Private health insurance is expensive. If you’re a Mature Australian, you may be wondering if it’s actually worth it. Perhaps you’re considering taking out a policy because you need health care services that you’ve not required in the past. Or you already have a policy that you’ve rarely used and are wondering if it’s worth keeping it. Maybe you’re just curious about the advantages of private health insurance given that Medicare covers so much.
Whatever your reasons, whether or not private health insurance is worth it depends on your individual circumstances. If you’re rarely seriously ill, have no medical conditions to speak of, and Medicare currently covers any treatment you do need – then it’s not really worth the expense, or not yet at any rate. However, at some point almost all of us reach a stage where ‘things’ start needing a bit of help to work properly. When that happens, private health insurance should definitely move up your list of priorities!
When Private Health Insurance Is Worthwhile For Mature Australians
Some of the reasons it’s worth taking out private health insurance – at any age – but particularly if you are mature, include:
1. Access to faster treatment at private hospital emergency departments:
Emergency departments at public hospitals are very busy places – Joondalup for example treats over 300 patients a day through their ED! However, if you have private health insurance, you can get faster emergency treatment by attending the less busy ED’s at a private hospital like St John of God. NB: you can still go to a private ED without health insurance but you’ll have to pay for your treatment.
2. Less waiting time for specialist medical treatment and care:
If you have private health insurance, you don’t have to join the long queues waiting for some types of treatment or elective procedures through the public health system. This is an important consideration if you need semi-urgent treatment. Unfortunately, people have died waiting for medical treatment that was not considered critical when initially diagnosed (some types of cancer treatments are a case in point).
3. More choice about when to have certain non-urgent medical procedures done:
With private health insurance, you can usually choose when to have elective surgical procedures done. You’re not just another person waiting in a (very) long queue.
4. Choosing your doctors and hospitals:
Having private health insurance lets you choose your doctor, and your hospital. Private hospitals can be quite luxurious in comparison to public hospitals! However, you can still choose to be treated in a public hospital as a private patient. That’s one of the perks of private health insurance!
5. A private hospital room, even in a public hospital:
People using the public health system and relying on Medicare are often placed on public wards. If you like your privacy and want your own room, you’ll need private health insurance to ensure that happens.
6. Medicare doesn’t cover some health services, products, and procedures:
If you need an ambulance, wear spectacles, need physiotherapy but don’t have a Medicare qualifying condition, or want some dental work done for example, you’ll have to pay some or all of the cost of these yourself unless you have private health insurance with the relevant extras cover. A single trip in an ambulance for instance could cost you up to $6,000 if it has to travel a long way to get to you!
7. It can provide peace of mind:
If you can comfortably afford private health insurance, and you have the right cover and all necessary extras, it does provide invaluable peace of mind. You know it’s there should you ever need it.
When Private Health Insurance May Not Be Worthwhile For Mature Australians
Just as there are reasons for taking out private health insurance as a Mature Australian, there are also reasons why many don’t consider it worthwhile, particularly if they’re still fit and healthy. These include:
1. Private health premiums are expensive:
The reality is that Australia’s public health system gives every Australian citizen access to quality medical care (eventually). So – if you don’t mind waiting for an elective procedure, being on a public ward in a public hospital, have faith in the ability of all medical staff (public or private), and in the care afforded by all our hospitals, then private health insurance may be an expense you can’t justify.
2. Health insurance doesn’t always cover 100% of your medical expenses:
Private health insurance won’t necessarily cover 100% of your medical expenses, particularly when it comes to hospital treatment. Whilst Medicare does pay for some of it, there is a cap (usually ~75%) when you have private health insurance. Does your cover make up that shortfall, or is there a gap that you’re responsible for paying? Remember, making up that ‘gap’ comes on top of what you’re already paying to have private health insurance. That could be a deal-breaker for many people.
This is where you’ll need to shop around and make sure you have the necessary extras to cover as much as possible. If you don’t have ambulance cover for example, you’ll find yourself out of pocket if you need one, even with private health insurance.
3. Some pre-existing conditions may not be covered when you take out private health insurance:
If you already have a medical condition when you take out a private health insurance policy, you may find it’s not covered. Therefore – if that’s the main reason you want to take out the policy, it won’t be worth it.
4. There are still waiting periods for some treatments:
Even as a private patient, some procedures still have a waiting list simply because there is a limit on the number of qualified medical professionals and/or facilities available to perform it.
5. Ambulance cover is available as a standalone product:
Another unfortunate reality is that even if you have ambulance cover through your health insurance, you still may not be covered for 100% of the cost of one. Always check the fine print for this type of cover. Some health insurers do offer standalone ambulance cover, or you can join the ambulance service provider itself and reduce your costs that way.
So is Private Health Insurance Worth It?
Private health insurance is definitely worth it if you:
- Want or require faster medical treatment (emergency or elective),
- Have healthcare needs that Medicare doesn’t cover (spectacles, dental, physio),
- Want the ability to choose your doctor and hospital,
- Frequently need an ambulance, and
- Prefer private hospitals.
If you don’t want or need any of these, it probably isn’t worth it. However, having it if you can afford it does provide peace of mind.
