Aging is a beautiful process and everyone goes through it. However, everyone experiences it differently. Our genes play a big part in how our body ages over time and what complications might show up. In addition to genes, our habits and activities also affect how our health reacts to aging. Over time, our body becomes more vulnerable to risks and chronic diseases, which calls for regular checkups, visits to the GP, medicine costs, and timely access to diagnostic tests and medical treatments.

The Australian Institute of Health and Welfare, which is Australia’s national agency for information and statistics on Australia’s health and welfare, states that 9.6% of patients waited longer than 365 days for elective surgery, an increase from 6.3% in 2021–22 and 2.1% in 2018–19. This means that over 70,000 people were waiting for over a year for elective surgery.

This is the single biggest reason why Aussie seniors keep private health insurance. When life strikes, you don’t have to put your needs on hold. Private health insurance empowers seniors to take back control of their health and life, giving them the power to not only choose their doctor but also the hospital they want to attend, avoiding lengthy public waiting lists for elective surgeries.

There are well over 50 brands of health funds for seniors to choose from, each with their unique differences. Within these health funds, there are thousands of different policy combinations to choose from. For the uninformed, it can seem quite daunting, but Health Deal will try to simplify it.

Generally, there are three main types of health insurance that Aussie seniors can purchase, namely: hospital cover, extras cover, and combined cover.

Seniors Hospital Cover

Private hospital cover is an insurance policy that will cover the costs associated with going to the hospital for elective surgery. The main benefits of private hospital coverage are that you get to choose your own doctor, choose the hospital and avoid public waiting lists for elective surgeries.

There are thousands of different hospital policies available on the market, all covering slightly different things to different degrees. In general, these can be broken down into 7 different categories:

1. Basic Hospital
2. Basic Plus Hospital
3. Bronze Hospital
4. Bronze Plus Hospital
5. Silver Hospital
6. Silver Plus Hospital
7. Gold Hospital

There are 38 different clinical categories of procedures, which health insurance covers, ranging from hernia and appendix, all the way through to joint replacements and cataract eye surgery.

By law, if your hospital policy has the word “Bronze” in its name, then that policy has to cover all of these clinical categories Brain and nervous system

• Eye (not cataracts)
• Ear, nose and throat
• Tonsils, adenoids and grommets
• Bone, joint and muscle
• Joint reconstructions
• Kidney and bladder
• Male reproductive system
• Digestive system
• Hernia and appendix
• Gastrointestinal endoscopy
• Gynaecology
• Miscarriage and termination of pregnancy
• Chemotherapy, radiotherapy and immunotherapy for cancer
• Pain management
• Skin
• Breast surgery (medically necessary)
• Diabetes management (excluding insulin pumps)

If your hospital policy has “Silver” in its name, then it has to cover all the services in Bronze, as well as:

• Heart and vascular system
• Lung and chest
• Blood
• Back, neck and spine
• Plastic and reconstructive surgery (medically necessary)
• Dental surgery
• Podiatric surgery (provided by a registered podiatric surgeon)
• Implantation of hearing devices

If the hospital policy has “Gold” in its name, then it has to cover every clinical category, including:

• Cataracts
• Joint replacements
• Dialysis for chronic kidney failure
• Pregnancy and Birth
• Assisted reproductive services
• Weight loss surgery
• Insulin pumps
• Pain management with a device
• Sleep studies

Some of you might be reading this knowing that you’re not on Gold cover, but you’re sure you have joint replacements covered. This is more than likely because you’re on a “Silver Plus” level of hospital cover. When you see a Basic Plus, Bronze Plus or Silver Plus policy name, that means that this policy covers everything associated with that category level, but also covers at least one more surgery from the higher level. In any case, it is best to refer to your policy to have an idea of what it covers.

Seniors Extras Cover

Most people will go to the dentist once or twice a year, they might get a new pair of glasses from Specsavers or OPSM every two years, and a few trips to the physio. But as we get older, we probably start seeing a podiatrist more often, go for an eye test multiple times in the years, and start using health aids like C-PAP machines and hearing aids. These all conditions are covered under the Extras cover.

When selecting an extras policy you want to be mindful of a few things, such as:

1. What extras do you need and use?
2. What is the yearly limit on the extras? (How much can you claim in total)
3. What is the rebate on the extras? (When you swipe your card how much do you get back)

When looking at an extras plan, you should follow a few golden rules.

Rule 1:

If you don’t use it often, then don’t worry about the yearly limit, only focus on the rebate. There’s no point in you having a massive $700 yearly physio limit if you only go once or twice a year and get back $25 each visit.

Rule 2:

If you go often, then look for a higher yearly limit. We understand that it may be the opposite of Rule 1 but essentially if you absolutely hammer certain services like chiro, group physio or exercise physiology, then don’t be too concerned about the rebate, focus on getting a higher yearly limit.

If you follow these rules when selecting an extras policy, then you’re on the right track to finding yourself a good value plan.

Seniors Combined Cover

Combined cover is a type of health insurance where you get both hospital and extras on the same policy. Most seniors who have health insurance may have separate hospital and extras cover, but not a combined one. Most hospital policies have the word “hospital” in them, such as Bronze Hospital $500 Excess or Silver Plus Hospital $250 Excess, and most extras policies have the word “Extras” in the name, such as “Core Extras” or “Vital Extras”. Combined policies will generally not have the word “hospital” or “extras” in their name, so you might see a product called “Top Choice $500” or “Deluxe Package Silver Plus” and you know it’s combined.

Something to remember here is that there is no such thing as “the best health insurance policy for seniors”. So for some people, a combined cover might be best, for others it might be just a standalone hospital or extras plan, and for others, it might be best that they have a hospital policy with one health fund and an extras policy with another health fund, it’s all about making sure you find a tailored solution to your individual health needs.

Now that you know about the different types of insurance that there are in the market, let us talk about how to choose the best one for yourself according to your needs. There are five key considerations that you should keep in mind while choosing the best senior health insurance policy for yourself or your loved ones.

Current Health Status

Before choosing a health insurance policy, assess your current health status. Think about how many times you went to the GP for a checkup or in an emergency in the last few months, what illnesses you are currently dealing with, what your overall health looks like, do you have any chronic pains or illnesses, and what type of medications are you on? Answering these questions is very important as this will help you assess if you need a health insurance policy that covers a wide variety of services or if you need a basic one.

Future Health Needs

Having assessed your health status, you can now move on to thinking about what your future health needs may be. Private health insurance in Australia is heavily regulated, so the waiting periods you will serve are all easily available. This allows you to think and plan what level of coverage you need at any given time. Remember, you will only serve hospital waiting periods when you are new to private health insurance or when you add new services to your plan. You will never re-serve a waiting period you have already served when switching health insurance. If you want to add certain services to your policy, you will need to be mindful of waiting periods. The waiting periods in health insurance are 2 months for new conditions and 12 months if it’s pre-existing.

So let’s say you are on a Bronze level of hospital cover, and you want to upgrade your policy to Silver because you now want to be covered for heart surgery, you will gain access to all the bronze surgeries on day 1 when you upgrade your cover because you had already served those waiting periods, and all the new services found on Silver (see list below), you would just have to wait 2 months if it was a new condition or 12 months if it was pre-existing to use.

• Heart and vascular system
• Lung and chest
• Blood
• Back, neck, and spine
• Plastic and reconstructive surgery (medically necessary)
• Dental surgery
• Podiatric surgery (provided by a registered podiatric surgeon)
• Implantation of hearing devices

Now you know if you add services onto your policy, the maximum you will need to wait is 12 months, it’s a good idea to think about your hospital policy in 3-year cycles. If you think there’s little to no chance you will need to go to the hospital for any of the services found on Gold in the next 3 years, then it might be worth looking at a Silver or Silver Plus level of hospital cover and re-assessing every year or two.

• Cataracts
• Joint replacements
• Dialysis for chronic kidney failure
• Pregnancy and birth
• Assisted reproductive services
• Weight loss surgery
• Insulin pumps
• Pain management with a device
• Sleep studies

The Cost of Seniors Health Insurance

Seniors’ health insurance can be quite expensive because as you get older, you might need to go to the hospital multiple times a year. Different insurance providers, health funds, and policies offer different costs, which may change throughout the year. This is why Health Deal always recommends that you set aside 15-30 minutes once a year to review your current health policy. Most policies increase in price every 1st April, so if you’ve been on the same policy for the last 5 years, you’ve probably had 5 price rises in that time, so it’s worth checking to see what else is on the market to see how your policy stacks up.

Yearly Limits & Extras Rebates

It’s important when selecting a policy that you pay attention to the yearly limits and rebates on your extras policy. You want to ensure that you get value for money for the services you are using. If you see a physio regularly (more than 10x per year), you want to look at getting yourself a high yearly limit on physio. Similarly, don’t be too hung up on the yearly limit or rebate for the services that you don’t use.

Government Rebates & Incentives

In many cases, you might be eligible for government rebates and reduced premiums. To assess your eligibility, visit this page. If you have any more questions regarding the matter, you can visit the Private Health Insurance Ombudsman for more details.

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Hospital insurance for seniors is of utmost importance and is the essence of private health insurance. This policy covers a very wide variety of medical and health-related issues which can be very beneficial for seniors. One benefit of senior hospital coverage is that it gives you a choice if you want to be treated as a private patient in a public hospital, a private hospital, or at a day hospital facility. This choice comes in very handy if you live away from the main city.

A hospital cover typically covers you for a range of other services, on top of the actual procedure, including, but not limited to:

• Overnight accommodation (private room where available)
• Special care unit accommodation (e.g. intensive care)
• Operating theatre fees
• Doctors’ surgical fees and in-hospital consultations
• Government-approved prosthetic devices
• Allied health services (e.g. physiotherapy, occupational therapy)
• Pharmaceuticals approved by the Pharmaceutical Benefits Scheme required
• Specific treatment when in the hospital
• Ward drugs and sundry medical supplies (e.g. bandages, painkillers)
• Nursing care
• Patient meals

Since COVID-19, health funds have started introducing a series of “at home” benefits on their hospital cover which help seniors. For example, Bupa, nib, and Australian Unity all have a “Rehabilitation at Home” program, whereby after your surgery, you have the option of doing your rehab at home, instead of having to trek all the way to the hospital and back regularly. Some health funds even offer dialysis and chemotherapy at home too. So make sure you ask your provider about these added benefits while buying a policy.

Extras cover for seniors is super important. This cover offers out-of-hospital services that help people live their day-to-day life to the fullest, like physiotherapy for seniors, optical cover for seniors, dental cover for seniors, and most importantly, hearing aids. This sort of cover is offered by many different leading private insurance companies, and the choice of which depends on your needs.

The best thing about extras cover is that you can select what services you require so they can be modelled into your policy. With this cover, you must maintain overall good health and get regular check-ups that might prevent serious conditions and ailments from befalling you. Make sure to keep an active lifestyle, meet your peers and friends wherever possible, and ask for support wherever needed. If you have more questions, we suggest you visit the Department of Health website.

Insurance has many types of costs, and understanding each is important for making an informed decision while buying a policy and consequently, using it where needed. Here we explain each type of associated cost:

Premiums

Health insurance premiums are the regular payments that you pay to maintain the coverage of the policy. You can choose to pay them fortnightly, monthly, quarterly, or yearly. The amount of your premium will depend on your insurance provider, what sort of coverage you have, what services are covered, and the excess level. It is important here to note that once you stop paying your premium, your coverage will cease. Some health funds will give you an extra discount if you pay yearly, and some will give you a discount if you pay via direct debit, so it’s worth asking when you sign up if you are entitled to any of these discounts.

Excess and Co-payments

Excess and co-payments are out-of-pocket costs that you pay when you go to hospital. If your policy has an excess attached, you will be asked to pay this amount on the day you are admitted. So if your policy has a $500 excess attached, and you go into the hospital for surgery, expect to have to pay $500 to the hospital on the day of your surgery.

If you are on a couple or family policy, pay close attention to how the excess works on your policy. Most policies will not charge excess if your kids are admitted into hospital, however not all, so make sure you know how it works on your plan. The same applies to couples policies. Most of the time, you will only pay the excess once per person per year if you are admitted into the hospital, but some couples and family policies can charge you the excess twice for the same person in one year, so make sure you don’t get caught out with this.

Some policies might charge you a co-payment when you go into hospital. This is often an additional cost you will have to pay on top of your excess. Co-payments are pretty rare these days and don’t appear on too many policies. They are a way of keeping down the monthly premium of policies but make sure you know if you need to pay one or not before you go to the hospital.

Lifetime Health Cover Loading

Lifetime health cover loading is the additional cost for those who take out hospital cover after the age of 31 years. This means that if you have not taken out any private hospital cover after turning 30, and later on you decide to buy one, you will have to pay a 2% LHC loading cost on top of your premium for every year you are aged over 30.

A simple example for you to understand this loading fee is that imagine if you take out private hospital coverage at the age of 40 years old, you will then have to pay an extra 20% on the cost of this coverage per year for 10 years. Likewise, if you buy a policy when you are 50 years old, you would pay 40% more per year for 10 years. This is why it is recommended that before you turn 30, you should have private health insurance in place which will save you a good amount of the loading fee in coming years.

Government Rebates

The Australian Government’s rebate can reduce premiums based on the age of the policyholder and their income. This also depends on if you are single or in a family. This page here describes various situations of a policyholder and how they may receive their rebates. Please check out the page and if you have any questions please feel free to email us your enquiries at enquiries@healthdeal.com.au.

The above-mentioned costs can be reduced and managed well according to your policy and its coverage. It is however very important to balance your costs from your end with benefits from your insurance provider and government rebates for senior health insurance. This will help you manage your bills more efficiently and ensure value for money.

Tailored Senior Policies

Many different insurance companies provide uniquely tailored health insurance for seniors. These policies are very carefully curated while keeping the needs and ease of seniors in mind. For example, seniors might require higher cover limits for specific age-related conditions which will be reflected in your policy. Furthermore, such policies also cater to no-gap arrangements with preferred providers and additional support services like health management programs, all to make it easier for seniors.

Health Deal has a range of health funds, with plans tailored towards senior’s health insurance. They have some really big health funds like Bupa, NIB, AHM, and Australian Unity and some smaller not-for-profit health funds like Westfund and HIF. If you would like to easily compare these different policies from one or more than one insurance provider and make a decision, we suggest you use our Health Insurance Comparison tool.

The government rebates for senior health insurance policies are a great help for managing your expenses. There are two main schemes available to seniors which include Private Health Insurance Rebate and the Medicare Levy Surcharge exemption.

Most Australians who hold a private health insurance policy receive a rebate from the government to help cover the cost of their premiums. This rebate is income tested, which means the amount of the rebate depends on your income if you are single or the income of you and your spouse if you are a family. You can get an idea of how much rebate you are eligible for based on your age and income through this page.

The Medicare Levy Surcharge is a levy that is paid by an Australian taxpayer who currently earns above a certain income and does not hold private hospital insurance. However, you might be eligible for a Medicare Levy Surcharge Exemption. You can assess your eligibility from this page. These senior health insurance incentives and rebates have a good impact on the overall affordability and accessibility of private health insurance for seniors.

We have covered a whole lot of information about the senior health insurance types, their providers, tiers, rebates, associated costs, and services, but now the question remains: which are the best senior health insurance providers according to your health and medical needs? While assessing the best insurance provider, you need to consider factors like coverage options, cost, customer service, and the ease of the claims process.

To make a careful decision, we suggest you compare senior health insurance providers and their products. Each insurance company offers broadly the same policy but with a few changes here and there. We encourage you to read their product disclosure statements with attention and also refer to their websites for more information. Additionally, you can also read senior health insurance reviews and view ratings of different insurance companies and their customer services on review sites like ProductReview and Trust Pilot. Health Deal has a 4.7/5 rating via Trust Pilot and is a trusted source in the health insurance industry to compare and review health insurance.

A big misconception in the industry is that there is such a thing as the “best health insurance provider” for seniors. Unfortunately, this is not the case. You want to steer away from slogans or advertising saying that certain policies or health funds are the best, even if they have been given an award from Canstar or Choice. The reason is that health insurance is an extremely personal product. Take the Canstar Award for Health Insurance in NSW, where Phoenix Health Fund won in 2023. Phoenix Health is a fantastic health fund, but the ombudsman’s website shows that they do not have hospital agreements with every private hospital in New South Wales.

What happens if you pick a health fund just because of an award, and you later realise the hospital you want to go to doesn’t have an agreement with your health fund? You’ll be left significantly out of pocket when you go in. This shows that when looking for the top health insurance for seniors, you always need to ask yourself, is this right for you? Do they have agreements with the hospitals you go to? Do they have agreements with your choice of surgeon? Do they offer other services that you might need like at-home health? Make sure you’re always asking these questions to yourself when selecting a health fund.

Using customer reviews is quite popular these days, being able to view and read personal feedback from customers is important. However, don’t let that be the sole deciding factor on whether to pick a health fund. Take Bupa for example, Bupa has a pretty low score on Product Review, with a 1.4/5 star rating at the time of writing. At first glance, this looks extremely poor, but under further inspection, this score is based on just 1,223 reviews, and considering Bupa currently has around 4.3 million members, that is just 0.0284% of their member base, not even half of a percent.

Interestingly, Bupa received Canstar’s national “Outstanding Value Awards – Health Insurance Australia” in 2023. This highlights the need to take everything with a pinch of salt and look into the policy details when selecting a policy. Find a policy that best suits your individual needs, and take on board reviews and awards, but don’t let that be the deciding factor.

How To Switch and Save on Seniors Health Insurance

Switching senior’s health insurance, especially with Health Deal, is super simple. Health Deal will handle the entire switching process for you, so you won’t have to lift a finger. When you sign up for a seniors health insurance policy through Health Deal, they’ll ask you for some information like your Medicare card number, your previous health fund member number, and payment details. Once you click submit on your application the following will occur:

1. Health Deal will securely transmit all your information over to your new health fund.
2. You will receive a welcome email from Health Deal and your new health fund.
3. Your new health fund will send a transfer certificate request to your old health fund. This is the document that outlines all the waiting periods you have already served.
4. Your old health fund will cancel your ongoing direct debit and will refund you any money you have pre-paid them for the fortnight/month/quarter/year, on a pro-rata basis (this takes about 10 working days to receive the refund).
5. Your new health fund will send you a card in the post, and you’ll receive an onboarding welcome call from someone in their customer service team.
6. All your payments will have been set during the signup process, so you can just sit back, relax, and enjoy your new health fund.

Remember, when switching health funds, you will not have to re-serve any wait periods you’ve already served, and any money you’ve pre-paid will be refunded back to you. Please also bear in mind that any claims you’ve made on your extras will follow you across, so if you’ve claimed $100 on your general dental limit with your current fund and switched to a new one, that $100 will be deducted from your yearly limit when you switch across.

Following are some of the common questions about senior health insurance.

What Is Covered Under Hospital and Extras Cover?

Under this cover, a wide variety of your in-hospital and out-of-hospital services are covered. The specific covered service will depend on your insurance provider and the tier of coverage you select, but the most commonly covered services include hearing aids, dental, optical, and physiotherapy services, and additionally, choice of public or private hospital, choice of specialist, and a choice of private room (if one is available), all chosen by you according to your needs.

If you would like more information on what is covered under hospital and extras cover, separately or in combination, here is the Health Deal Insurance Comparison tool that you can use to make an informed decision.

How Do I Claim The Australian Government Rebate on Private Health Insurance?

According to Service Australia, there are two ways that you can claim the government rebate on health insurance. One way is to claim it from your insurance provider as a reduced ongoing premium, and the other way is to claim it from the Australian Taxation Office. You can claim the rebate from the insurance provider as an upfront reduction to your private health insurance premium, whereas you can claim the rebate through the ATO tax return if you don’t get it as a premium reduction. The choice is yours. You can read more about health insurance rebates for seniors on this page.

What Are Waiting Periods?

Waiting periods refer to the initial time frames that begin as soon as you take out an Australian private health insurance policy. During this period, you won’t be able to claim or access any benefits covered by the policy. If you require medical services during this time, you’ll need to cover the full cost yourself. The length of these waiting periods can vary depending on the type of condition.

Here are the standard waiting periods for some common health insurance benefits:

• New Conditions: 2 months
• Pre-existing Conditions: 12 months
• Rehabilitation, Psychiatric Care, and Palliative Care: 2 months
• Pregnancy and Birth-related Services: 12 months
• IVF and Assisted Reproductive Services: 12 months
• Weight Loss Surgery: 12 months

Remember, if you’re switching to a new policy and have already served the waiting period with your previous insurer, you will not need to serve it again. For more details on waiting periods for senior health insurance, please visit this page.

How Can I Reduce My Premiums?

There are many ways that you can reduce your premiums. These include comparing different policies and their rates, switching to policies with lower premiums, only getting cover for services you will require, and removing coverage for services you no longer need. Another way you can reduce your premium is by pre-paying your premium for at least 12 months.

If you have any other senior health insurance FAQs, we invite you to email us at enquiries@healthdeal.com.au.

Senior health insurance comparison is the best way to choose your insurance provider, and you can do that by using the Health Deal Insurance Comparison tool. Here you can compare senior health insurance plans, costs, and providers. For health insurance expert advice, you can contact Health Deal at enquiries@healthdeal.com.au. You can speak to our experts at 1300 369 399 or fill out the online form here. Get in touch now to speak with an insurance expert for tailored advice and support in making viable health insurance decisions.

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