silver Plus could be all you need – especially when it includes benefits towards joint replacements and cataracts hospital treatment.

Coverage Benefits for Senior Health Needs

Joint Replacements

Knee, hip, and shoulder replacements are some of the most common surgeries for Australians over 60. Without private hospital cover, you could be looking at long public wait times or expensive out-of-pocket costs for treatment in a private hospital.

Many Silver Plus hospital covers include benefits towards joint replacements – something that standard Silver does not guarantee. This gives you access to private hospitals, the ability to choose your specialist, and potentially much faster treatment.

Cataracts

Vision changes are common with age, and cataract surgery can make a big difference in quality of life. Some Silver Plus policies offer cover for cataracts hospital treatment, which may include the surgery itself, the anaesthetist’s fees, and the cost of your stay in a private hospital.

Keep in mind there’s usually a waiting period of 12 months for cataract surgery if it’s considered a pre-existing condition. But once you’ve served the waiting period, Silver Plus cover can significantly reduce or eliminate the cost of this procedure.

Comprehensive Coverage vs. Cost Savings

One of the main reasons seniors choose Silver Plus is because it provides access to high-value treatments, without paying for benefits they’re unlikely to use.

A full Gold policy includes all 38 clinical categories, including pregnancy, assisted reproductive services, weight loss surgery, and in-hospital psychiatric care. But if those aren’t relevant to you, paying the higher Gold premium might not make financial sense.

By contrast, Silver Plus can cover most of the treatments seniors are likely to need, including joint replacements, cataract surgery, palliative care, rehabilitation, and heart and vascular treatment. And it usually comes at a lower cost than Gold.

How Silver Plus Works (Real Life Example)

Margaret, 68 has recurring hip pain and her doctor suggests she’ll need a hip replacement within the next 12 months. She compares hospital covers and finds that:

A Gold policy will definitely cover the surgery – but it’s the most expensive option.
A Silver Plus policy from a recognised fund also covers joint replacements hospital treatment – and it’s more affordable each month.

She chooses Silver Plus, knowing it includes what she needs, without paying extra for services she’ll never use.

In short, Silver Plus offers a smart middle ground, giving seniors access to many essential treatments in private hospitals, with real savings compared to full Gold cover. If you only need specific Gold-level treatments, Silver Plus might give you exactly the protection you're after and at a price that feels more sustainable.

Silver Plus Key Coverage Areas for Seniors

While every Silver Plus policy is slightly different, many include the core hospital treatments seniors are most likely to need – especially when it comes to cancer care, chronic illness, and access to private specialists. Understanding what’s covered can help you make a more informed choice and avoid unexpected out-of-pocket costs.

Cancer Treatments

If you’re undergoing treatment for cancer, private health insurance can make a big difference, especially when it comes to timing, comfort, and access to the right specialists.

Many Silver Plus hospital treatment policies include benefits for:

Chemotherapy, radiotherapy and immunotherapy

Radiotherapy for cancer, including advanced planning and follow-up care

In-hospital medications and support services during your stay

These services are typically provided in private hospitals and can be expensive if you're uninsured. Having Silver Plus cover can give you access to faster treatment, continuity of care, and more control over who’s involved in your treatment plan.

Chronic Conditions

Conditions like chronic kidney failure often require regular, ongoing hospital care. Some Silver Plus policies offer cover for dialysis for chronic kidney failure, which helps manage the high costs associated with this type of treatment over time.

Other chronic condition support may include hospital stays related to diabetes complications, heart failure, and long-term rehabilitation. This kind of access is particularly valuable for seniors managing more than one condition at once.

What It Means to Be a Private Patient

With Silver Plus, you’re generally covered as a private patient, but it’s important to understand what that actually means.

As a private patient in a private hospital, you can usually choose your doctor or specialist, book surgery sooner, and access a private room (when available).

As a private patient in a public hospital, you might still get access to your preferred specialist – but you'll be subject to public hospital waitlists and availability. You may also face out-of-pocket costs for certain services, depending on your policy and the hospital's billing arrangements.

hat’s why checking whether your policy includes no-gap or known-gap arrangements is so important – it can help reduce or avoid unexpected charges.

Comparing Health Insurance Providers

When it comes to choosing the best health insurance for seniors, there’s no single answer that fits everyone. The right policy depends on your health needs, budget, and the kind of access you want to private hospitals, specialists, and recognised providers. That’s why it’s important to compare policies carefully as what works for one person may not suit another.

What to Look for in a Health Fund

As a senior, here are the key factors to consider when comparing health funds:

Coverage options: Does the policy include hospital treatments you’re likely to need, like joint replacements, cataract surgery, or chronic illness care?
Premium costs: Are the monthly or annual payments sustainable for you long-term?
Provider networks: Does the fund have agreements with your preferred doctors, specialists, and private hospitals? No-gap and known-gap arrangements can make a big difference in out-of-pocket costs.
Waiting periods: Will you need to re-serve waiting periods if switching funds, or are your previously served periods recognised?

Rather than looking for the “best” health fund in general, the goal should be to find the one that offers the best fit for your health and lifestyle.

Senior-Focused Health Funds

Some health funds are known for offering strong coverage for seniors, such as including common procedures like cataract surgery or joint replacements in their Silver Plus options.

Health Deal specialists can help you explore which partner fund policies may be better suited to your age group, especially when it comes to balancing cost and coverage.

In summary, the best health insurance for seniors is one that matches your personal needs – not just your age. Comparing private health insurance policies across multiple funds, both partner and non-partner, gives you the best chance of finding the right cover, without paying for things you don’t need.

Understanding Costs and Benefits of Silver Plus

Choosing Silver Plus hospital cover isn’t just about what treatments are included; it’s also about understanding what you’ll pay, what your insurer will cover, and how to make the most of tools like the Australian Government Rebate to keep your policy affordable.

Out-of-Pocket Costs

Even with good hospital cover, it’s possible to have some out of pocket costs. These are the expenses you may need to pay when there’s a difference between what your doctor charges and what your health fund pays.

Medicare covers 75% of the Medicare Benefits Schedule (MBS) fee for in-hospital medical services. Your health fund pays the remaining 25%, provided the treatment is included in your cover.

If your surgeon, anaesthetist, or specialist charges more than the MBS fee, the extra amount is your responsibility – unless your fund has a no-gap or known-gap agreement with that provider.

So, even if your policy says it will pay benefits towards a particular treatment, that doesn’t always mean you’ll be fully covered for every cost. It’s always a good idea to check with both your doctor and your insurer before a hospital visit so you know exactly what to expect.

Using the Australian Government Rebate to Reduce Premiums

To make private health insurance more affordable, the Australian Government offers an income-tested private health insurance rebate that can lower the cost of your premiums.

If your income is below a certain threshold and you’re under 65, you may be eligible for a rebate of up to 24.288% on your health insurance premium (as of April 2025). If you’re 65-69, you may be eligible for a rebate of up to 28.337%, and if you’re 70 or older, up to 32.385%. The lower your income, the higher the rebate.

The rebate applies whether you pay your premium monthly or annually. You can choose to receive the rebate as a discount on your premium or claim it as a tax refund when you lodge your return.

Additional Coverage Options

While hospital cover like Silver Plus focuses on inpatient treatments, many seniors also consider extras cover to help manage everyday health costs, especially when it comes to dental, physio, and allied health. It’s important to understand how hospital cover and extras cover work together and where they differ.

Dental Implant Surgery

Dental implant surgery is a common need later in life, especially when dentures aren’t suitable. However, this procedure can be a grey area when it comes to cover.

If the implant is done during a hospital admission under general anaesthetic, it may be covered by hospital insurance – but this depends on the reason for the admission and whether the dentist or surgeon is recognised by the fund.
The implant itself and the prosthetic tooth (the part that replaces the tooth) are generally considered extras, and often fall under major dental.

If dental implants are important to you, make sure to check both your hospital and extras policies, and ask your fund about any required item numbers or pre-approvals.

Podiatric Surgery

Foot and ankle issues can seriously affect mobility and comfort, and it’s common for seniors to need podiatric surgery for things like bunions, bone spurs, or chronic pain.

Some health funds include podiatric surgery in their hospital policies – especially Silver Plus and Gold levels – but others may only pay a limited benefit (for the hospital bed, for example) and not the surgeon’s fee, especially if the surgeon isn’t a registered medical practitioner under Medicare.

It’s important to ask your fund how they handle podiatric claims and whether recognised providers are required to claim benefits.

Physical Rehabilitation and Pain Management

After surgeries like knee or hip replacements, physical rehabilitation is often essential for a full recovery. Silver Plus policies commonly include benefits towards physical rehabilitation as a hospital treatment, meaning you'll be covered for inpatient programs that help you regain mobility and strength.

Likewise, pain management hospital treatment, including treatments that involve a device implant (like a spinal cord stimulator), may be included in higher-level Silver Plus plans. These services are typically more relevant in later life and can improve quality of life significantly

Wrapping Up

Choosing the right health insurance as you get older means making sure you’re covered for the hospital services you’re most likely to need without paying for extras that won’t apply to you.

Silver Plus health insurance for seniors offers a strong middle ground. It provides access to many high-cost treatments without the higher premiums that come with full Gold cover. For many older Australians, it strikes the right balance between comprehensive support and long-term affordability.

Your coverage needs will change over time, so it’s worth reviewing your policy regularly to make sure it still fits. A carefully chosen Silver Plus policy can help you stay on top of those changes while also avoiding unnecessary costs, especially if you’ve already served waiting periods or want to avoid lifetime health cover loading.

Compare with Confidence with Health Deal

If you're unsure whether Silver Plus is right for you, or want help comparing different options, Health Deal’s free comparison tool can make things easier. It allows you to explore hospital services across a range of policies and health funds based on your age, budget, and cover needs.

Need personalised support? You can speak directly with a Health Deal insurance specialist for expert guidance. We’ll help you compare policies, explain key differences, and recommend options that fit with your health needs and budget. Call 1300 369 399 or email enquiries@healthdeal.com.au.

FAQs

Does Silver Plus cover all major surgeries?

Not always, but it often covers hospital treatment for surgery that’s relevant to seniors, like joint replacements, cataracts, and heart procedures. Each Silver Plus policy is slightly different, so check the list of included hospital covers before you sign up.

Do I need a referral to get coverage for certain procedures?

Yes, in most cases. Just like with Medicare, you’ll usually need a GP or specialist referral to access surgical treatment or other inpatient care under your private hospital cover. Your health fund may also require pre-approval before you’re admitted.

How does the waiting period work if I switch from another fund?

If you're moving to a policy with the same or lower level of cover, you typically won’t need to re-serve waiting periods. But if you're upgrading to a policy that includes new medical services (like joint replacements or psychiatric care), you’ll need to serve waiting periods for those added benefits (often 12 months for pre-existing conditions).

Does Silver Plus include extras like dental or physio?

No – hospital covers like Silver Plus only apply to inpatient care. Services like dental, optical, and physio are part of extras cover, which is sold separately. You can combine extras with your hospital cover if you want more complete protection.

Disclaimer

This guide is for informational purposes only and should not be taken as medical or financial advice. Health Deal is proud to partner with a range of health insurance providers. While we strive to provide accurate and up-to-date information, health insurance policies and benefits may change. Always check with a financial professional before making any decisions. Health Deal compares selected products from a panel of trusted insurers but does not compare all products in the market. Before signing up for any policy, make sure to read the Product Disclosure Statement (PDS) and check the fund’s official website for the most up-to-date information. For the most current information, please refer to your chosen health fund’s official website or speak with one of our health insurance experts.