Ten Tips for Comparing Health Care Policies

Australians already know that health coverage can provide security for individuals and families when medical needs arise. Many, however, do not know how to find the best value when comparing health insurance policies. Below are ten tips everyone should read before shopping for private health coverage.

1. Choose the coverage that concentrates on your specific or potential health needs. The first thing you should do before comparing your health plan options is determine which policy features best fit your needs. A 30-year-old accountant, for instance, is going to need very different coverage than a 55-year-old pro golfer or a 75-year-old retired veterinarian. By understanding the health needs that most often correspond to people in your age and activity level group – your life stage – you can save money by purchasing only the coverage you need and avoid unnecessary services that aren’t relevant. For instance, a young family with two small children doesn’t need joint replacement or cataract surgery coverage. A 60-year-old school teacher isn’t going to need pregnancy and birth control-related services.

Whether it’s high-level comprehensive care you’re after or the least expensive option to exempt you from the Medical Levy Surcharge while providing basic care coverage, always compare health insurance policies with only those services that make sense for you and your family.

2. Consider options such as Excess or Co-payment to reduce your premium costs. When you agree to pay for a specified out-of-pocket amount if you are hospitalized, you sign an Excess or Co-payment option to reduce your health insurance premium.


If you choose the Access option, you agree to pay a predetermined, specific amount when you go to a hospital, no matter how long your stay lasts. With a Co-payment chance, you agree to pay a daily sum up to a pre-agreed amount. For example, if Joanne has an Excess of $250 on her medical coverage policy and is admitted to a hospital, regardless of her stay, she will pay $250 of the final bill. If Andrew has signed a $75×4 Co-payment with his provider, he will pay $75 per day for the first four days of his hospitalization.

For younger individuals who are healthy and fit with no reason to expect to land in the hospital anytime soon, either of these options is a great way to reduce the monthly cost of your medical insurance premiums.
Remember that private insurers have their own rules regarding Excess and Co-payments, including how many payments you must make annually on either option. It is important to read the policy thoroughly and ask questions in advance to understand what you are paying for and what coverage you can expect if you are hospitalized. Also, make sure you choose an Excess option greater than $500 if you’re purchasing an individual policy or $1,000 for family coverage to be exempted from the Medicare Levy Surcharge.

3. Pay your health insurance premium in advance before the cost increases. Each year, insurance providers increase their premiums by approximately five percent sometime around April first, a practice approved by the Minister of Health. By instituting these annual increases, your health insurance provider can fulfill its obligations to policyholders despite increasing medical costs.

Most private medical policy providers allow policyholders to pay for one year’s premium in advance, which locks them into the previous year’s rate for an additional 12 months – a great way to save money. To take advantage of the savings offered, most insurers require payment in full to be made within the first quarter of the year, between January and March.

4. Look into low-cost health insurance at an early age. The most obvious advantage any Australian can take when saving on insurance premiums is buying in early at the least expensive rate. And by early, we mean before age 31. Everyone eligible for Medicare will receive at least a 30 percent rebate from the government on the price of their health care premium, no matter what age they are. However, purchasing hospital coverage before July 1, following your 31st birthday, ensures the lowest premium rate.

After age 31, your health insurance rate is subjected to a two percent penalty rate increase for every year after age 30 that you did not have health insurance. Therefore, if you wait to purchase private health coverage until age 35, you will pay 10 percent more annually than if you had purchased it at age 30.

There are exemptions for some people who were overseas when they turned 30, new immigrants, and others under special exception status. However, suppose you purchased private insurance after the age of 30 and paid an age-loading penalty on your health coverage. In that case, you will be relieved of the excess liability after ten years of continuous coverage.

The earlier you look into a private health plan, the more money you will save immediately and over your lifetime.

5. Choose a healthcare provider who works with your health fund. Determine which hospital you prefer if and when the need for treatment arises, and seek out those health insurance providers that agree with your hospital of choice before deciding on your health insurance purchase.

It’s also a good idea to find out if your insurer has a list of “preferred providers,” including those physicians and practitioners who have also made arrangements with the health funds regarding their service charges. Request this information from every provider when comparing health insurance policies. This way, you can be sure you’ll receive the full gamut of benefits available at the lowest possible cost. These preferred providers often have “no gap” coverage – special rates that reduce or eliminate out-of-pocket expenses to policyholders.

6. Double-check your health insurance policy before scheduling treatment or procedures to ensure coverage. Anytime you are headed to a private hospital for treatment, check to see if the hospital and your health insurance provider have an agreement to ensure you have adequate coverage. At the same time, check with your insurance provider, physician, and the hospital to see a Gap between their fees and the government’s Medicare Benefits. This is extremely important because if your physician charges more than Medicare covers and you do not have a “no Gap” plan, you could be responsible for a considerable bill. Contact your doctor and insurance company to double-check these items and avoid being saddled with an out-of-pocket expense you weren’t expecting.

7. File your expense claims promptly. When you have a health insurance membership card, you can file a lawsuit against your benefits at the time of treatment with no additional paperwork or filing to worry about, at least in most cases. Sometimes, you may still need to file a claim with your insurance provider. When that happens, make sure to file your claim promptly. The typical cut-off for insurers to pay health care claims is two years. You can file your health insurance claim directly with your provider or at your area Medicare office, which has a reciprocal agreement with most insurance providers.

8. Whenever you travel overseas, suspend your health coverage. Anytime you travel overseas for more than a few weeks. Still, in less than 24 months, certain medical insurance providers allow policyholders to suspend their memberships when they’re out of the country, freeing the policyholders from paying premiums during that period. While your insurance policy is broken, your Lifetime Health Cover status remains intact, so you do not have to worry about age loading added when you return home. Contact your health insurance provider to make sure of their policy and rules regarding waiting periods and re-activation.

Australia also has reciprocal arrangements with certain countries, including New Zealand, Finland, Ireland, Italy, Malta, the Netherlands, Sweden, and the UK. For more information, visit http://www.smartraveller.gov.au.

9. Review your policy benefits annually. Lifestyles change; individuals get married, have children, age – children grow up and move out independently, and couples separate. A lot can happen in 12 months, so the Private Health Insurance Ombudsman recommends that everyone review their policy benefits once yearly to ensure their coverage still fits their needs.

Regardless of your life changes, your Lifetime Health Coverage status remains protected. Per the Private Health Insurance Act of 2007, waiting periods for benefits equal to your current coverage are waived. This means you can file claims related to features you had before making any changes without interruption in benefits.

10. Compare policies to get the best price and the coverage you need. To ensure that you get the best possible price on your health insurance premium, you must compare policies from different insurers and compare policies that reflect the treatment plan and coverage you need without filler services you won’t need. The more you know about private health coverage and government-sponsored Medicare, the more likely you will find the best value for your money when purchasing or renewing your health coverage.


Alcohol scholar. Bacon fan. Internetaholic. Beer geek. Thinker. Coffee advocate. Reader. Have a strong interest in consulting about teddy bears in Nigeria. Spent 2001-2004 promoting glue in Pensacola, FL. My current pet project is testing the market for salsa in Las Vegas, NV. In 2008 I was getting to know birdhouses worldwide. Spent 2002-2008 buying and selling easy-bake-ovens in Bethesda, MD. Spent 2002-2009 marketing country music in the financial sector.