Private Health Insurance – should you have it?

Private Health Insurance Benefits

Increasingly, Australians are choosing to have private health cover. If you don’t, but are wondering if you should, here’s a quick rundown of 8 key benefits.


1. The gap. Private health insurance helps members pay hospital and medical costs not covered by Medicare, dramatically reducing – but not always eliminating – the ‘gap’.

This is the difference between the amount paid by the patient, especially for fees charged by doctors, surgeons, anaesthetists or other specialists for elective surgery, and the amount reimbursed (by Medicare and the insurer).

2. ‘Elective’ surgery. Surgery for conditions not considered life threatening are considered to be ‘elective’ even if they are painful and debilitating.

Many people would be surprised to hear that the following procedures are considered ‘elective’:

– coronary artery bypasses

– hip replacements

– total knee replacements

– cataract extraction.

Public patient waiting periods for elective surgery are often measured in months – sometimes many months, and occasionally over 12 months. Even worse, as operations are scheduled in order of priority, patients finally allocated a date for an operation can be told that it has been pushed back for another patient whose situation is more critical. The average waiting period for a knee replacement is six months, and for many patients the wait is closer to a year.

Waiting periods for private patients are usually substantially less (or even zero). Private patients also have a ‘locked in date’, meaning that their operation will not be pushed back due to another patient’s needs. It should be noted, however, that there is a great deal of variance from policy to policy (and even hospital to hospital) about what elective surgery is covered and how much of ‘the gap’ is covered.

3. Dental. Basic dental care such as check-ups and cleans are not covered by Medicare unless you are a teen or have a chronic condition affecting your general health.

If you are uninsured and have a dental problem the only alternative to paying in full, is a state run public dental clinic, some of which are limited to pension or concession card holders, and most of which involve very long waiting periods.

Over half a million Australians are estimated to be on a dental waiting list and the average waiting period is over two years.

4. Choice. Members can choose their preferred doctor / specialist / surgeon. READ MORE  [page 2/2]

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