A while ago, the only point of paying for private health cover was for aromatherapy and private rooms in private hospitals (glorified hotels, basically), but it seems the rules have changed. Including for children! Is it now a requirement for basic cover?
In Which Cases Is It Not Worth Paying for Private Health Insurance in Australia (for Australian Citizens) ?
wisdomtooth on 29/05/2023 - 12:13
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I didn't think CT scans were covered by private health insurance, unless as part of a hospital stay.
I'm guessing there was no claim made just that the private hospital had an earlier vacancy (at a cost).
yeah correct.
But it was either wait for 3 months for a potential diagnosis, or pay a bit out of pocket for an answer 48 hours later. It wasn't ER level of emergency, but it was driving her crazy not having a diagnosis
@87percent: OK, so unrelated to private health insurance.
I don't know where you are, but if you're in a metro location, there are generally many private CT, x-ray, MRI, ultrasound providers.
Don't think so, if you need medical care then we pay medicare fees every year.
We did an assessment a couple of years back with an in-person health insurance rep and she told us not to bother as we have no health issues. If we did have constant issues that might have been different. Otherwise we use a BB doctor and pay for any dental stuff out of pocket and we still come out miles ahead.Will do. Thanks.
If you are young (under 30 specifically), healthy and earn less than the medicare levy threshold I'd argue against paying for cover. Our family get regular dental checks covered, but I am sure that's well below the ~$4k per year cost of our cover.
If you're not churning through the '6 weeks free' offers, you're doing it wrong.
I'll investigate! Cheers!
No worries. If you keep following those offers, you'll save approximately 60% per annum.
Pay one month get 6 weeks free, churn, Pay one month get 6 weeks free, churn etc etc
@YesPleaseThankYou: you said pay a month get 6 weeks free, its pay 12 months get 6 weeks free at the end normally
its pay 12 months get 6 weeks free at the end normally
After years of churning, I have never seen a 'pay 12 months get 6 weeks free'. That is a ridiculous offer that no-one should churn to.
Peoplecare https://www.peoplecare.com.au/, right now, is offering pay one month get six weeks free.
I don't know where or how you're doing your research, but I would suggest that you're not doing it very well.
@YesPleaseThankYou: Yeah 12 month program maybe for some, but most are much shorter. I just did the 6 week free and 30,000 points with Medibank and got it all after 10 weeks. I had to remind them though!
But not sure who to go to next. Even with the offers, some premiums are so much higher than my current provider that the offers aren't worth it.
But not sure who to go to next
The answer is above.
Even with the offers, some premiums are so much higher than my current provider that the offers aren't worth it.
I don't see this. The premiums have to be competitive, else they'll go out of business.
Under churn strategy, the premiums almost don't matter. Just churn to the same level of cover (Gold, Silver, Bronze etc) and away you go.
@wisdomtooth: Would I still get PHI? Yes.
Would I switch to a fund if they didn't have the discount at the time? No.
@YesPleaseThankYou: Do you churn any time or close to your payment due date? Or in other words, how is your experience with the old provider refunding the unused portion of your premium?
I read some need it in writing although my last provider refunded without this.
@OldBugger: I start my new policy the day after the conclusion of the promotional period with the former fund.
I rarely have to ask for a refund as, when you tell the old fund that you want to terminate your policy, they usually cease direct debits at that point.
I do not factor in direct debit dates as they all do it differently. I focus on maximising my promotional return.
On the rare occasion there has been an overpayment of premiums, they refund freely. (They are obligated to do so. Although some say they may charge a fee for refunds, I have never been charged such a fee.)
@YesPleaseThankYou: Nice one. Have you considered adding in a 30 day cooling off period with a random insurer every now and again?
@OldBugger: No. When you cancel under the cooling off period, your policy cancellation will be backdated to when it started. For all intents and purposes, it will be as if you never held the policy. This is not a scenario I want.
@YesPleaseThankYou: Yeah, fair enough. I've been tinkering with some a bunch of insurers today offering cash or 6 weeks free with waived waiting periods on extras (using Silver tier / low extras). I'll see how I go. Cheers for the help.
Insurer Monthly Premium frank $ 251.85 Bupa $ 254.90 GMHBA $ 255.10 Bupa $ 270.60 australianunity $ 271.55 ahm $ 275.15 peoplecare $ 304.60 nib $ 327.18 @OldBugger: My thoughts about the promotional offers, looking only at the minimum holding periods to be eligible^:
Insurer Comment frank ✅ Good as the 6 weeks are available after one month Bupa ✅ Good as the initial 6 weeks free are available after 30 days GMHBA ✅ Good as the 6 weeks are available after one month australianunity ⛔ Not good as 'minimum period of 60 continuous days' required ahm ⛔ Not good as offer applies 'after their first 60 days' peoplecare ✅ Good as 'must be held for 30 continuous days' nib (and nib resellers) ⛔ In years of churning, NIB offers are never good. There is no current 6 weeks free on the home page. The $600 offer that is there requires holding the policy for a minimum of 2½ months before the offer applies. This same rule typically applies to the 6 weeks free offers from NIB and other brands that resell NIB. You can exclude all of these immediately for being uncompetitive. ^ This is the key thing I look at, then the other rules. You want maximum benefit in the shortest period of time.
@wisdomtooth: No because at various times the other funds also have offers.
The list of funds in the above table simply replicates the funds nominated by OldBugger.
@YesPleaseThankYou: Thank you for this table, it's a really great starting point as there are so many different options out there.
I am under 30 and new to private health insurance and getting it to avoid the Medicare Levy surcharge.
From your comments, this is my understanding. Please correct me if wrong. For the purpose of simply avoiding medicare levy surcharge (i.e. saving $$ but not so much individual coverage):
Sign up with any insurer ASAP, for example, Frank. After 1 month with them, get 6 weeks free. After the 6 weeks, then switch to the next insurer such as BUPA, for 30 days, and then get 6 weeks free. Continue that cycle.In the meantime, keep an eye out for any insurers that may have promotions - anything that offers 6 weeks free after one month is considered good value in this market.
Also keep an eye out for each insurer as some have a period (such as two months) in which you cannot abuse this one month membership then 6 weeks free when you rejoin them as a 'new member'.
How does this work when doing taxes? Do you have to put in the insurer details + period you are with them for all of the insurers, to avoid the Medicare Levy surcharge? i.e. do i need to keep this documented somewhere.
Do the 6 weeks free period kick in automatically once you have met criteria (e.g. 1 month membership), or do you have to email them? i.e. if you forget to tell them you are leaving, does it go like this: 1 month paid, 6 weeks free, and then further months paid?
Thanks in advance.
I am under 30 and new to private health insurance and getting it to avoid the Medicare Levy surcharge
There are many other posts elsewhere about avoiding the surcharge.
As 'avoiding the surcharge' is of little interest to me, I know little about that. However, based on my limited understanding, 'avoiding the surcharge' can be achieved by purchasing the cheapest qualifying policy—but then don't come complaining when something happens and you're not covered for that body system etc.
Note that hospital and extras cover are separate. You don't need extras to avoid the Medicare Levy Surcharge. Note, however, most of the '6 weeks free' promotions require you to take out both hospital and extras. Very rarely will be an offer that does not require both (though I do recall seeing one recently).
Continue that cycle.
Basically correct. The terms and conditions of each insurer and promotion vary wildly. Read those carefully.
anything that offers 6 weeks free after one month is considered good value
Private health insurers are limited by law how much they can discount. My guess is that the 6 weeks free is the maximum insurers can offer without being in breach.
I calculate savings based on what I refer to as the 'minimum holding period'. With 6 weeks free offers, you usually pay 1 month then get 6 weeks free. A back of the envelope calculation looks something like this:
- Pay for one month (converted to 31 days for this example)
- 6 weeks free (converted to 42 days)
- Total period of cover: 31 paid days + 42 free days = 73 days
- Discount: 42 / 73 = 58%
When there are multiple offers available, I see which brings me the biggest discount.
How does this work when doing taxes? Do you have to put in the insurer details + period you are with them for all of the insurers, to avoid the Medicare Levy surcharge?
No. The funds supply the info to the ATO. I have never had a problem with this.
Do the 6 weeks free period kick in automatically once you have met criteria (e.g. 1 month membership)
Mostly, yes. Due to incompetence by the fund, you may have to chase up.
- Use email so you have a record.
- Use complaints escalation policy of fund
- Use Private Health Insurance Ombudsman ('PHIO') in need.
Don't be afraid to do so.
if you forget to tell them you are leaving, does it go like this: 1 month paid, 6 weeks free, and then further months paid?
Yes, they will restart billing after the free period. After all, the free period is intended to have you join and stay.
with the churning, what happens about waiting periods?
No impact—they are transferred to your new fund, refer https://www.ombudsman.gov.au/__data/assets/pdf_file/0020/294…
Most u need hospital and extra. And 6 weeks doesn’t kick in till 2 month have been paid. Still will save money especially when on high salary and you have to pay levy surcharge otherwise.
I just switch between bupa and Ahm so the claim limit resets 6 month instead of 12
Is this the claim limit for extra? So you just switch between the 2?
and if you're over 30, healthy and earn less than the medicare levy threshold, and haven't had cover since you were 30, you definitely wouldn't get it due to the premium loading.
The loading is not that bad, much less than paying PHI for several years when you don't need it.
says the 31yo
but I agree, being forced into a lifetime of insurance is a lot of money
@SlickMick: Actually 53, I had insurance for a couple of years at about 40 then cancelled when the MLS threshold increased, I took it up again last year and still saving money compared to the MLS while paying the loading, I think its about 15% (average of family members). The loading also expires after 10 years.
@SlickMick: You're still ahead, no? You saved 24 years of PHI, and will pay less than 5 extra by the end of the 10 years of LHC loading, yeah?
@wisdomtooth: How so? I pay 148% for the next 10 years, right?
Sure, I'm ahead of paying 100% for 30 years, even considering medical expenses I've paid out of pocket.
But I'd also be out of pocket a heap paying 148% of RRP.I'm happy to be corrected if I'm missing something…. in fact, I'd really like to be corrected, because I'd like to avoid that medicare levy surcharge.
@SlickMick: You only pay 48% extra due to LHC for the next ten years. The first 100% is what you'd be paying anyway if you didn't have the loading. The low end cover works out substantially less than MLS for me with 17% loading. Not sure if it still does at 47% (they take average of members for couples policy). Does depend on income and whether you expect to be earning enough for MLS for more than 10 years. Whether you pay the MLS or not, you are still better off by about 20 years worth of premiums (if assuming the health insurance itself has no value, that is another argument altogether).
Private insurance doesn't improve access to cover, just the ability to pay for it.
You can pay cash for any service covered by private insurance.
Whether paying a predictable premium every month is better than the possibility of a large one off cost goes to the very root of insurance.In Australia, where cover for serious issues is included as part of Medicare, means private cover is only sensible if you think you need the hotel style accommodations and choice of doctor etc. but don't have access to a lump sum to pay for it.
I think it is poor value for younger people and healthy people, and the population agrees, hence the penalties to force wealthier young people take out the cover
But some people can't sleep at night for the risk they might injure their knee and not be able to see a specialist immediately without paying private fees. In that case, maybe private insurance is a good deal.
And if you are older, with a family history of heart issues, or a hip or knee that might need replacement, then private insurance is likely a better deal, as you are much more likely to actually use some of the costly things it covers
You can pay cash for any service covered by private insurance.
Some specialists won't see you unless you have private health insurance for the related surgery.
Tell them you are paying for the surgery cash. I think what you mean is they don’t want to give an opinion that then ends up with you on a public waiting list, so they prioritise people who will use them for the treatment.
I think what you mean is they don’t want to give an opinion that then ends up with you on a public waiting list, so they prioritise people who will use them for the treatment.
No, I meant what I said.
There are now many reports of specialists who will decline to see you if you dont have PHI. It's not about prioritisation, it's flat out 'we won't see you'.
I guess these are doctors that are prioritising volume work ($$$) over care for the patient.
@YesPleaseThankYou: That is wild. Quite apart from the patient care aspect, it isn’t financially most advantageous. Though I suppose I might do that too if I had experienced a few bad debtors who wouldn’t pay my $15k bill.
Though I suppose I might do that too if I had experienced a few bad debtors who wouldn’t pay my $15k bill.
its not necessarily the initial 'bill' cost that's the issue, its the ability to cover the liability for 'unforeseen' expenses due to complications etc.
You might be fine to pay $5k for some surgery out of own pocket, but if a complication arises during surgery the resulting $10's k additional emergency cost fees are the liability some specialists don't want to have to deal with, so some have restrictive 'no non-private' patient rules.I couldn't even get one ankle specialist to give me an appointment to review a scan and explain potential 10+ year impacts being a non-private insurance covered patient.
its the ability to cover the liability for 'unforeseen' expenses due to complications etc
I think this is what mskeggs is suggesting. But this is spot on.
It's not about prioritisation, it's flat out 'we won't see you'.
I can attest to this. Being a full advocate for self insurance, my recent "breakage" was a real eye opener. Ringing around, many reception staff would, as you say, flat out refuse to book me in for an initial consult without health insurance. Others would book me in, and gladly take the consultation fee, but once I saw the surgeon, he/she would decline to go further once they knew I didn't have PHI. One even went out and told his reception staff off for allowing me to see him without checking on this.
I asked one surgeon, who I got in to see but then got all hesitant once he realised I didn't have PHI, why are so many are hesitant to see patients who want to pay in cash (especially for a common operation)? He said it is not questioning the patient's ability to pay the quoted operating cost, but the fact that once you are being operated on, anything can happen. For example, if something goes wrong and the patient ends up in the private hospital's ICU, costs blow out dramatically and cannot be estimated.
@OldBugger: I bet you were both filthy with these specialists.
FWIW, I have self insured two surgeries in my family and didn't have this issue, but it would be extremely annoying to encounter.I wonder if they would similarly decline Chris Hemsworth or Lachlan Murdoch, or if it is only non-celebrities they refuse.
@mskeggs: Ha, nah… I wasn't slamming doors behind me, but took it as a learning experience, especially as I was interested in the HI topic already.
I have self insured two surgeries
Yeah it is definitely possible. Actually the first surgeon I saw on the injury was awesome, made up quotes and was happy to go ahead. He was almost too relaxed about it all (didn't even look at my scans). When I returned back to book in, after getting a few more opinions, he then went all timid like the rest and declined. Was odd… kind of like that Seinfeld episode where Elaine kept getting refused by doctors… maybe they have notes on me now.
You might be fine to pay $5k for some surgery out of own pocket, but if a complication arises during surgery the resulting $10's k additional emergency cost fees are the liability some specialists don't want to have to deal with, so some have restrictive 'no non-private' patient rules
Aren't you signing papers before the surgery that you agree to cover all costs including non-expected?
@YesPleaseThankYou: Same happened to my son, tore the ligaments off the bone in his ankle while running and twisted his ankle. No specialist would see him because he didn't have Private health and over 12 months wait to even see a specialist for his first appointment public. He couldn't even get past the front reception and offers to pay privately were dismissed. The big kicker was not being able to work for ages which was an even bigger cost. You might be fine if you are lucky and live in a capital city and have lots of options but live regionally and you are totally stuffed.
That's me, in the "being severely unwell or in pain is not a way to live" so I pay the PHI in case I need something with a 2 year waiting list on Medicare. That being said I try balance the price with the cover so I'm only on silver plus.
I don't fully understand the question. But I guess some cases where it may not be wise to have PHI is when one can't afford the premiums, or one is already covered under their parent's cover. Maybe also if one is on their death bed or possibly leaving the country for an extended period of time. Just some cases that came to mind.
If you don’t want private cover, I’d recommend at least getting ambulance only cover. Ambulance costs are not covered by Medicare.
Costs start at around $5/month, but a single ambulance trip starts at around $400 and can go into the thousands depending on distance.Ambulance costs are not covered by Medicare.
They are in Qld (for actual emergencies).
I don’t believe it’s covered by Medicare (federal funding) even in Qld. Ambulance fees are covered by the state government.
Right.
Qld govt used to have Electricity company add an ambulance levy to every power bill. I got one for home bill and another for business bill - double dipping by Qld. govt..
I have basic hospitals and basic Extras mostly for tax and dental reasons if it wasnt for the medicare Levy Surcharge i wouldnt have PHI
Just get hospital for surcharge. For dental, if it's mainly basic clean n fill, just pay outright
Just get hospital for surcharge. For dental, if it's mainly basic clean n fill, just pay outright
i got 'family' cover it works out roughly the same once you put the kids into it cost me and extra 12 bucks a week 600 pa) i usually spend around 1200 on dental the extras gives me the 'add' benefit of other services like optical which i do 'sometimes' use - i personally dont use anything else but it is roughly the same price and usually PHI have some kind of bonus if you sign up to Hospitals and extras for 12mos ie gift cards, free weeks cover etc
If you earn <$90k a year.
This would be my yardstick.
As a single 😉
Surely they should up the threshold for the polyamorous!
Going up to 93K next financial year
Lifetime health cover (LHC) loading. Are you under 31? If you have not taken out and maintained private patient hospital cover from the year you turn 31, you will pay a 2% LHC loading on top of your premium for every year you are aged over 30, if you decide to take out hospital cover later in life. For example, if you take out private patient hospital cover when you are 40 years old, you could pay an extra 20% on the cost of this cover per year for 10 years.
But wouldn't it still be less to pay for loading when you need it/start earning $$ than to pay for PHC without utilising it?
LHC only applies to hospital cover, not extras. Younger people who have no chronic health conditions are unlikely to need private hospital cover, but the government needs the healthy to subsidise those who consume health care services.
Yes, much less.
I wonder what the stats are for take-up of this? I tried finding some but couldn't.
Here is the latest analysis on the PHI industry. https://www.accc.gov.au/system/files/Private%20Health%20Insu…
A quick search didn't show anything about LHC, but people might find the report interesting nonetheless.
When you can't trust your state health system.
Ready to blame Dan ?
I mean Dan has had enough time in power to fix the system. But I think all health departments are too big and corruption culture too strong for him to do anything about it without risking losing the top job. You can't fix the system if you've been stabbed in the back.
In Which Cases Is It Not Worth Paying for Private Health Insurance in Australia (for Australian Citizens)?
- earning under $90k as a single or $180k as a family, or
- not planning on starting a family, or
- aren't old and have impending hip replacement/knee reconstruction/pre-existing elective surgery conditions etc etc.In any other cases, you'll be better to use the money otherwise spend on premiums in your offset account or an investment account, and then self fund medical bills.
As it is, I'm really subsidising those in the above three categories.
Note the previous comments about specialists refusing to treat uninsured patients, a problem I recently discovered. I actually have PHI, but my high excess ($1000) meant I wanted to be a public patient for a very common minor procedure, but this isn't possible short of travelling a significant distance (& possibly hitting the same issue anyway)
The Medicare levy surcharge income threshold for a family has remained at $180k from 2014–15 to 2022–23
Now after 8 years,they increased it to $186k.
What a joke?
The government is basically killing Medicare deliberately and wanting us all to pay private profiteering companies for medical services which should be available to everyone in a developed country.
Medical services is available to everyone in a developed country. It's just you have to pay for it instead of the taxpayer (think the US).
I am the taxpayer. I dont mind if I have to pay more taxes but I want the best Medicare possible.
I dont want to be at the mercy of these blood sucking private companies paying their CEO's hundreds of millions by looting us.
Its well established that the most expensive private medical system(USA) has poorer results than the best funded public health systems of various developed countries.
I wasn't making a comment which funding model is best. I was simply referring to your statement "… for medical services which should be available to everyone in a developed country." - it is available, it's just either you or the taxpayer having to pay for it. It's still "available to everyone".
Yes you are a tax payer but your tax money isnt used to fund Medicare. The government uses its money to fund Medicare.
Like most insurance based on probability it's probably not worth it. However, for some it definitely is.
My uncle was told it was a min 3 month wait in the public system for a possible cancer removal. He had private insurance so decided to pay the gaps and go that way and had the surgery the following week. It turned out it was cancer and he started treatment immediately. His doctors told him if he'd waited another 3 months he'd be unlikely to have lived another 12 months.
A friend had a knee issue that required surgery and meant he couldn't walk without bad pain after a few mins. Public system was 12month wait minimum, he had surgery in 2 weeks in private and was back to normal again after 6 weeks. Yes he wouldn't have died but that's a year of his life he wouldn't had been able to do the things he wanted if he didn't have PHI.
For me, I have been paying the premiums and not needed anything so probably not worth it if you look from that perspective. Probably a bit deep but as I've got older I value time and health a lot more than money so I'll continue to pay just incase.
100%
You seem to be equating private insurance with private hospital, but one can pay private hospital out-of-pocket. Unless… one can't pay. But, then, one can't pay PHI either. So the question is: which one is cheaper; private funding or private insurance? This of course varies case by case, so question really is: which cases private funding is cheaper than private insurance, and vice-versa?
This is a fair point. I don't know the costs of the two situations I mentioned out of pocket. I'm not sure if being able to afford PHI and being able to self-fund would be equivalent though.
My dad had two knee replacements done privately, which the PHI paid out over $50k for about 12 years ago. I'm not sure if that's also the cash price or inflated for insurance like many things. I'd be curious to see the cash prices with no insurance on some of the more common serious issues if you're able to find them.
In my uncle's situation, it would be an easy decision to self fund if you didn't have PHI if you knew 100% it was cancer, however the docs indicated it most likely wasn't but they couldn't be 100% sure until they did the surgery. He was faced with the decision of about $1.5k total out of pocket to get it done immediately and be sure or wait the 3 months for public so he decided it was worth it. If you didn't have PHI and were faced with $25k (just a guess) or wait 3 months for the public system for something that most likely isn't cancer I think many would wait even if they had the savings. That decision would've cost him his life in his situation.
I have private health insurance for two main reasons:
- I'm going to be beginning the process of having a baby soon and want to be covered just in case.
- I train and compete in a strength sport, and an accident could easily occur (already had one this year that was inches off of 200kg dropping on both of my knees, which would not have ended well haha). I want to know that if I do tear a bicep, or dislocate a shoulder, or whatever, that I will be able to get surgery from a potentially private doctor, not just whoever is on at the public hospital whenever I can get in.I recommend Private for sports injuries. Had a complete grade 3 bicep tear in my 20s (water skiing). Was in surgery and sewn back together within a week. I was told by the surgeon if i had to wait for surgery through the public system i'd most likely never have full function of that muscle again.
Took along time to heal, 1 year before i could fully straighten my arm. But now it's stronger than ever, with a nice 5 inch scar.
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Wife needed to get a ct scan a couple of weeks ago. The earliest public appointment, was in August. Private was able to get an appointment later that week