Health insurance for seniors: what you should know

As we get older our health needs evolve, and having the right health insurance can make a significant difference in accessing healthcare and managing medical expenses. In this guide, we will explore some information older Australians need to know about health insurance, helping you make an informed decision for your wellbeing and get the most out of your health cover.

Is private health insurance still important as you get older?

While we enjoy some of the best healthcare in the world¹ through the public system, private hospital cover offers several key advantages.

Greater control over your hospital experience

With private hospital cover, you can choose the doctor you know and trust for your treatment*, and may get access to a private room⁺ depending on hospital resourcing, availability and clinical need.

Shorter wait times for non-urgent elective surgery

The wait times in the public system can also be considerably longer, even if you are in discomfort.²

In fact, 10.6% of cataract surgery patients waited longer than 365 days³ to be admitted for surgery in 2021-2022. Alarmingly, around 1 in 3 patients with cataracts in both eyes suffered a fall while waiting for surgery.⁴

Some health services aren't covered by Medicare

While Medicare provides great coverage, it doesn't include some health services. Extras cover can bridge the gap by helping with the cost of services like dental check-ups, prescription eyewear, and physiotherapy.

How to choose the best health insurance for seniors?

When selecting or reviewing your health insurance policy, it's important to consider your age, current health, and what your future needs might look like.

Consider your life stage and health concerns

As we get older, the likelihood of needing hospital care increases. Our bodies naturally require more attention and care, often leading to more substantial hospital admissions.⁵ Among the most common for Medibank members aged 60-64 are endoscopies, orthopaedics and chemotherapy.⁶

Some health funds take a proactive approach to healthcare, partnering with leading medical researchers to develop health programs. These programs are designed to help manage health conditions and provide access to more affordable care options.

Getting better value from your cover

Make sure you’re getting better value from your health insurance by avoiding services you don’t need, like pregnancy and birth and assisted reproductive services, if you don’t need it.

However, while downgrading from Gold to Silver cover often removes pregnancy services, it may also exclude procedures you might need in the future.

That’s why it’s crucial to understand the inclusions and exclusions of every health fund policy. For example, Medibank Silver Plus Secure hospital cover has services that can support your body as it gets older such as cataracts and joint replacements, while leaving out pregnancy and birth services.

In any event, we’re always here to help you better understand your cover and to direct you to the programs and services that best suit your needs. If you’d like to do just that, get in touch.

What about pre-existing conditions?

A pre-existing condition is any ailment, illness, or condition that showed signs or symptoms in the six months before you switched cover or upgraded to a higher level.

If you're a new member, you'll need to wait 12 months before receiving benefits for pre-existing conditions. If you upgrade to a higher level of cover, either within Medibank or from another fund, you may also need to wait 12 months to access the higher benefits, including coverage for new services.

However, if you’re switching from another fund and have already served your waiting period for a specific benefit, you won’t need to re-serve them again.

Do you need private health insurance in a nursing home?

Private health funds don’t cover the cost of care in aged care homes.

While aged care facilities have nurses for daily medical needs, residents could still need hospital access for emergencies or serious illnesses, so maintaining hospital cover could be a good idea, whether they’re at home or in a nursing home.

With some Medibank hospital covers you may be eligible to receive hospital care, rehab, dialysis, infusions, cardiac rehabilitation, and palliative care at home where clinically necessary for greater choice and flexibility.^~

Are there any government incentives for seniors?

Yes. When you turn 65, you’re eligible for a government rebate on your premiums. For singles earning up to $97,000 and couples/families earning up to $194,000, your rebate jumps from 24.6% to 28.7%. And when you reach 70, it goes up to 32.8%. Plus, if one member of a family or couple is 65, the higher rebate applies to the whole family or couple's policy.

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Things you need to know

¹ The Commonwealth Fund; Healthcare in Australia; retrieved November 2024.

² Australian Institute of Health and Welfare; Patients waiting longer than ever for elective surgery as public hospitals work to clear the backlog; retrieved November 2024.

³ AMA; Shining a light on the elective surgery 'hidden' waiting list; retrieved November 2024.

⁴ NSW Government-Agency for Clinical Innovation; Falls in older people with cataract: a longitudinal evaluation of impact and risk; retrieved November 2024.

⁵ Australian Institute of Health and Welfare; Admitted patients; retrieved November 2024.

⁶ Based on 2019-2024 Medibank internal hospital claims data for members aged 60-64.

⁺ Applies to admissions to Members’ Choice Hospitals only. Subject to eligibility criteria. You'll need to provide Medibank with supporting documentation from the hospital.

^~ Must have eligible hospital cover, all relevant waiting periods must have been served and treating doctor must consider it appropriate. Out of pocket expenses may apply. Chemotherapy, palliative, infusion and dialysis program not available in all areas.

* Subject to doctors availability and hospital resourcing.

While we hope you find this information helpful, please note that it is general in nature. It is not health advice and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).