Seniors Health Insurance

What are the health insurance options for seniors?

As a senior, you have 2 options for your health insurance.

Option 1

Medicare Rely on the public health system (Medicare). This is cost-effective but you have less choice about your healthcare and have to pay out of your own pocket for treatments not covered by Medicare.

Option 2

Seniors Private Health Insurance Take out Private Health Insurance so you can:  choose your doctor or specialist  avoid long waiting lists in the public health system for elective surgery  get your own room in hospital if one is available get cover for treatments that Medicare does not cover, including:  Chiropractic  Optical  Physiotherapy.  Remember, higher levels of cover can be quite expensive, and there can be out-of-pocket costs. While some surgeons may waive out-of-pocket fees for seniors, this is not guaranteed, so it is important to research health insurance policies carefully.

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Option 1: Medicare 

As a senior, you can rely on the public health system Medicare for your health needs.

You are entitled to a wide range of medical treatments for free or at a lower cost. 

However, if you rely on Medicare, you cannot choose: 

• the doctor who treats you in a public hospital 

• when you receive that treatment. 

You also have less choice about the treatments you receive and may have to go on long waiting lists for elective surgery. 

 You have to pay out of your own pocket for treatments not covered by Medicare, including: 

• Chiropractic 

• Optical 

• Dental.  

Do seniors receive additional healthcare support from the Australian Government?

Yes. If you are eligible for a Commonwealth Seniors Health Card, you are eligible for additional discounts.

If you are eligible for a state or territory Seniors Card, you may benefit from lower costs for state, territory or local council services.

Am I a senior?

In Australia, the age when you become a ‘senior’ and are eligible to receive a Seniors Card (which entitles you to concessions) varies depending on whether it is commonwealth, state or territory.  

Commonwealth Seniors Health Card	67 years or older
ACT Seniors Card	60 years or older
NSW Seniors Card	60 years or older
NT Seniors Card	60 years or older
QLD Seniors Card	60 years or older
SA Seniors Card	60 years or older
TAS Seniors Card	60 years or older
VIC Seniors Card	60 years or older
WA Seniors Card	65 years or older

It is worth taking advantage of these offers and discounts. 

As well as age, other criteria will apply, so check the eligibility requirements for your state or territory’s Seniors Card. 

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Commonwealth Seniors Health Card

When can get a Commonwealth Senior Health Card and what does it mean?

You become a senior and eligible for a Commonwealth Seniors Health Card if you:

• are age-pension age or older: 
  • 67 years 
• are not receiving income support from Centrelink or the Department of Veterans’ Affairs 
• meet the income test, which means you earn: 
  • less than $99,025 a year for singles 
  • $158,440 a year for couples 
  • $198,050 for couples separated by illness, respite care or prison. 

There is no asset test.

What benefits will I receive if I have a Commonwealth Seniors Health Card?

The Commonwealth Seniors Health Card is a concession card for cheaper healthcare and a range of benefits which may include:

• cheaper medicine under the Pharmaceutical Benefits Scheme (PBS) 
• bulk-billed doctor visits, which is up to your doctor 
• a refund for medical costs when you reach the Medicare Safety Net 
• lower state or territory government costs: 
  • electricity and gas bills 
  • property and water rates 
  • healthcare costs, including ambulance, dental and eyecare 
  • public transport. 

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Option 2: Seniors Private Health Insurance

There are no specific private health insurance products for seniors. However, some insurers offer Hospital Cover or Extras Cover policies that are tailored to seniors. 

You have the option of taking out: 

• Hospital Cover

• Extras Cover

• Combined Hospital and Extras Cover 
• Ambulance Only Cover. 

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How much does health insurance cost for seniors?

Prices

For one adult (per month): 

• The lowest Hospital Cover starts at around $38 in the NT ranging up to around $103 in TAS  

• Extras Cover ranges from around $11.45 in the NT up to around $15.55 in most other states and territories for the lowest cover 

• Basic Combined Hospital and Extras Cover starts from around $55.75 in the NT up to around $120.45 in QLD and TAS. 

For 2 adults (per month): 

• The cheapest Hospital Cover starts at around $76 in the NT ranging up to around $206 in TAS 

• Extras Cover starts at around $22.90 in the NT up to around $31.10 in most other states and territories for the lowest cover 

• Basic Combined Hospital and Extras Cover starts at around $111.50 in the NT, ranging up to $241.80 in QLD. 

Key factors affecting the cost of Private Health Insurance for seniors

Ultimately, the cost of Private Health Insurance for seniors depends on the tier of Hospital Cover/or extent of Extras Cover, where you live, excess payable and any co-payments: 

• The tier of Hospital Cover:
  • Basic Cover
  • Bronze Cover
  • Silver Cover
  • Gold Cover. 
• Extent of Extras Cover
• Where you live. You will pay more if: 
  • you live in a state or territory where there is a higher rate of claims 
  • your state or territory charges more for hospital services. 
• Higher excess: applies if you want to pay this in exchange for a lower premium 
• Co-payment: applies if you want to make a contribution for every day you are in hospital in exchange for a lower premium. 

Other factors that could impact your premium 

If government incentives and penalties apply to you, these will impact how much you pay for your policy. These are determined by: 

• You and your partner’s age: 

• if you did not take out Hospital Cover before the age of 31, you have to pay the Lifetime Health Cover Loading, which means you pay 2% per year for every year you have not taken out cover, up to a maximum of 70%.  

• Your combined income: if you’re single and your income is less than $151,000 or living with a partner and your combined income is $302,000 or less, you may be eligible for the Private Health Insurance Rebate, which gives you a premium reduction on: 

• Hospital Cover 

• Extras Cover 

• Ambulance Cover. 

Different premium reductions apply depending on your age and income bracket, so check your eligibility.  

If you’re single and your income is more than $97,000 or living with a partner and your combined income is more than $194,000 per year, and you do not have Hospital Cover, you may have to pay the Medicare Levy Surcharge. 

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Can seniors include adult children on health insurance cover? 

You cannot include adult children (referred to as adult dependants by insurers) on your health insurance policy if they are over the age of 31, unless they have a disability.  

If your adult child is participating in the National Disability Insurance Scheme (NDIS), they are eligible to be included on your policy as ‘dependants with a disability’, regardless of their relationship status or where they live. Some insurers will allow you to include dependants with a disability on your cover even if they are not participating in the NDIS, so check with your insurer about their conditions and how this will affect your premium. 

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What is the best Private Health Insurance for seniors?

To find the best seniors health insurance for you, ask yourself these 10 questions: 

Q 1:	What do you want from your health insurance? Do you want more choice than Medicare provides?  Are your health needs increasing so you want a higher level of cover?  Do you want health insurance to reduce your tax bill only?
Q 2:	What type of health insurance do you need? Hospital Cover Extras Cover Combined Hospital and Extras Cover Ambulance Only Cover
Q 3:	If you want Hospital Cover, what Hospital Cover tier do you need? Basic Bronze Silver Gold
Q 4:	If you want Extras Cover, what treatments do you and your dependants need and are likely to use? There is no point taking out Extras Cover if you are not going to use it.
Q 5:	For Extras Cover, what are the claim limits, annual limits or lifetime limits on the policy?
Q 6:	What is your budget? Does the cover you selected fit within your budget? Are you eligible for the Private Health Insurance Rebate? Will you have to pay the Lifetime Health Cover Loading?
Q 7:	Will you have to pay an excess if you make a claim on Hospital Cover? How much is the excess? Will you be able to afford the excess if you make a claim?
Q 8:	Will you have to make a co-payment if you make a claim on your Hospital Cover and, if so, can you afford it?
Q 9:	Will you have to pay out-of-pocket fees, such as Medical and Hospital Gaps, and if so, can you afford this?
Q 10:	Check the waiting periods before you can make a claim for any policy you are considering.

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How can I compare health insurance for seniors?

Use our free Calculator to find the best and cheapest health insurance policy for you. You can also compare your existing policy against other relevant policies currently in the market.  

We compare every insurer and every policy, with no commercial bias, and guarantee you the cheapest policy.  

You can also personalise your premium by calculating whether you: 

• can save on your health insurance because you are eligible for the Private Health Insurance Rebate  

• have to pay more due to the Lifetime Health Cover Loading.