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What is Hospital cover?
Hospital-only cover is a private health insurance policy that helps pay for treatment and accommodation when you’re admitted as a private patient in a public or private hospital. Depending on your level of cover, it typically pays benefits towards costs like hospital stays, surgery, theatre fees and doctors’ charges.
One of the key advantages of Hospital cover is that it gives you more choice when it comes to your doctor or specialist, and it can help you avoid public hospital waiting lists by allowing treatment in a private facility. There are also tax benefits and rebates for taking out an appropriate level of cover.
According to our health insurance analysis, around 12.3 million Australians have some form of Hospital cover, either as a standalone product or as a combined Hospital and Extras policy. This includes cover held under singles, couples, family and single parent policies.
Hospital cover tiers explained
Hospital cover in Australia is divided into four tiers, each offering different levels of inclusions and price points:
Basic
Basic Hospital cover offers minimal coverage and is designed mainly to provide access to private hospital treatment for a limited number of services. Basic policies usually include restricted cover for certain procedures and are often chosen to avoid the Medicare Levy Surcharge (MLS) or Lifetime Health Cover (LHC) loading, rather than for comprehensive protection (we’ll speak more to this below).
Bronze
The next tier is Bronze Hospital cover, which includes a wider range of treatments than Basic cover. It typically covers services such as joint reconstructions, hernia and appendix procedures and gastrointestinal endoscopies. It generally excludes treatments like pregnancy, heart-related procedures and joint replacements. Bronze policies might be a good option if you’re after more than minimal cover but want to avoid the higher premiums of Silver or Gold tiers.
Silver
Silver Hospital cover builds on Bronze and generally includes heart and vascular procedures, blood disorders, major dental surgery and the implantation of hearing devices. According to the latest report from the Private Health Insurance Intermediaries Association (PHIIA), Silver is the most popular Hospital tier among Australians switching funds. It’s especially popular with seniors, with more than 70% of Aussies over 60 choosing Silver or Silver Plus Hospital cover.
Gold
Gold health insurance is the highest level of private Hospital cover available in Australia, offering the broadest coverage and the most extensive benefits. It includes all 38 clinical categories listed on PrivateHealth.gov.au, covering treatments like rehabilitation, palliative care, mental health care (hospital psychiatric services), cataracts, joint replacements, cover for pregnancy and birth, and more. Despite being the top tier in Hospital cover, Gold policies only account for 3.5% of total sales, likely due to its higher cost.
The Basic, Bronze, Silver and Gold tier system was introduced in 2019 to make it easier for Australians to compare Hospital cover. But recent research from Money.com.au paints a different picture – only 31% of Australians say they easily understand the tier system. Meanwhile, 56% say they somewhat understand it, and 13% find it just as confusing as the old insurer-specific policies.
What are you covered for with Hospital-only health insurance?
Hospital-only health insurance covers you for treatment as a private patient in a public or private hospital. It typically includes hospital accommodation, theatre fees, and a portion of the doctor and specialist fees while you’re admitted.
The exact treatments you're covered for depend on your policy tier – Basic, Bronze, Silver or Gold – each of which includes specific clinical categories as outlined by the Australian Government. Again, you may be able to add certain treatments from higher tiers provided the fund allows it.
Hospital cover also helps you avoid or reduce the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading, and may offer shorter wait times for elective surgery.
While it doesn’t cover out-of-hospital services like dental, physio or optical (those are included under Extras cover), Hospital cover is designed to give you more choice, control and peace of mind around when and where you receive treatment.
Hospital treatments covered per tier
Clinical category | Rehabilitation |
|---|---|
Basic | R |
Bronze | R |
Silver | R |
Gold | Y |
Clinical category | Hospital psychiatric services |
Basic | R |
Bronze | R |
Silver | R |
Gold | Y |
Clinical category | Palliative care |
Basic | R |
Bronze | R |
Silver | R |
Gold | Y |
Clinical category | Brain and nervous system |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Eye (not cataracts) |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Ear, nose and throat |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Tonsils, adenoids and grommets |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Bone, joint and muscle |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Joint reconstructions |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Kidney and bladder |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Male reproductive system |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Digestive system |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Hernia and appendix |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Gastrointestinal endoscopy |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Gynaecology |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Miscarriage and termination of pregnancy |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Chemotherapy, radiotherapy and immunotherapy for cancer |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Pain management |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Skin |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Breast surgery (medically necessary) |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Diabetes management (excluding insulin pumps) |
Basic | O (R) |
Bronze | Y |
Silver | Y |
Gold | Y |
Clinical category | Heart and vascular system |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Lung and chest |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Blood |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Back, neck and spine |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Plastic and reconstructive surgery (medically necessary) |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Dental surgery |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Podiatric surgery (provided by a registered podiatric surgeon) |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Implantation of hearing devices |
Basic | O (R) |
Bronze | O |
Silver | Y |
Gold | Y |
Clinical category | Cataracts |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Joint replacements |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Dialysis for chronic kidney failure |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Pregnancy and birth |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Assisted reproductive services |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Weight loss surgery |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Insulin pumps |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Pain management with device |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
Clinical category | Sleep studies |
Basic | O (R) |
Bronze | O |
Silver | O |
Gold | Y |
| Clinical category | Basic | Bronze | Silver | Gold |
|---|---|---|---|---|
Rehabilitation | R | R | R | Y |
Hospital psychiatric services | R | R | R | Y |
Palliative care | R | R | R | Y |
Brain and nervous system | O (R) | Y | Y | Y |
Eye (not cataracts) | O (R) | Y | Y | Y |
Ear, nose and throat | O (R) | Y | Y | Y |
Tonsils, adenoids and grommets | O (R) | Y | Y | Y |
Bone, joint and muscle | O (R) | Y | Y | Y |
Joint reconstructions | O (R) | Y | Y | Y |
Kidney and bladder | O (R) | Y | Y | Y |
Male reproductive system | O (R) | Y | Y | Y |
Digestive system | O (R) | Y | Y | Y |
Hernia and appendix | O (R) | Y | Y | Y |
Gastrointestinal endoscopy | O (R) | Y | Y | Y |
Gynaecology | O (R) | Y | Y | Y |
Miscarriage and termination of pregnancy | O (R) | Y | Y | Y |
Chemotherapy, radiotherapy and immunotherapy for cancer | O (R) | Y | Y | Y |
Pain management | O (R) | Y | Y | Y |
Skin | O (R) | Y | Y | Y |
Breast surgery (medically necessary) | O (R) | Y | Y | Y |
Diabetes management (excluding insulin pumps) | O (R) | Y | Y | Y |
Heart and vascular system | O (R) | O | Y | Y |
Lung and chest | O (R) | O | Y | Y |
Blood | O (R) | O | Y | Y |
Back, neck and spine | O (R) | O | Y | Y |
Plastic and reconstructive surgery (medically necessary) | O (R) | O | Y | Y |
Dental surgery | O (R) | O | Y | Y |
Podiatric surgery (provided by a registered podiatric surgeon) | O (R) | O | Y | Y |
Implantation of hearing devices | O (R) | O | Y | Y |
Cataracts | O (R) | O | O | Y |
Joint replacements | O (R) | O | O | Y |
Dialysis for chronic kidney failure | O (R) | O | O | Y |
Pregnancy and birth | O (R) | O | O | Y |
Assisted reproductive services | O (R) | O | O | Y |
Weight loss surgery | O (R) | O | O | Y |
Insulin pumps | O (R) | O | O | Y |
Pain management with device | O (R) | O | O | Y |
Sleep studies | O (R) | O | O | Y |
It’s common for health funds to offer variations of each Hospital cover tier, such as ‘Bronze Plus’ or ‘Silver Plus’. According to PrivateHealth.gov.au, all policies must meet the minimum requirements of their base tier, but ‘Plus’ policies can include extra treatments from higher tiers. For example, if you only need Bronze cover but want access to a treatment usually included in Silver, you may be able to add it, depending on the fund.
How much is Hospital cover?
Hospital cover in Australia typically costs between $85 and $270 per month for singles, $169 to $525 for couples, and $174 to $541 for families, including single-parent families. Your premiums will vary based on factors such as your age, location, and the level of cover you choose – Basic, Bronze, Silver or Gold.
Your income also affects how much you pay, as it determines your eligibility for the Private Health Insurance Rebate. Higher income earners without Hospital cover may be charged the Medicare Levy Surcharge (MLS), while those who delay taking out cover after 31 could face the Lifetime Health Cover (LHC) loading.
Lastly, the health fund you choose can impact the cost of your premiums, especially if they’re offering discounts or sign-up incentives. These deals often include a few weeks free, cashback offers or eGift cards to add extra value when joining.
A $612 annual saving with better-suited Hospital cover
Sean Callery, Editor of Money.com.au
"One of the most common issues we encounter is people overpaying for Hospital cover they don’t need. A couple from Victoria recently got in touch because their Gold-tier policy was costing them $509 per month. It included clinical categories, like pregnancy and weight loss surgery, which were of zero use to them.
By switching them to a more cost-effective Silver Plus policy, the team was able to retain coverage for key services like joint replacements and cataracts, but with a $612 per year saving versus their old cover and a reduced $100 excess for day procedures.
By switching funds, the couple also got an extra saving of $634 in the first year through an introductory offer. In total, the switch saved them more $1,200 in the first year."
Sean Callery, Editor of Money.com.au
How to choose the best Hospital cover
Given the range of tiers and health funds available, deciding on the best health insurance for your needs can some complicated, but there are some really key points to prioritise. Here’s how to choose the best Hospital cover for your needs:
Assess your healthcare needs
Start by thinking about your current health and any foreseeable medical needs. Are you planning to start a family? Do you have a chronic condition that may require hospitalisation? Are you nearing an age where joint replacements or other age-related treatments might become relevant? Knowing what you may need cover for – whether now or in the future – can help you narrow down your choices. If you’re young and healthy, a lower level of cover might be enough, but as your circumstances change, your needs may too.
Review your existing cover
If you already have Hospital cover, it’s worth revisiting your policy at least once a year. Health funds often update what’s included or excluded under their policies, and your needs may have changed since you last signed up. Check if your current cover still aligns with your lifestyle, and whether you’re paying for things you don’t need, or missing out on things you do.
Compare your options
Use a health insurance comparison tool to compare policies side-by-side. Look beyond the price as what’s included in the cover matters just as much. Consider factors like the types of hospital treatments covered, whether you have access to your preferred or local providers, and whether you’ll be treated as a private patient in a public or private hospital.
Check the excess and co-payments
These are the out-of-pocket costs you may need to pay when you're admitted to hospital. An excess is a lump sum you agree to pay, usually once per hospital admission, while a co-payment is a set daily charge for each day you stay in hospital. Choosing a higher excess or co-payment can reduce your premium, but it's important to make sure the amount is manageable if you ever need to claim. Some policies also place a cap on how often you have to pay these costs – such as limiting the excess to once or twice per year, or capping the co-payment to a set number of days per admission – so it's worth checking the fine print to understand your total potential out-of-pocket costs.
Be mindful of waiting periods
Most Hospital policies have waiting periods for certain services, especially for pre-existing conditions, pregnancy, and psychiatric care. If you’re switching policies, you may not have to re-serve waiting periods for equivalent cover, but you will if you’re upgrading to a higher level of cover. Make sure you understand what you’re covered for immediately versus what you’ll need to wait for.
Choose a suitable level of Hospital cover
Hospital cover in Australia is categorised into four tiers: Basic, Bronze, Silver and Gold. Each tier includes a standard set of treatments, and some funds offer “Plus” versions (e.g. Bronze Plus), which include selected treatments from higher tiers. Your goal should be to choose a level that covers the treatments you’re most likely to need, without overpaying for services you’ll never use.
Sean Callery, Editor of Money.com.au
“With premiums rising every April, making sure you’re getting the best value for money has never been more important – and it’s a big reason why so many Australians turn to us for help. Our experts take the time to understand your situation by asking the right questions, so we can compare Hospital policies not just on price, but also on what they cover, the benefits they offer, and which one is likely to be the best fit for your needs.”
Sean Callery, Editor of Money.com.au
New research from Money.com.au reveals eight in ten Australians with private health insurance (80%) support reforms to private hospital funding.
More than half (53%) favour any model that reduces patient out-of-pocket costs, while 27% support the Federal Government’s proposed Activity-Based Funding (ABF) model, which would pay private hospitals a standard price for treatments based on the type and volume of care provided.
Just 20% say the current system should remain, where private hospitals are funded through a mix of insurer contracts, patient fees and Medicare benefits.
Why take out Hospital cover?
Avoiding the Medicare Levy Surcharge (MLS)
Higher-income earners without eligible Hospital cover are charged an additional tax – the MLS. Taking out cover helps you reduce or avoid this extra cost. The Medicare Levy Surcharge ranges from 0% to 1.5%, depending on your household income.
Choosing your own hospital or doctor
Private Hospital cover gives policyholders the flexibility to select their preferred hospital and specialist, rather than being assigned one through the public system. However, your ability to choose may still depend on the availability of doctors and hospital facilities at the time you need treatment.
Skipping public waiting lists
Accessing treatment through the private system can significantly reduce wait times for elective surgeries compared to the often lengthy queues in the public health system. Waiting periods will still apply on your cover for various treatments (e.g. 12 months for pregnancy).
Dodging the Lifetime Health Cover (LHC) loading
Australians who delay taking out Hospital cover past the age of 31 can be hit with a financial loading. The LHC is a 2% loading on top of your premium for every year you are aged over 30. Getting covered early helps avoid this long-term penalty.
Covering the whole family
Parents often take out Hospital cover to ensure their children have access to private care if they need it, especially for unexpected or urgent health issues. This often involves switching to family or single-parent cover, which provides protection for both the parent and their dependants.
Managing ongoing health conditions
People with chronic or pre-existing health concerns may choose Hospital cover for better access to treatment, rehabilitation or ongoing care that may not be readily available through the public system. Waiting periods on your cover will still apply, however.
In 2025, the top Hospital services requested by our Money.com.au customers were access to private hospitals (93.58%), bone, joint, and muscle treatments (35.69%), back, neck, and spine care (35.32%), and heart and vascular services (33.78%).
Our latest Money.com.au survey found that 51% of Australians said they use their Hospital cover to claim benefits once or twice a year. Meanwhile, 31% reported never making a claim, 10% claimed 3 to 5 times annually, 5% used it six to 10 times, and 2% said they claimed more than 10 times a year.
Private Hospital cover vs Medicare
Private Hospital Cover
- Choose your own doctor or specialist in hospital
- Access to private hospitals and potentially shorter waiting times for elective surgery
- May help you avoid the Medicare Levy Surcharge if you earn above the income threshold
- Covers a private room (if available and included in your policy)
- May cover for additional services like rehabilitation or psychiatric care, depending on your level of cover
- Can avoid the Lifetime Health Cover loading by taking out cover before age 31
- May allow you to claim on a broader range of services and treatments
Medicare
- Doctor or specialist is assigned to you in the public system
- Treated in public hospitals, with potentially long waiting times
- You may need to pay the Medicare Levy Surcharge if you don’t have private cover and earn above the threshold
- Typically accommodated in a shared room in public hospitals
- Covers only medically necessary treatments under the public system
- No protection from the Lifetime Health Cover loading – applies if you delay taking out private cover
- Only covers services listed under the Medicare Benefits Schedule (MBS)
Is Hospital cover worth it?
Cost is the biggest reason Australians don’t have private Hospital cover, with 80% citing it as the main barrier in our survey. While the cost of premiums can be a downside, 72% of those with cover said it gives them peace of mind.
In fact, insurers paid out $18.4 billion in Hospital benefits in the 12 months to September 2024, according to the latest APRA data.
Despite the cost concerns, many find Hospital cover worthwhile because it offers faster access to treatment, more choice of doctors, and protection from tax penalties like the Medicare Levy Surcharge.
With nearly half of policyholders regularly using their cover and billions paid out annually, Hospital cover can provide important financial and health security, especially when unexpected medical issues arise.
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