Private health insurance

25 Mar 2013

Private health cover needs will change as you get older.

While you may not need dental cover for dentures in your thirties or forties, you may need it in your sixties or seventies, depending on your dental care. This is the same when it comes to artificial or other hearing aids. 

Most health funds offer different packages according to age, whether you’re planning a family or whether you are a family with kids. Some also offer complete ‘peace of mind’ packages for over 65s, covering you for everything and anything including hospital and plenty of extras.

Medicare vs. private cover

Medicare provides health insurance to Australian citizens and permanent residents, however it doesn’t cover everything.

Hospital

Medicare offers cover for hospital stays, but only as a public patient in a public hospital and by a doctor appointed by the hospital. You also may not be given a choice about when you are admitted for a specific procedure.

If you have private health insurance, you are a private patient treated by a doctor of your choosing and are given the choice between a private or a public hospital.

While Medicare will cover you for 75 per cent, it does not cover you for everything, especially associated private patient costs, for example theatre fees or accommodation.

General medical services

Medicare does reimburse you for a portion of your doctor’s visit, or the entirety of it if it’s part of the Medicare Benefits Schedule. This also applies for specialists.

There are plenty of medical services that Medicare does not cover including most physiotherapy, dental, optical and home nursing.

It’s always important to check whether you can claim with Medicare when you make an appointment with a doctor. If not, check your private health insurance policy. 

Changing cover

When looking at your policy, make sure you are checking both aspects of private health insurance – hospital cover and general treatment policies. Most funds offer combined policies or you can choose to purchase hospital and general treatment separately if the combined policy doesn’t suit you. 

When you change your cover, whether it’s increasing or decreasing, there are certain things you need to be aware of. The most important and relevant factor is waiting periods. 

Generally, if you lower you rcover, you’ll be entitled to benefits immediately. If you move to a higher level of cover, there may be a waiting period to access the benefits requested. For example, if you had a benefit limit of $500 per year and you increased your cover to include a benefit limit of $800 per year, there will probably be a waiting period, which you will have to endure until you can access that extra $300. 

Besides your changing health needs, a key consideration of changing your cover is the fact that you’re probably no longer a family where your children can be covered under your policy. Switching to a couples or singles package can save you hundreds of dollars.

Another consideration is that you may be travelling a lot more than you used to. You don’t have the kids to worry about anymore so you’ve got the free time to do what you’ve always wanted. If you’re travelling within Australia, make sure your policy covers you across all states – most companies offer national coverage however it doesn’t hurt to check. 

Choosing the right policy

When it comes to deciding which policy to change to or purchase, it’s important to remember what it is exactly you need.

Do you have pre-existing conditions that need to be covered? Do you envisage needing more cover for hospital or eye care? Is there a hereditary condition that may impact you in the coming years?

You must also take into consideration what you can afford. There are plenty of health insurance companies so if there’s something you want but it’s too expensive with the provider that you’re currently with, shop around. 

Changes in premiums

In February, the Federal Government announced an increase on premiums for private health insurance. This is usually to cover the increase in costs of services and claims for funds, plus the increase in the cost of medical treatment, largely due to improvements in technology.

From 1 April, premiums will increase on average 5.6 per cent. However, health funds with raise premiums at different rates. For example, while BUPA will raise its premium by 5.8 per cent, NIB customers will face a premium increase of 6.5 per cent.

This makes it even more important to compare prices with the different providers and to make sure your health insurance reflects your needs.