Without doxing myself, I’m a somewhat healthy person that’s under 25.
Wouldn’t the optimal play be just get a decent extras plan to cover optical and dental cover?
And unless you earn over $93k for Medicare levy then just opt in for Medicare
As private would cost $100-$150 a month easily with seemingly little benefit for those that are younger and highly improbable that you’ll need a knee reconstruction covered anytime soon.
Interested to hear thoughts.
@SlickMick: The cost of private vs public isn’t simple. Can you work in your usual role whilst waiting for public, do you get deconditioned and if so what are the associated costs, do travel plans have to be changed, do you get a secondary injury due to the first? Etc.
@morse: Hence just pay the upfront cost rather than spending 1000's on cover which at the end of the day only covers a small portion.
@Drakesy: It covers more than a small portion. In the event of a claim for admitted care the insurer pays the vast majority. Which is why investors are also invested in the private hospitals that get a combination of revenue streams so they are effectively paying themselves as well as Medicare paying them; remembering that the gov also pays part of most procedures done in the private system.
@morse: But when you break it down to the amount youve paid for premiums vs the amount they pay out 90% of the time tou would've been better off not taking our phi and putting the money in the bank.
I had to get a septoplasty. Medicare covered $500, phi (at $1500 a year) covered $2000, i was out of pocket $1500 at the end of it.
So basically they gave me $500 of my previous year's premium back. How charitable.
@Drakesy: The big bucks are procedures worth way more than this. Like $20-150k, that’s what both sets of punters (patients/hospitals) are in it for + all the partner ancillaries like pathology.
I’ve had private health hospital and extras since I came off my parents, and I think for some of the years over the last 15, it was not really worth it. I mean I’d get maybe $450 back in dental if I didn’t need fillings, $150 in optical, $300 in massage and $300 in physio if I was having a bad back year, so extras was likely covered but hospital not so much… most of the time I’ve been to hospital it’s been as a private patient in public too for some reason…
In a year when I need a sleep study, or an endoscopy or colonoscopy, or when I’ve had an operation for various minor things, it covers about 1.5 years worth of premiums. In my mid 30s now and just increased my hospital cover cos… getting old sucks and I don’t think I’ll be far off more procedures 🥲
For context I’ve got a couple of mild-ish musculoskeletal issues and neuropathy from 20 years of sitting at a computer for games or work…
Do you have at least 100K cash or assets that you can turn cash for emergencies? If not you don't have the rights to consider if PHI is worth it. Find the best that suits your budget and move on. Save people around you trouble when you are in health debt.
If you do have the ability to pay for everything then you are self insured you don't have to care about PHI. I am financially able to pay for most major operations and long term hospital stays but I still purchase PHI.
PHI is a type of business and a business needs profit to survive. So you are not only paying for insurance but also to keep a company running. Hope you understand your money is not going down the drain but for the PHI employees salaries.
don't even need 100k. 20k would cover most elective surgeries/short admissions, for anything acute and more expensive you would likely be in a public hospital anyway (acute trauma/ICU)
Why would I care about paying PHI employees salaries? Is rather put more money into Medicare.
Hear, hear.
( or just inflate the share-price of transnational corporations )
PHI is a type of business and a business needs profit to survive. So you are not only paying for insurance but also to keep a company running. Hope you understand your money is not going down the drain but for the PHI employees salaries.
What kind of logic is this? So we should always go out and buy everything regardless of whether we need it or not because the companies making the things we're buying are paying salaries of their employees?
Unless you're making a brazillion bucks a year then no. If you use it, you'll be paying out of pocket for the pleasure. You could also try the "fxck around and find out" approach. Dropped mine quick smart when I needed to "use" it, the out of pocket costs were insane.
No.
There is no blanket rule as everyone’s situation is different. I opted in last year as mls + out of pocket expenses for general healthcare is higher than pvt health for similar level of cover + other signup bonuses you get ✌️.
The story of any insurance is you don't know what will happen. As a 25 years old the odds is quite low you will need it so you can take the risk until 31 when the loading kicks in for not having PHI. We used it first time when in our middle 30s, and it was a quite ok experience with a doctor of your own choice, hospital of your own chocie, and even the timing of your hospital stay etc.. so I would say with the peace of mind as a bonus, after 31, if you earn above the penalty threshold for not having a PHI, definitely go get one.
So we pay for PHI and if we need to use we pay the excess and then we pay the "gap" for the surgeon, assistant surgeon and more gaps depending our treatment. I thinks the wheels have fallen off the wagon.
I used to work in the PHI industry. Based on my personal experience, the vast majority of PHI for the vast majority of people is not worth it.
There were only 2 scenarios I ever found that were worth paying for PHI imo:
1 - If you are actively paying for extras type services prior, and will continue to use them, this can be beneficial - based on what you said in OP you are not.
2 - Depending on your income it may be beneficial to get junk cover to reduce your Medicare levy surcharge.
I mean even absolute max cover dental which you mention in your OP, has Lifetime limits on it, and based on what I have seen, you end up out of pocket the majority of times.
There are other less financial tangible benefits, reduced wait times, "choice of doctor" etc.. but personally I just don't see the value in it and choose not to purchase it.
"highly improbable that you’ll need a knee reconstruction covered anytime soon."
I guess you aren't playing sport then
.
Health insurance isn't a free market. It is heavily regulated. The premium you pay is not based upon risk. A healthy young person pays as much as a sick old person with diabetes, rheumatoid arthristis, hypertension and renal failure. As a young person you are subsidizing the sick.
Australia should scrap the private system and have a pure single payer system. Wealthy people shouldn't get the red carpet treatment while the proletariat only has a massively underfunded public system (eg 2 year wait to see as hospital specialist as an outpatient). The money that was previously flowing to the private system gets redirected to public. Private hospitals become part of the public system.
Equality means equal treatment regardless of wealth (just like we are supposed to have equal treatment before the law).
I am still paying for it, but i know more and more people (not even that young) who have decided to not pay for it anymore. They felt the prices kept rising too high and they werent seeing much back and its somewhat true. It comes across as a bit of a scam in a way to get a lot of money into certain peoples pockets as they keep lowering what i get back but keep increasing the prices.
It's a scam for healthy young people. Only get it if it reduces your tax.
Most Private Health Insurance are useless or cost you an arm and a leg then it's useful. It does not benefit people with good health history, especially young people. Optical/dental/gym/massage/etc benefits are charged on top of what you pay, at an even more expensive rate than when you take them out by yourself. This is why the government want to charge you life time health cover loading after 31 otherwise not many people take Private Health Insurance.
Take the premium and invest it instead. In twenty years time you'll be way ahead. If something happen next week just create a go-fund-me page
By at least having the lowest tier cover you get into the private system. Even if you have to pay out of pocket it saves you from having to wait for a spot in the public system. My dad is a specialist surgeon. At the moment it is over a 2 year wait to see him or another surgeon in the public system and less than 2 months in the private system. His speciality is an area that if you need this kind of surgery, a 2-year wait may mean you have issues for life. This is not just the case for this specialty many surgical specialists are the same.
But there is nothing stopping you getting a GP referral and just being seen as a self-funded private patient. You don't need PHI to get into the private system.
Sure but a lot of surgery self funded privately will cost an absolute fortune. Mine easily would have been over $50k
Unless you're really cashloaded and that's peanuts.
Not worth it before 30 and even now I prefer to pay the medicare levy.
F**** private health companies. Health should be universal.I would rather pay the levy and put the money back into public hospitals instead of greedy corporations. Just another step to become like America.Not sure if its true but sounds about right, most people in America go bankrupt from medical bills. No one should have to do that.
Not sure if this helps but its a niche example that I think sheds light on how trash the whole system is.
My old job (I was around 26 at the time) had a reimbursement scheme for health insurance so naturally I went for a very fancy one.
I knew I had surgery in my medium term future so I tailored it to suit.
After a couple years I had wisdom teeth extraction under anaesthetic and significant nose/sinus surgery. All in all I got about $2k back from them, paid about $10k out of pocket, all while 'paying' about 3k per year premiums as a young adult. The main reasons for the charges were insane caps, deliberately dodgy item coding by the surgeons (so they could charge more and not be covered), and tonnes of made up private charges. In short, I was screwed by all three sides, the doctors, the hospitals and the insurance company.
In hindsight, if I had just gone public for it all I would have received the same procedures, faster, and likely at a better standard (my private doctors were unbelievably bad. eg the anaesthetist had 5 failed cannulas in my arm before knocking me out, and when I woke up my entire arm was busted from about 4 baaaadly failed arterial lines… I have quite prominent veins, was fit and low bf%)
TLDR: I had Rolls Royce private cover for about 3 years. I estimate it cost around $18k out of pocket compared with going public and bare bares insurance. All to get woefully bad care.
As a side note, I have now started going the bare minimum route, and the absolute cheapest I can find that offers literally nothing is $1000. If I don't get it I'm charged $3000 medicare surcharge (on top of already paying $4k for the base Medicare tax).
How could this be seen as anything other than a mafia scam??
This is an incredible story. $xx,xxx to get out wisdom teeth in a corrupt system. Who knows how much you would have paid if you got it done overseas at a great facility. Maybe $xxx.
why would the surgeon care whether a code is covered by insurance or not? it doesn't make any difference to them. the problem is your cover was junk and your surgeon was very expensive. it's a very complex system. always compare surgeon fees, ask about no-gap surgeons, and look at policies and how much it actually pays and whether it's "gap cover"or otherwise . if you get the top tier cover from doctors health fund for example it will give you AMA fees which most surgeons charge.
hey sorry have been on here since my rant.
I actually called around at the time and it wasn't due to junk cover. It was specifically due to the surgeon using a hospital code that immediately maxed out the care specific part of the hospital cover. I begged them to change it to what literally every other surgeon used, and they refused as they knew I wasn't going to spend another year waiting via a different surgeon.
Thanks insane, I had all my wisdom teeth out under general all private out-of-pocket and it was between 3-4k total for the dentist, day surgery stay (private center) and anesthetist
Yeah, I have always known this but at the same time have also heard from people how if they didnt have private insurance, they may not have been alive..
By the way, who is your insraunce provider for the $1000 insurance?
Yeah the Private health system is really just a way to funnel money away from the capable public system (which would be more capable if provided with the funding that PHI companies are draining from it.)
Whenever this come up people seem to not understand that you can just pay for things if you don't have private cover and by doing so YOU get the medicare rebates and the costs are typically much lower then the same services charged to an insurer. I feel like people watch to much American coverage and think everything costs vastly more then it does.
The biggest cost for almost anything is going to be the hospital stay but even that isn't generally that bad especially if you can get day surgery or better yet get the procedure done in a public hospital just with private surgeon/Anesthetist. With how expensive PHI is and with the 'gaps' it is going to be cheaper for most people, most of the time to just pay fully out of pocket to skip public waiting lists rather then gamble on spending thousands/10s of thousands in hospital premiums only to still end up with inflated out of pockets.
Also on the subject of Medicare levy that is 110% a scam that is ripping off tax payers. I proudly pay the levy, getting shit-tier PHI to avoid the levy is pure political corruption to funnel more money into private company hands. I get people are generally quite selfish and happy to throw future generations under the bus if it means saving a few bux but I'll pass on aiding in the shitification of our medicare system thanks
If you are a private pt in a public hospital you would have to pay for both the bed and surgeon/anaes. You can't get medicare to pay for one and get private treatment paying for surgeon only. The govt wants to funnel money towards PHI and hospital cover because PHI will pay for your admission instead of Medicare. So you aren't doing them any favours by paying MLS UNLESS you never end up in hospital as it's likely cost of one admission would cost over 10 years of MLS
Another option, find companies that subsidise or provide private health insurance to employees for free - there are quite a few doing so and that's why each PHI has corporate plans.
Currently get a generic corp discount on extras ,
Although still feel phi isn’t worth it,
This is why I wanted to know others options on it
Its a scam we all are forced into.
Wait till you're 30 and take out the trash tier cover or sooner if you meet the Medicare limits. Blow it on all message coupons
If your income allows, put aside some savings for medical situations enough to pay for things like dental instead of paying high health insurance premiums. You'll still be better off as compared to being stuck with never-ending premiums with these blood suckers.
Buy it when you're 30.
Seems to be the thing.
Im 32 and have had my own cover since i was 18, i mainly use it for dental and have a had a few operations and have had nothing out of pocket to pay. If you have ever been into a hospital as a patient you would much rather be on the private side.
Hi,
As a rather extremely unwell young person (23 year old). I would say private health insurance is not worth it IF you are well up to date with your health checkups. Simply going to the GP once every 6 months for a full check up including full blood work etc will probably set you up well for the next 40 years. Preventative medicine is much better than the solution.
For me the best thing with private health is how fast you can have the surgeries you need. It's also nice to be able to pick the private specialists you want. But just note that consultation with these specialists you're still paying full price out of pocket. Private health is really only good for the extras (if you use them) and for when you do need surgery. If you were to just simply save up a certain about of money. Lets say ~50 a month and just a bit of luck. You can still go to any private doctor and pay for the surgery while still probably saving money overall.
Hope this helps :)
To those suggesting self insuring, and paying full fees out of pocket -
I have seen people mention in similar discussions that surgeons may actually refuse surgery. You may be able to front 30K for the operation but what happens if something goes catastrophically wrong (1% of cases eg) and you need another 100 days of hospital after that. Based on this risk they may not accept you because the risk becomes theirs.
Extras for optical is only worth it if you want to / need to buy new glasses every year. You still get (profanity) over with things like the frame, anti-reflective coatings, etc.
Dental, only really if you do the cleaning thing every 6 months on schedule.
P.S. Since you're 25 and talking about your long term health, always protect your hearing, wear ear plugs when you go to noisy venues!
Extras is the most profitable part for the insurers and the bit thats easiest to cover if needed
I always had private health insurance, from my 20s to now 30s.
I've hardly ever used and even so I'm a healthy individual, I've had to do exams in the past that would have cost me easily $1k but I barely paid $100
Also, it reduces tax I have to pay.
Health insurance is one of those things that you cancel because you find it useless, then you need and regret it.
I have Bupa which is fairly cheap against my income, $160 monthly paid fortnight.
I don't think the benefits of cancelling it even if I really only use it once within a decade saving me hundreds is worthy.
Here's a LPT. If myself and my partner use up our extras budget for the year (regardless of kid's usage), we break even at least, but with the added peace of mind from really decent hospital coverage.
With AHM, we're able to claim back $50 per pharmacy prescription, which we use on medical cannabis.
With Flexi extras, we just do the twice yearly dental check-up and clean, the odd massage/chiro here and there, then use the rest of $900 pp on pharmacy.
That's like a $1500 cannabis subsidy that would have gone to waste in the past with Bupa and a more traditional split cap extras plan.
What do you do with pharmaceuticals?
As it’s usually a PBS or Medicare covered thing right? They generally don’t cover prescribed medicine
Medical cannabis is non-PBS, so I only need to pay a minimum $30 co-payment for them to cover up to $50 per item.
I get back $150 on a $300 purchase.
It's worthy as long as you take advantage of benefits.
Hospital, yes. Extras, no.
Reason for hospital: Hospital some things can cause a fortune. Yes you have public system, but having that private option there when you need to can be invaluable. Insurance for hospital is like house insurance. You hope you never need to use it, but when you do it pays out many x times over it's premium.
Reason for extras: benefits are capped. So your total upside is going to be capped (unlike hospital). i.e. you can mock your own extras by just setting aside the premium in it's own account. That said, if you know in near horizon-but-beyond-cooling-off you will have some big expenses (e.g. major dentistry, orthotics, birth related, etc.) then you can do a quick calc to see if you are better off on the extras and what type. Also extras can be worth it if you have bunch of kids as they come under your family cover, meaning more opportunities that the extras will be used.
Or waiting for public system. To me, it's enough to give me the confidence to go without insurance. If something happens, then I weigh the cost of private vs the wait of public.