Putting members’ health before profit

Do I Need Private Health Insurance? 6 Situations You May Need It

If there’s one thing that’s certain in life, it’s that you never know what it’ll throw at you. While we’re fortunate to live in the most medically-advanced period of history, unfortunately, that doesn’t mean that you won’t get ill, sick or hurt at some point in your life.

Luckily, we have some great healthcare providers here in Australia, in both the public and private sectors, so if you are ever in need of medical care, you’re going to be able to get the help you need. However, private health insurance does have certain benefits over the public health system, and here, we’ll be looking at those advantages, as well as the situations where private health cover may be preferable.

1. You Want or Need Shorter Waiting Times for Surgery and Emergency Care

One of the situations you’ll most likely need private health insurance, is if you’re in need of elective surgery, and want it carried out as soon as possible to improve your quality of living. 

According to the AMA, the wait for surgery in the public system can extend well beyond two years. That can mean putting your life on hold, being in pain and becoming dependent on strong painkillers like opioids. 

In Tasmania in 2022, patients who are assessed as Category 1 and need to see a neurosurgeon 30 days from the referral by their GP, were expected to wait for 880 days. Less than one in two children with Category 2 referrals (to be seen in 90 days) from GPs in Queensland are seen within clinically recommended times (48.7%). 

By opting for private hospital cover, you can skip long waits by getting access to private hospitals and can have your elective or planned surgery carried out much more quickly.

No-one wants to be left to languish in pain and uncertainty and there’s evidence to suggest that many people have been switching to private health insurance policies in recent years for exactly that reason. To avoid long public hospital waits. In fact, over 860,000 Australians have signed up for private health insurance since the beginning of 2020.

It’s a similar story when it comes to receiving emergency care. In 2021-2022, almost 40% of Australians spent four hours or longer in the emergency department (ED). Provided you’re admitted as an inpatient following your visit to the ED, there’s a good chance you’ll be seen more quickly in a private hospital, with your costs being covered by your health insurance policy.

2. Your Medical Needs are More Complex or Comprehensive

Certain aspects of healthcare aren’t covered under Medicare, including dental treatments, ambulance services, glasses or physiotherapy. One of the benefits of private health insurance cover is that these services are covered (or can be, depending on the level of coverage you take out).

Knowing you’re covered grants policyholders greater peace of mind. Put simply, you know you’re protected when you take out private health insurance.

So, if you think you’re going to be in need of additional healthcare, then consider taking out an Extras policy. It’s important to note that you may also need to take out additional Ambulance cover, as a separate part of your policy. 

Get in touch with your private health insurance provider for specifics on this front. This way, you’ll help avoid any surprising out-of-pocket expenses.

3. You Want to Be Able to Choose Your Doctor

If being able to choose your doctor is important to you, then private health insurance is the answer. With public healthcare, you have little or no choice when it comes to the doctor you want to carry out your planned surgery, for instance, you could receive care from a junior registrar.

In the private system, you can choose the doctor that you want, putting you more at ease, and removing stress from what may already be a highly stressful situation.

In the private system, because you choose your doctor you also benefit from greater continuity of care. You get to see the same doctor throughout the course of your treatment and can reliably schedule appointments.

There can also be more resources available in the private health system such as prehab to prepare you for surgery and team-based care to assist recovery after surgery.

4. You Want to Avoid the Medicare Levy Surcharge

If you’re a middle to high-income earner, then it can make sense to take out private health insurance. Why? To avoid the Medicare levy surcharge. This is an additional charge paid by people who don’t have private healthcare. For single people, the surcharge kicks in if you have an annual taxable income of over $90,000, whilst, for couples/families, the income figure is $180,000, plus $1,500 for each dependent child after the first one.

If you’re going to end up paying more anyway, then you might as well take out private health insurance that’ll see you get treated more quickly and with greater flexibility. Indeed, the whole purpose of the surcharge is to encourage those who can afford it to transition to private health insurance. So, do the smart thing, the one that makes financial sense, and avoid that fee.

5. You Belong to a Specific Industry

One of the great things about the Australian private health insurance sector is the number of different members’ health funds that are available to people. Whether you work in the education, health or military sectors to name just three, or live in a particular state, city or region, there’s a fund that’s right for you.

It can be reassuring knowing that you’re part of a fund specifically set up with your profession or location in mind. There may be certain nuances, needs and complexities that affect your healthcare/insurance needs, and taking out a policy under one of these specialised funds can help in that regard.

6. You Want Flexibility With Your Medical Cover

It’s impossible to know just what medical needs you’ll have years from now, or even tomorrow. Because of this, you want the ability to choose your level of cover.

When a private health insurer offers a hospital policy, it can be categorised into one of four tiers: basic, bronze, silver or gold. The difference, as an example, is that complex medical needs like joint replacements, palliative care or dialysis for chronic kidney failure may only be covered in a silver or gold policy. More straightforward needs, however, may be covered by a bronze policy (which still requires that the insurer cover everything from the brain and nervous system to gynaecology).

Other Things to Know About Private Health Insurance

Age-Based Discounts

Private health insurance is surprisingly affordable for young individuals, debunking the myth that it’s unattainable at that age. Specifically tailored to those aged 18 to 29, age-based discounts are available, allowing for up to a 10% reduction in premiums.

These discounts provide a practical avenue for young adults to secure comprehensive coverage without straining their finances. Learn more about the advantageous age-based discounts by clicking here.

Tax Rebates

To make private hospital insurance more affordable for more people, the government offers an income-tested private health insurance rebate which people can claim off of their private policy. This rebate applies to both hospital and extras policies but does not take effect on lifetime health cover loading. Find out more about this rebate here.

Types of Private Health Insurers

Broadly speaking, there are two main types when it comes to private health insurers; for-profit and not-for-profit or member-owned. As you might have already inferred from the names, the main difference between the two relates to their attitude towards money generated from policy premiums.

The former aims to generate as much profit as possible, while the latter (which is where we stand here at Members Health) is focused on the care of its members. Using ourselves as an example, for instance, as a group we pay more of the premium dollar back in benefits to members.

Whereas for-profit insurers operate with shareholders’ interests at their core, not-for-profit and member-owned funds are run firmly with their members in mind.

Final Thoughts on Private Health Insurance

Private health insurance is a great alternative to public health cover, offering you greater control, choice and flexibility, reducing your wait time for treatments and providing access to private hospitals. With age-based discounts available to younger individuals and couples, industry-specific funds, funds based in different regions and cities, and a private health insurance rebate offered by the Australian government, there’s never been a better time to go private.

Check out Members Health’s full list of private health insurance funds. If you’d like to get in touch, then don’t hesitate to send us a message via one of our online enquiry forms, or by sending us an email at info@membershealth.com.au. We look forward to hearing from you.