How to Compare Health Insurance Properly

Before looking at any policies, answer three questions:

Do you need hospital, extras, or both?

If you...	You need...	Why
Earn over {{MLS_THRESHOLD_SINGLES}} (singles) or {{MLS_THRESHOLD_FAMILIES}} (families)	Hospital cover (minimum)	Avoids Medicare Levy Surcharge
Are approaching age 31	Hospital cover (minimum)	Avoids Lifetime Health Cover loading
Want private hospital treatment	Hospital cover	Covers hospital admissions as a private patient
Want dental, optical, physio rebates	Extras cover	Covers out-of-hospital services
Want both hospital and out-of-hospital	Combined cover	Bundled — typically {{COMBINED_DISCOUNT_RANGE}} cheaper than buying separately

What hospital tier do you need?

If you...	Consider...	Policies available
Just need MLS/LHC compliance	Basic or Bronze	{{BASIC_POLICY_COUNT}} Basic, {{BRONZE_POLICY_COUNT}} Bronze
Want accident and emergency cover	Bronze	{{BRONZE_POLICY_COUNT}} policies
Want most common treatments covered	Silver	{{SILVER_POLICY_COUNT}} policies
Are planning pregnancy or want no exclusions	Gold	{{GOLD_POLICY_COUNT}} policies

What extras services do you actually use?

Don't pay for Top extras if you only use dental and optical. Track your actual usage over the past 12 months — check-ups, glasses, physio sessions, other allied health — and match your extras level to what you'll genuinely claim.

Two policies at the same tier and similar price can differ significantly in what they actually cover. Here's what to check:

For hospital cover — compare clinical categories:

At the same tier (e.g., Silver), one insurer might cover 28 categories while another covers 24. The categories that vary between policies at the same tier are the ones most likely to catch you out.

Use our comparison table to see exactly which clinical categories each policy covers, restricts, or excludes. Pay particular attention to:

• Categories marked "Restricted" (⚠️) — these may have benefit limits or conditions
• Whether "Plus" variants include categories important to you (pregnancy on Silver Plus, cardiac on Bronze Plus)
• Any insurer-specific exclusions beyond the tier minimum

For extras cover — compare annual limits and benefit percentages:

What to compare	Why it matters
Annual limit per service	Determines how many sessions/items you can claim per year
Benefit percentage	Determines what proportion of each bill the insurer pays
Combined vs separate limits	A $600 "allied health" limit shared across 5 services gives less per service than separate limits
Sub-limits	Some policies cap specific items within a category (e.g., $200 for frames within a $400 optical limit)
Preferred provider benefits	Some policies pay 100% at preferred providers but only 60% elsewhere

This is the factor most people skip — and the one that causes the most unexpected bills.

Hospital agreements are contracts between an insurer and specific private hospitals. At an agreed hospital, your insurer covers accommodation, theatre fees, and prostheses at negotiated rates. At a non-agreed hospital, you may face gap payments of {{NON_AGREED_GAP_RANGE}} or more — even for procedures fully covered under your policy.

How to check:

1. Identify private hospitals near you (or hospitals you'd want to use)
2. Check each insurer's hospital agreement list for those hospitals
3. If you live regionally, this is especially critical — some areas have only one or two private hospitals, and not all insurers have agreements with them

Every hospital policy offers a choice of excess — the amount you pay per admission before your insurer pays. Higher excess means lower weekly premium.

Excess	Typical weekly saving vs $250	Best for
$250	Base premium	People with planned surgery or frequent admissions
$500	Save {{SAVING_250_TO_500}}/week	Moderate risk — most common choice
$750	Save {{SAVING_250_TO_750}}/week	Low-risk, budget-focused, maximum premium savings

The calculation: If choosing $750 excess saves you {{ANNUAL_SAVING_250_TO_750}}/year over $250 excess, you'd need to be admitted to hospital at least once per year for the lower excess to be better value. Most young, healthy people are admitted less than once per year — making $750 excess the better financial choice.

The policy matters most, but the insurer behind it affects your experience when you actually need to claim.

Complaint ratios: The Private Health Insurance Ombudsman publishes quarterly complaint ratios for all insurers — the number of complaints per {{OMBUDSMAN_RATIO_DENOMINATOR}} policies. Lower is better. The industry average is {{INDUSTRY_AVG_COMPLAINT_RATIO}}.

Customer satisfaction: Independent surveys rank insurers on claims experience, communication, and value for money. Consistently high-ranked insurers include several not-for-profit funds.

Claims acceptance rate: What percentage of claims does the insurer pay? Most insurers accept {{INDUSTRY_AVG_CLAIMS_ACCEPTANCE}} of claims, but rates vary — and a 2-3% difference across thousands of claims represents real money.

Digital experience: Can you claim via an app? Is HICAPS supported at most providers? Can you manage your policy, check benefits, and find providers online? For frequent extras claimers, a good app saves significant time.

The weekly premium is only part of the cost. A true comparison factors in:

Cost Component	How to calculate
Annual premium (after rebate)	{{POLICY_WEEKLY_PREMIUM}} x 52
Government rebate savings	Premium x {{PROFILE_REBATE_RATE}}
MLS avoided (if applicable)	{{PROFILE_MLS_AMOUNT}}/year saved
Excess (if admitted)	{{POLICY_EXCESS}} per admission
Typical extras gap per year	Annual usage - annual extras rebates
Net annual cost	Premium - rebate - MLS saved + expected gaps

Example for {{PROFILE_LABEL}}: A Bronze hospital + Basic extras combined policy at {{EXAMPLE_COMBINED_PREMIUM}}/week:

• Annual premium: {{EXAMPLE_ANNUAL_PREMIUM}}
• Government rebate ({{PROFILE_REBATE_RATE}}): -{{EXAMPLE_REBATE_AMOUNT}}
• MLS avoided: -{{PROFILE_MLS_AMOUNT}} (if applicable)
• Net annual cost: {{EXAMPLE_NET_COST}}

If the net cost is near zero or negative (MLS savings exceed premium), you're effectively getting hospital cover for free while also receiving extras benefits.

Once you've worked through the factors above, use our comparison tool to apply them systematically:

1. Set your profile — age, state, cover type (single/couple/family), income tier
2. Filter by coverage type — hospital, extras, or combined
3. Filter by tier — Gold, Silver, Bronze, or Basic
4. Set your price range — based on your budget from Step 6
5. Compare 2-3 shortlisted policies side by side — coverage, excess, hospital agreements, extras limits
6. Check each shortlisted insurer's hospital agreements in your area
7. Read the PDS for your top choice before purchasing

[Compare {{TOTAL_POLICIES}} Policies →] → /compare/ [Not sure what you need? Try our Coverage Finder →] → /coverage-finder/

Common comparison mistakes

Choosing on price alone — The cheapest policy often has the highest exclusions. A $30/week Bronze policy with no hospital agreements near you is worse value than a $40/week Bronze policy with full local hospital coverage.

Ignoring hospital agreements — This is the most expensive mistake. Being treated at a non-agreed hospital can add {{NON_AGREED_GAP_RANGE}} in gap payments to a procedure that should have been fully covered.

Over-insuring on extras — Top extras at {{MAX_TOP_EXTRAS_PRICE}}/week makes sense if you use dental, optical, physio, and other services heavily. If you only get two dental check-ups and one pair of glasses per year, Basic extras at {{MIN_BASIC_EXTRAS_PRICE}}/week covers that.

Under-insuring on hospital — Bronze saves money weekly but excludes pregnancy, cardiac, cataracts, and back surgery. If any of these become relevant, upgrading triggers a 12-month waiting period. Anticipate your needs 1-2 years ahead.

Not checking the PDS — The policy name and tier give you a general idea. The PDS gives you the legally binding details — restrictions, exclusions, sub-limits, co-payments, and conditions that the comparison table can't fully capture.