Putting members’ health before profit

Should You Use Your Private Health Insurance in a Public Hospital?

If you’ve found yourself needing care in a public hospital, but you already pay for private health insurance, you might be wondering whether you should use that private insurance, or just opt to use Medicare instead.

If you didn’t know: just because you have private health insurance doesn’t mean you have to use it in a public hospital. You can still decide to stick with Medicare if you prefer.

We’ll explore exactly what that means and how to choose the best option for you.


What Happens if I Use My Private Health Insurance in a Public Hospital?

If you use your private health insurance in a public hospital, then you can expect the following potential benefits:

  • Your choice of doctor. As a private patient, you have the right to choose your doctor in a public hospital. This allows you to choose a more experienced and senior clinician as opposed to a junior registrar. 
  • Similar waiting periods to those without private health insurance. Waiting times are far longer in the public health sector. This is a large reason why so many patients choose to go to private hospitals in the first place.
  • You won’t be guaranteed a private room. You might get some preferential treatment in terms of room allocation depending on availability, but the priority will be the medical needs of you vs. other patients.
  • There may potentially be additional fees incurred, depending on the medical treatment you require.

You should always give your health fund a call before going into hospital to ask for advice and ensure you’re covered.

When Should I Use My Private Health Insurance?

Using your private health insurance in a public hospital is primarily to improve the quality of your stay.

However, this is usually only possible in non-emergencies or when the public hospital has plenty of space and availability. If that is the case, then you may want to consider being a private patient for the duration of your stay and treatment.

What are the Benefits of Being a Private Patient in a Public Hospital?

The main benefits of using private health insurers in public hospitals are:

Private Rooms (Availability Permitting)

If there’s availability, you may be able to get a private, single room or choice of room for the duration of your hospital stay. Having your own room is one of the most attractive aspects of choosing a private health fund. Surveys in the past have found that “security, protection, and peace of mind” were the main reasons for going private (67.9%).

Requesting a Specific Doctor

For non-emergencies and less urgent situations, like elective surgery, you have the right to request a certain specialist for treatment.

If you require ongoing treatment, being able to choose your own clinician means you may be able to continue to see the same person throughout your treatment, rather than seeing a different person each time. 

If your preferred specialist works in a public hospital, this might be a reason why you’ve chosen public over private in the first place.


When Shouldn’t I Use My Private Health Insurance?

There may be certain situations where it’s inadvisable to use your private health cover. This includes:

  • When the hospital is running at (or near) capacity. This will likely make it difficult for you to receive the main benefits that private patients receive (like your own private room).
  • Your preferred specialist is not available at the hospital you’re at. A benefit of private health insurance is that you usually get to request a doctor of your choice. However, if that doctor doesn’t work for the public hospital you’re attending, it can prove cheaper to opt for the public patient route and be seen by a doctor under Medicare.

Will I Incur any Out-of-Pocket Costs?

Even though Medicare and your private health insurance policy will cover your public hospital visit as a private patient, you may still incur some additional, out-of-pocket hospital costs.

Why? This could happen if your current level of cover doesn’t extend to the treatment in question, or if the specialist you’re seeing charges a higher price than the Medicare Benefits Schedule (MBS) fee.

Additional Doctor’s Fees

There are also certain scenarios where you may have to pay extra if you use your private insurance policy, rather than Medicare.

For example the anesthetist may charge a higher fee than that set by the Government under the MBS.

It’s always worth doing your research and comparing your policy to the treatment you require, regardless of whether you’re going to a public or private hospital.

Am I Obligated to Use My Private Health Insurance or Can I Be a Public Patient?

No. This is one of the biggest misconceptions in the Australian healthcare world. You’re under no obligation to use your private insurance in a public hospital and are well within your rights to use Medicare instead. 

What Should I Ask the Hospital Staff Before Handing Over My Insurance Details?

If you do decide to be a private patient in a public hospital, then there are a few things you should ask your healthcare providers before you hand over your details. This way, you’ll be fully aware of any additional costs or charges.

Questions to Ask:

  • Do you, as a private patient, get any benefits from using your insurance rather than Medicare, e.g.: a private room?
  • Will you have to pay additional charges to be admitted as a private patient simply for choosing the private insurance route (and not any procedural charges)?
  • Are there any additional charges or out-of-pocket costs incurred for specific procedures/medical requirements e.g.: blood tests, theatre fees, anesthesia, etc.?
  • Ask for the public hospital to provide Informed Financial Consent so that you are fully aware of any fees that you might have to pay if you choose to use your private health insurance. Note: Public hospitals are obligated to provide you with this information.

Does This Contribute to Rising Premiums?

If you decide against being a public patient and instead go down the private insurance route, then you won’t be the first.

In fact, between 2004 and 2014 the number of patients in public hospitals using private health insurance rose from 6.8/1000 to 22.7/1000. More recent findings (published in 2020) have found that “around one in four adults in Australia with PHI cover prefer to use public care.” This is thought to have had an impact on private health premiums, however.

According to the Queensland Country Health Fund, the “decision to be treated as a private patient in a public hospital is contributing to the ongoing increases in health insurance premiums.”

Final Thoughts

All things considered, there’s no one set rule when it comes to whether you use private health insurance or not in a public hospital. It will depend entirely on your own individual needs, the capacity of the hospital, and whether there are additional charges.

Your insurance will be valid whether you use it in a private or public hospital.

Remember, you don’t have to use your private health insurance, even if you’re asked for your insurance details. It’s your choice.

If you do choose to go with a private health insurer in a public hospital, then check out our member funds to find a policy that suits you.