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Health Insurance For Over 65-Year-Olds

Name: Health Insurance For Over 65-Year-Olds
Creator: Savvy
Published: 2023-03-29T17:23:00+10:30

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Written by , updated on July 6th, 2023

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Most people find they have the greatest need for health care once they’re aged over 65. For this reason, making sure you have the best health cover in your senior years is very important for most Australians in that age bracket.

Savvy can help you quickly find a range of health insurance policies suitable for seniors to compare from our panel of health funds. You can look at these plans side-by-side to compare their features, costs and the cover they provide. Start getting your health insurance sorted out here through Savvy today.

What health insurance options are there for Australians aged over 65?

Under Australia’s health insurance community rating system, everyone is entitled to buy the same health cover, regardless of age, gender or pre-existing health conditions. This means the same private health insurance policies are available to a healthy 30-year-old as they are to a senior Australian who may have more complex health needs.

However, even though health insurance policies offer the same to all age groups, there are some policies which may be more suited to older people or those aged over 60, or which offer the best coverage for pensioners. For example, why pay more for a private health policy that offers cover for pregnancy when you are now retired and enjoying time with your grandchildren?

Health insurance is divided into two broad categories: cover for hospital visits and cover for healthcare provided outside of hospital.

Hospital cover

This type of health insurance can enable you to be treated as a private patient, either in a private hospital or in a public hospital. Some health funds also include ambulance cover as part of their hospital cover policies. Such a policy may help cover expenses such as:

Costs associated with being treated as a private patient in a public or private hospital, including having your own private room (subject to availability, eligibility and your policy’s terms and conditions)
Consultations with doctors, surgeons and anaesthetists while an in-patient
Costs associated with surgery, including theatre and recovery ward fees
Tests administered as part of your treatment while an in-patient (such as blood tests, CT scans, MRI scans and x-rays)
Allied health services such as pain management
Some medications and prescriptions given to you whilst you’re in hospital

However, there may still be some out-of-pocket expenses if you do have to stay in hospital. These may include paying an excess and/or co-payment for your time in hospital.

Extras cover

This type of insurance assists with the costs of many types of healthcare offered outside a hospital setting. Extras cover can include areas such as:

Optical and hearing aids
General and major dental
Physiotherapy, chiropractic and remedial massage
Podiatry
Speech therapy
Dietetics
Psychology
Vaccinations
Non-PBS prescription medications
Health and wellbeing services, such as phone helplines and assistance to manage weight loss or diabetes

Most policies allow you to claim a certain amount on each type of treatment, which is known as the benefit limit. These limits are either per year or for the life of the insurance policy. As a senior looking at health insurance, it’s well worth considering a policy with the most suitable benefit limits you can afford.

How should I compare health insurance policies for seniors over 65?

The trick to comparing health insurance policies as a senior or aged pensioner is to try to find a policy which offers you the maximum coverage for areas you need, without paying for cover you won’t use.

Aspects of hospital cover policies to compare

Hospital cover is offered in four tiers: basic, bronze, silver and gold. The most expensive are gold policies, but they offer the most comprehensive cover for seniors, including areas such as joint replacements, cataract surgery and sleep studies. However, they also include services that you may not need cover for in your retirement, such as reproductive assistance, pregnancy and birth.

Cost – look at what you can afford to pay for your heath cover per month
Inclusions – compare what areas of treatment are covered
Exclusions – look at what is excluded from the policy
Excess – look at the excess that comes with the policy, which can range from zero to $750 per person
Co-payments – compare whether there are any co-payments you’ll be required to make if you are admitted to hospital
Waiting periods – if you’re upgrading your health cover, there may be additional waiting periods you have to serve

Aspects of extras policies to compare

Extras policies also come in different levels, although these aren’t as clearly defined as hospital cover tiers. The more you pay for your extras, the higher level of cover you may have and the more you’ll likely be able to claim back on healthcare services. For example, a cheap policy may offer 50% of the cost of a physio visit as a benefit, whereas a more expensive one may allow you to claim back 85% of the cost.

Cost – ranging from cheap cover to the most expensive and comprehensive policy
Policy limits – how much you can claim back in benefits in total or for each area of healthcare, either per year or overall
Inclusions – which types of treatment are covered by the policy
Levels of cover – how much of the cost of each individual treatment you can claim back
Waiting periods – look at whether you’ll have to wait to claim (some insurers may waive waiting periods as part of special extras policy offers)
Non-PBS prescription medications – particularly important if your doctor has prescribed you a medication that is not listed on the Australian Government’s PBS list
Exclusions – look at what isn’t covered or is excluded, particularly if you’re looking for cover for areas such as alternative or complementary medicine, naturopathic medicine or acupuncture

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about health insurance for over 65-year-olds

Are there any age-related discounts for health insurance for over 65-year-olds?

There are no direct health insurance discounts for aged pensioners over 65 years old, but you may be entitled to receive more assistance from the government with the cost of your health cover. The Private Health Insurance Rebate increases for those aged 65 to 69 up to 28.71%, and once you’re 70 or over, it increases again to 32.81%*.

*Figures are correct as of March 2023 but subject to change. The rebate is income tested so is not available to all people.

If I don’t have health insurance as a 65-year-old, will I have to pay extra tax?

You may have to pay the Medicare Levy Surcharge if you don’t have private health insurance, but this will depend on your income. If your annual income is less than $90,000 p.a. or $180,000 as a couple or family, you won’t have to pay the surcharge. However, this is not age-dependent, so it doesn't matter whether you're over 50 or over 65, it's the income level that will determine whether you have to pay MLS or not.

Does private health insurance cover the cost of residential aged care?

No – the cost of residential aged care is not covered by private health insurance in Australia in any form.

If I change health cover providers, will I have to serve waiting periods again?

This will depend on whether you increase your level of cover, such as from a bronze to a silver hospital policy or from a cheap extras policy to an expensive one. You don’t usually have to re-serve waiting periods that you’ve already served with your former health fund for a new equivalent cover. Waiting periods will generally apply for coverage for areas/services not included under your previous policy.

Is there any upper age limit for taking out private health insurance in Australia?

No, there is no upper age limit on when you can take out a private health insurance policy in Australia. Under Australia's community rating health insurance system, it is illegal to discriminate against anyone based on their age, gender or pre-existing health conditions.

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Savvy’s comparison service is provided by Compare Club. Compare Club compares selected products from a panel of trusted insurers and does not compare all products in the market.

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