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HEALTH INSURANCE
Health insurance with no waiting period
By Sean Callery
What is Gold health insurance?
Gold health insurance refers to the highest level of private Hospital cover available in Australia. Under the government’s health insurance tier system, Gold policies must include all 38 categories of hospital treatment, covering everything from pregnancy and birth to joint replacements, heart surgery, psychiatric care and more.
This level of cover is designed for people who want the most comprehensive protection and peace of mind when it comes to their hospital care. It also offers the standard benefits that all tiers of Hospital cover come with, including treatment as a private patient in a public or private hospital, choosing your doctor and potentially reducing wait times for elective surgery.
Because Gold policies cover the widest range of treatments, they also come with the highest premiums. That’s why it’s important to consider whether you need all the benefits included or whether a lower tier might be more suitable for your health needs and budget.
Australia’s Hospital cover is divided into four tiers: Basic Hospital cover, Bronze Hospital cover, Silver Hospital cover and Gold Hospital cover. Each tier includes a set list of treatment categories, with higher tiers covering more services. Some insurers also offer “Plus” options (like Bronze/Silver Plus), which include additional treatments from higher tiers.
What does Gold Hospital cover include?
Gold cover includes every treatment category that private health insurers are required to offer. This means you’ll be covered for all 38 clinical categories, including some of the most complex and high-cost hospital services that lower-tier policies often exclude.
Here are the key treatments that are only included automatically under Gold health insurance:
1
Pregnancy and birth
This covers hospital care for childbirth, including labour, delivery and postnatal care. It also includes complications related to pregnancy, whether you’re giving birth naturally or via caesarean.
2
Assisted reproductive services
Includes treatments such as in-vitro fertilisation (IVF) and other fertility procedures carried out in hospital. This can be a valuable option for couples needing help to conceive.
3
Joint replacements
You’re covered for joint replacement surgeries like hip, knee or shoulder reconstructions in a private hospital. This is a popular inclusion on seniors health insurance and gives you more choice in your surgeon and recovery setting.
4
Cataracts and eye lens procedures
Gold cover includes surgery to remove cataracts and insert intraocular lenses, which can improve or restore vision.
5
Rehabilitation and psychiatric care
You’ll be covered for inpatient hospital rehabilitation, such as after a stroke or major surgery, and for mental health treatments that require hospital admission. This includes conditions like depression, anxiety and eating disorders.
6
Pain management and devices
This covers hospital treatment for chronic pain using devices like pain pumps or nerve stimulators. It’s typically used for long-term pain that hasn’t responded to other treatments.
7
Weight loss surgery
Gold policies include procedures such as gastric bypass or sleeve gastrectomy for people with obesity-related health issues. These surgeries must meet clinical guidelines to be covered.
8
Palliative care
This includes hospital treatment focused on relieving pain and improving quality of life for people with life-limiting conditions. It supports both physical and emotional wellbeing during end-of-life care.
Are there waiting periods on Gold tier policies?
Yes, Gold level policies still have waiting periods, just like other levels of Hospital cover. A common example is 12 months for pregnancy and birth services. Other treatments like palliative care, psychiatric care and rehabilitation usually have a two-month waiting period.
If you have a pre-existing condition – meaning any ailment, illness or condition where signs or symptoms were present in the six months before you took out or upgraded your cover – a 12-month waiting period generally applies for hospital treatment. This rule is assessed by a medical practitioner appointed by your insurer and applies across all tiers, including Gold, according to the Commonwealth Ombudsman.
How much is Gold private health insurance?
Gold Hospital cover generally costs between $265 and $420 per month for singles, $510 to $750 for couples and families, and $455 to $640 for single-parent families, according to Money.com.au analysis.
Your exact premium will vary based on several individual factors. These include your age, location and chosen health fund, as well as whether you’re eligible for the Australian Government Private Health Insurance Rebate, which can reduce your premium based on your income and age.
Other factors, like the Lifetime Health Cover (LHC) loading, may also apply. This is an extra cost of up to 70% added to your premium if you didn’t take out eligible Hospital cover by July 1 after your 31st birthday.
If you're a high-income earner without Hospital cover, you may be required to pay the Medicare Levy Surcharge (MLS) at tax time, which can range from 1% to 1.5% of your income. Having Gold or any eligible Hospital cover can help you avoid this surcharge.
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
“While Gold offers the most comprehensive Hospital cover available, it’s not going to be worth the higher premiums for a lot of people – especially if they’re not at a life stage where treatments like pregnancy, joint replacements or cataract surgery are relevant. But what’s often overlooked is that Gold cover can offer significant long-term value for those with chronic health needs or who want certainty in accessing complex procedures without exclusions.”
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
Pros and cons of Gold cover
Pros
- Covers all 38 clinical categories, offering the most comprehensive hospital treatment available.
- Includes major services like pregnancy, joint replacements, and psychiatric care without restrictions.
- Can help avoid high out-of-pocket costs for complex or expensive procedures.
- Must provide unrestricted cover for every clinical category – there are no exclusions or restricted benefits.
- May suit people with ongoing or multiple health concerns, or couples and families planning for pregnancy and birth-related services.
Cons
- It’s the most expensive tier of Hospital cover, with higher monthly premiums.
- You may end up paying for treatments you don’t need or won’t use.
- Still subject to standard waiting periods for certain services, like pregnancy or pre-existing conditions.
- Not all Gold policies offer the same benefits beyond the mandatory categories.
- Extras like dental and optical aren’t included unless you take out a combined Hospital and Extras policy.
Gold vs Silver or other tiers
Here’s a simple comparison of the key differences between Gold cover to the other hospital tiers:
Feature / Tier | Coverage scope |
|---|---|
Gold | Covers all 38 clinical categories without restrictions |
Silver | Covers most clinical categories, some exclusions or restrictions |
Bronze | Covers fewer categories, many exclusions and restrictions |
Basic | Covers essential and emergency hospital treatments only |
Feature / Tier | Pregnancy and birth |
Gold | Included, usually with 12-month waiting period |
Silver | Often excluded or limited |
Bronze | Usually excluded |
Basic | Excluded |
Feature / Tier | Pre-existing conditions |
Gold | 12-month waiting period applies |
Silver | 12-month waiting period applies |
Bronze | 12-month waiting period applies |
Basic | 12-month waiting period applies |
Feature / Tier | Psychiatric and rehabilitation care |
Gold | Included with standard 2-month waiting period |
Silver | Included, may have some limits |
Bronze | Limited or excluded |
Basic | Excluded |
Feature / Tier | Premium cost |
Gold | Highest |
Silver | Moderate to high |
Bronze | Moderate |
Basic | Lowest |
Feature / Tier | Out-of-pocket costs |
Gold | Lowest for covered treatments |
Silver | Moderate |
Bronze | Higher |
Basic | Highest for non-covered treatments |
Feature / Tier | Ideal for |
Gold | People needing comprehensive care or pregnancy services |
Silver | Those needing good cover but less extensive than Gold |
Bronze | People on a budget with basic hospital needs |
Basic | Those needing minimal cover for emergencies only |
| Feature / Tier | Gold | Silver | Bronze | Basic |
|---|---|---|---|---|
Coverage scope | Covers all 38 clinical categories without restrictions | Covers most clinical categories, some exclusions or restrictions | Covers fewer categories, many exclusions and restrictions | Covers essential and emergency hospital treatments only |
Pregnancy and birth | Included, usually with 12-month waiting period | Often excluded or limited | Usually excluded | Excluded |
Pre-existing conditions | 12-month waiting period applies | 12-month waiting period applies | 12-month waiting period applies | 12-month waiting period applies |
Psychiatric and rehabilitation care | Included with standard 2-month waiting period | Included, may have some limits | Limited or excluded | Excluded |
Premium cost | Highest | Moderate to high | Moderate | Lowest |
Out-of-pocket costs | Lowest for covered treatments | Moderate | Higher | Highest for non-covered treatments |
Ideal for | People needing comprehensive care or pregnancy services | Those needing good cover but less extensive than Gold | People on a budget with basic hospital needs | Those needing minimal cover for emergencies only |
Who should consider Gold hospital cover?
Gold health insurance is best suited to people who want the highest level of private hospital protection and are comfortable paying more for broader coverage. This may include individuals with ongoing or complex health conditions, those planning to start a family and needing pregnancy and birth-related services, or anyone who wants peace of mind knowing all clinical categories are covered without restrictions.
It can be a good fit for older Australians who may need access to treatments like joint replacements or cataract surgery, which are only fully covered under Gold policies.
Gold cover may also appeal to families who want more flexibility around out-of-pocket costs. Some insurers, like ahm and Medibank, waive the excess for children on a family policy, which can help reduce unexpected expenses if your child needs hospital treatment.
How to get the best Gold health insurance
Here are four easy ways to ensure you get the best Gold health insurance in Australia:
Compare inclusions across funds
Not all Gold policies are the same. While they must cover all 38 clinical categories, the specifics (like contract hospitals, gap cover and support programs) can vary. Look closely at what's offered beyond the minimum. Hint: Our health insurance experts can help you here.
Check excess and co-payment options
Some insurers offer flexible excess options to help lower your premium, while others waive the excess for kids on family policies. Make sure you choose an excess that’s affordable if you need to claim, and consider whether the policy has a per-admission or annual excess cap.
Factor in waiting periods
Even the best Gold policy will have waiting periods, such as 12 months for pregnancy or pre-existing conditions. If you’re switching from another fund to the same level of cover, you won’t need to re-serve these – but always confirm with the insurer. If you’re combining your Gold Hospital cover with Extras, some health funds offer no waiting periods on Extras to new customers.
Balance benefits against cost
Gold cover comes with higher premiums, so consider whether you’ll actually use the treatments it covers. If not, a Silver policy (or a variant of it such as “Silver Plus”) may offer the services you need at a lower price. Use our comparison tool or speak to one of our health insurance advisers if you’re unsure.
Is Gold health insurance worth it?
Gold health insurance is the crème de la crème of Hospital cover in Australia. For individuals or families with specific health needs or who want top cover, Gold policies can be worth the investment. But for most, especially those who are on lower incomes or don’t see the value in it, Gold cover may be financially out of reach or simply unnecessary.
In such cases, opting for Silver Plus or Bronze Plus policies might provide a more cost-effective balance between coverage and affordability. Ultimately, whether Gold health insurance is worth it depends on individual circumstances, and if the pros outweigh the cons for your current health needs, life stage and financial situation.
