Read the policy against the treatment you need
Hospital cover contributes to admitted private-patient treatment. Extras contributes to listed non-hospital services. Neither promises that every invoice will be paid. The official clinical-category matrix defines hospital minimums; insurers can include additional categories.
| Category example | Basic | Bronze | Silver | Gold |
|---|---|---|---|---|
| Rehabilitation / hospital psychiatry / palliative care | Required; may be restricted | Required; may be restricted | Required; may be restricted | Required |
| Joint reconstructions | Optional | Required | Required | Required |
| Heart and vascular | Optional | Optional | Required | Required |
| Cataracts / joint replacements / pregnancy and birth | Optional | Optional | Optional | Required |
This selection is not the complete matrix. “Required” refers to the clinical category, not payment of every fee. Restricted benefits can leave substantial private-hospital costs. Plus policies add categories above the minimum; compare actual inclusions, not just the name.
Separate the premium from tax and loading
For 2026–27 the base MLS thresholds are $105,000 single and $210,000 family, with higher tiers and dependent-child adjustments. Check current MLS rules or use the income-tier check. A policy is not automatically cheaper than your actual surcharge.
Domestic policies are community rated. Age-based discounts, the income/age-tested rebate and LHC loading are distinct adjustments. New migrants generally have a specific LHC base day based on interim/full Medicare registration and age, with exceptions. Confirm your LHC base day before using an age example.
Use a written comparison
- Annual premium after your actual rebate, loading and discounts
- Clinical categories included, excluded or restricted
- Hospital excess, co-payment, annual caps and doctor gap arrangements
- Waiting periods and whether previous cover gives credit
- For extras: item numbers, per-visit benefits, annual/shared and lifetime limits
- For a planned admission: hospital agreement, doctors’ written fees and insurer authorisation
Illustrative quote comparison: a $1,500 premium with a $750 excess totals $2,250 if one admission attracts that excess. A $1,800 premium with a $250 excess totals $2,050 for the same assumed claim. Other gaps and differences in cover are excluded. With no claim, the first policy costs less. These are invented inputs, not market estimates.
Domestic hospital waits are generally capped at 12 months for pregnancy/pre-existing conditions and two months for other treatment, including hospital psychiatry. Extras waits are insurer-set. Waiting periods and exceptions.
Frequently asked questions
Does Silver include cataracts and joint replacements?
They are optional at Silver and required clinical categories at Gold. A Silver Plus policy may add either; check its actual categories.
Are extras tiers standardised?
No. The regulated Basic, Bronze, Silver and Gold categories apply to hospital cover. Compare extras by item benefits, waiting periods and limits.
Will a higher age automatically increase the base premium?
Domestic health insurance is community rated. Permitted age-based discounts, LHC loading and rebates may affect your payment; health risk is not an age multiplier for the same base policy.
Will hospital cover eliminate all costs?
No. Excesses, co-payments, medical gaps, exclusions and hospital agreements matter. An agreement hospital does not guarantee no doctor gap.
Will private cover remove my Medicare levy?
The ordinary Medicare levy is separate. Appropriate domestic hospital cover can affect MLS liability for eligible days; extras, OSHC and OVHC are not MLS-exempt hospital cover.
Source checked 1 October 2026. Compare actual domestic policies on PrivateHealth.gov.au. This page does not assess eligibility, quote premiums, calculate a rebate or recommend an insurer.