What’s the difference between Silver and Silver Plus?

Silver Plus adds at least one Gold-level treatment to a standard Silver policy. This makes it more flexible and often more expensive, but you only pay for the extra services you need. Most health funds allow you to select additional treatments to a Silver Plus policy.

Is pregnancy covered under Silver health insurance?

Pregnancy is not included in standard Silver cover. However, some Silver Plus policies do include pregnancy and birth-related services. Always check the policy details, as not all Silver Plus options cover maternity. Keep in mind a 12-month waiting period will apply if you add on pregnancy and birth.

Is Silver health insurance cheaper than Gold?

Yes, Silver cover is generally more affordable than Gold. However, premiums vary based on the insurer, your location and any Gold-level benefits added to a Silver Plus policy. Your age and income can also influence the overall cost, as they determine your eligibility for the government rebate.

Is Silver better than Gold insurance?

In terms of coverage, Gold includes more clinical categories than Silver, but is generally more expensive. If you don’t need all the treatments covered under Gold, Silver may offer better value. With a Silver Plus policy, you can also add selected Gold-level services, making it a more flexible and cost-effective option for many.

Can I upgrade to Silver Plus later?

Yes, you can upgrade to Silver Plus at any time. Keep in mind, a 12-month waiting period may apply to any newly added services, especially for pre-existing conditions or pregnancy.

Will there be any out-of-pocket costs with Silver cover?

Yes, out-of-pocket costs can still apply with Silver cover. These may include a hospital excess, co-payments or fees if your chosen hospital or specialist isn’t fully covered by your health fund. Always check provider agreements and ask for a cost estimate before going to hospital.

Will Silver health insurance help me skip public wait times?

Silver Hospital cover may help you avoid public hospital wait times for many treatments by allowing you to access private hospital care. However, wait times can vary depending on the procedure, your insurer and the hospital. For urgent or emergency care, public hospitals still provide treatment regardless of your cover.

Silver Hospital Cover & Silver Plus Policies Australia

What is Silver health insurance?

Silver health insurance is a mid-level tier of private Hospital cover in Australia. It includes at least 26 core clinical categories like cancer treatment, bone and joint surgery, and kidney and bladder. It excludes higher-cost services such as pregnancy, joint replacements and cataracts – unless you opt for Silver Plus, which allows you to add treatments.

Silver policies must meet the minimum standard set by the Australian Government, ensuring you're covered for medically necessary hospital treatment in a private or public hospital. It's a popular choice for people who want more than basic or lower cover without paying for services they’re unlikely to use.

Australia’s Hospital cover is categorised 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 Silver Plus), which includes additional treatments from the Gold tier for added flexibility.

What does Silver Hospital cover include?

A Silver policy covers a wide range of hospital treatments for illnesses, injuries and medical conditions. Here’s what’s typically included as outlined by PrivateHealth.gov.au:

Brain and nervous system: Treatment for neurological conditions such as stroke, epilepsy, Parkinson’s disease and other brain or nerve disorders.

Eye (not cataracts): Surgical treatment of eye conditions excluding cataract surgery, such as glaucoma or retinal procedures.

Ear, nose and throat: Procedures addressing issues like sinus surgery, nasal septum correction, and treatment of chronic ear infections.

Tonsils, adenoids and grommets: Surgical removal of tonsils or adenoids and insertion of grommets, commonly in children with recurrent infections.

Bone, joint and muscle: Treatment for musculoskeletal conditions, including fractures, tendon repairs and non-replacement joint surgeries.

Joint reconstructions: Surgical repair of joints, such as anterior cruciate ligament (ACL) reconstruction, excluding full joint replacements.

Kidney and full bladder: Treatment for kidney stones, urinary tract infections, and other renal or bladder conditions.

Male reproductive system: Procedures related to the prostate, testes and male fertility issues.

Digestive system: Treatment for gastrointestinal conditions like ulcers, hernias and inflammatory bowel diseases.

Hernia and appendix: Surgical repair of hernias and removal of the appendix.

Gastrointestinal endoscopy: Diagnostic procedures such as colonoscopies and gastroscopies to examine the digestive tract.

Gynaecology: Treatment of female reproductive system issues, excluding pregnancy and birth services.

Miscarriage and termination of pregnancy: Hospital care related to miscarriage management and elective pregnancy termination.

Chemotherapy, radiotherapy and immunotherapy for cancer: Cancer treatments including chemotherapy, radiation therapy and immunotherapy administered in a hospital setting.

Pain management: Non-surgical hospital treatments aimed at managing chronic pain conditions.

Skin: Treatment of skin conditions requiring hospital admission, such as infections or removal of skin lesions.

Breast surgery (medically necessary): Surgical procedures for medical conditions affecting the breast, excluding cosmetic surgery.

Diabetes management (excluding insulin pumps): Hospital treatment for complications arising from diabetes, not including the provision of insulin pumps.

Heart and vascular system: Treatment of heart and blood vessel conditions, such as angioplasty or pacemaker insertion.

Lung and chest: Treatment for respiratory conditions like pneumonia, asthma and other lung-related illnesses.

Blood: Treatment of blood disorders, including anaemia and clotting disorders.

Back, neck and spine: Surgical and non-surgical treatment of spinal conditions, excluding spinal fusions unless specified.

Plastic and reconstructive surgery (medically necessary): Reconstructive procedures necessary for medical reasons, such as post-trauma or post-cancer surgery.

Dental surgery: Surgical procedures on the teeth and jaw that require hospital admission, excluding general dental care.

Podiatric surgery (provided by a registered podiatric surgeon): Surgical treatment of foot and ankle conditions performed by a registered podiatric surgeon.

Implantation of hearing devices: Surgical implantation of hearing devices, such as cochlear implants, for hearing loss treatment.

Keep in mind that some categories may be covered on a restricted basis, meaning you're only partially covered – usually in a public hospital setting. This applies to treatments like rehabilitation, hospital psychiatric services and palliative care. Some insurers also allow you to add Gold-tier treatments to your Silver policy, such as pregnancy and birth or weight loss surgery.

Are there waiting periods on Silver tier policies?

Yes, waiting periods apply to Silver tier hospital policies, just like with all levels of private Hospital cover in Australia. These are set timeframes you must serve before you can claim benefits for certain treatments or services.

Here the waiting periods that apply to Silver Hospital cover:

No waiting period for accidents, where hospital treatment is required due to an unforeseen injury.

No waiting period if switching to the same or lower level of cover and you've already served the waiting periods.

1 day for ambulance services, if included in your Hospital cover (not applicable in Queensland or Tasmania, where it’s state-funded).

2 months for psychiatric, rehabilitation and palliative care, even for pre-existing conditions.

2 months for new conditions and services, such as a sudden hernia or appendix removal.

12 months for pregnancy-related services, if added under a Silver Plus policy.

12 months for pre-existing conditions, as assessed by the health insurer’s medical advisor.

Silver Hospital cover typically costs between $115 and $260 per month for a singles policy, $230 to $500 for couples and family cover, and $205 to $425 for policies covering single-parent families, according to Money.com.au analysis.

Your Silver Hospital premium will depend on a range of personal factors, including your age, where you live, your chosen insurer, and whether you qualify for the Private Health Insurance Rebate – a government subsidy that lowers your premium based on your income and age.

You might also face additional costs like the Lifetime Health Cover (LHC) loading, which applies if you didn’t take out eligible Hospital cover by July 1 after turning 31. This loading can add up to 70% to your premium.

If you’re a high-income earner without Hospital cover, you could also be hit with the Medicare Levy Surcharge (MLS) – an extra tax of 1% to 1.5% of your income. Taking out Silver or any eligible Hospital policy can help you sidestep this cost at tax time.

Chris Whitelaw General Manager Health Insurance Money.com.au

Chris Whitelaw, General Manager - Health Insurance at Money.com.au

“There's a strong shift towards Silver and Silver Plus Hospital cover, especially among switchers and new policyholders looking for better value without going all the way to Gold, according to data from the Private Health Insurance Intermediaries Association. We speak to our customers every day and it’s becoming clear that many view Silver as the sweet spot for comprehensive protection at a more manageable cost.”

Chris Whitelaw, General Manager - Health Insurance at Money.com.au

Pros and cons of Silver cover

Pros

Silver policies cover at least 26 clinical categories, including treatments for the heart and vascular system, lung and chest, and back, neck, and spine, offering substantial protection without the higher premiums of Gold cover.

Many insurers offer Silver Plus policies, allowing you to add specific Gold-tier treatments – like joint replacements or weight loss surgery – tailoring your cover to your needs without committing to full Gold premiums.

70% of Australians aged 60 and over hold some form of Silver cover, signifying that this tier is popular for seniors health insurance.

Cons

Does not cover all 38 clinical categories; treatments like cataracts, joint replacements and pregnancy services are typically excluded unless added via Silver Plus.

It’ll still incur out-of-pocket costs, especially if treatments are not fully covered or if you’re treated in non-partnered hospitals and care facilities.

Cover is limited to inpatient services; outpatient treatments like general dental, optical and physiotherapy require separate Extras cover.

Some treatments – like psychiatric care, rehabilitation and palliative care – are only covered on a restricted basis under standard Silver policies. This usually means you're only fully covered in a public hospital, which can limit your choice of provider.

Here’s a quick comparison of the key differences between Silver cover to the other hospital tiers:

Feature / Tier	Coverage scope
Silver	Covers most clinical categories, some exclusions or restrictions
Gold	Covers all 38 clinical categories without restrictions
Bronze	Covers fewer categories, many exclusions and restrictions
Basic	Covers essential and emergency hospital treatments only
Feature / Tier	Pregnancy and birth
Silver	Often excluded or limited, unless added to a Silver Plus policy
Gold	Included, usually with 12-month waiting period
Bronze	Usually excluded
Basic	Excluded
Feature / Tier	Pre-existing conditions
Silver	12-month waiting period applies
Gold	12-month waiting period applies
Bronze	12-month waiting period applies
Basic	12-month waiting period applies
Feature / Tier	Psychiatric and rehabilitation care
Silver	Restrictions apply
Gold	Included with standard 2-month waiting period
Bronze	Limited or excluded
Basic	Excluded
Feature / Tier	Premium cost
Silver	Moderate to high
Gold	Highest
Bronze	Moderate
Basic	Lowest
Feature / Tier	Out-of-pocket costs
Silver	Moderate
Gold	Lowest for covered treatments
Bronze	Higher
Basic	Highest for non-covered treatments
Feature / Tier	Ideal for
Silver	Those looking for mid-level cover
Gold	People needing comprehensive care or pregnancy services
Bronze	People on a budget with basic hospital needs
Basic	Those needing minimal cover for emergencies only

Feature / Tier	Silver	Gold	Bronze	Basic
Coverage scope	Covers most clinical categories, some exclusions or restrictions	Covers all 38 clinical categories without restrictions	Covers fewer categories, many exclusions and restrictions	Covers essential and emergency hospital treatments only
Pregnancy and birth	Often excluded or limited, unless added to a Silver Plus policy	Included, usually with 12-month waiting period	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	Restrictions apply	Included with standard 2-month waiting period	Limited or excluded	Excluded
Premium cost	Moderate to high	Highest	Moderate	Lowest
Out-of-pocket costs	Moderate	Lowest for covered treatments	Higher	Highest for non-covered treatments
Ideal for	Those looking for mid-level cover	People needing comprehensive care or pregnancy services	People on a budget with basic hospital needs	Those needing minimal cover for emergencies only

This is a general guide only. Always read the Product Disclosure Statement (PDS) and other relevant policy documents before making a decision.

Who should consider Silver Hospital cover?

Silver and Silver Plus Hospital cover are ideal for Australians who want more than the basics but don’t need every high-cost treatment included in Gold. It strikes a balance between affordability and comprehensive protection – making it a popular choice across different life stages. Here are some examples of who might benefit:

Singles in their 30s and 40s

Those who no longer need cover for pregnancy but want protection for heart procedures, hernia repairs, or surgeries on the back, neck or digestive system. Silver Plus can add joint replacements or weight loss surgery if needed.

Couples planning ahead for future needs

Those approaching their 50s or 60s. Silver cover includes a wide range of treatments like kidney and bladder issues, cancer therapies, and lung and chest conditions – common concerns as people age.

Young families not planning on having more children

Silver Plus can offer high-value coverage for child-specific needs (like ear, nose and throat surgery or tonsil removal) without paying for pregnancy and birth services.

Older Australians and retirees

A Silver Plus policy may benefit seniors and retirees because it includes many age-related treatments – like gynaecology, prostate surgery and pain management – without the cost of unused services like IVF or pregnancy.

Here’s how to find the best value in a Silver health insurance policy:

1

Compare multiple policies across funds

Silver policies must include at least 26 clinical categories, but many funds offer “Silver Plus” options that include additional treatments from the Gold tier. This gives you the flexibility to tailor your cover. Compare what’s included in each policy and which hospitals and facilities each insurer has agreements with.

2

Prioritise your health needs

Consider your current health, lifestyle and family medical history. If you're planning a pregnancy, want access to mental health care, or expect orthopaedic treatment down the line, make sure those services are included in your Silver or Silver Plus policy.

3

Check for excess and co-payment flexibility

Many insurers allow you to customise your premium by adjusting your excess or co-payment. Choosing a higher excess can reduce your premiums, but make sure you can afford the out-of-pocket costs if you need hospital care – especially if it’s unexpected or frequent.

4

Review fund benefits and member perks

Some funds offer extras like no excess for children, health insurance sign-up incentives or access to wellness programs. If you're also taking out Extras cover, check if the health fund waives waiting periods to sweeten the deal. These perks can improve overall value without raising your premium.

5

Make the most of comparison tools

Use trusted platforms like Money.com.au to compare health insurance policies side-by-side. Focus on what you’re covered for, not just the brand. Check that your preferred hospitals, specialists and services are included, especially if you want to avoid unexpected out-of-pocket costs.

Is Silver health insurance worth it?

Silver Hospital cover offers a strong middle ground. It includes more than Bronze but usually costs less than Gold. Standard Silver policies cover a wide range of treatments, like gynaecology, lung and chest procedures, and ear, nose and throat surgery. This makes it a solid option if you want broad protection without paying for every Gold-level service.

Silver Plus policies give you more flexibility. You can add extra treatments, like pregnancy or joint replacements, depending on what you need. This allows you to tailor the policy to suit your stage of life. Even without the extras, standard Silver still covers many common procedures – making it a worthwhile choice for many singles, couples and families.

That said, Silver cover isn’t the right fit for everyone. Monthly premiums can still be costly, especially with a Silver Plus policy. For low-income earners, families on a tight budget or pensioners, even mid-tier cover may stretch the finances. In these cases, a Bronze policy might be more manageable.

Be sure to weigh up the good and the bad, plus the pros and cons of private health insurance more broadly, before making a decision.