Private Health Insurance Value Calculator
Enter your details and click "Calculate My Savings & Benefits" to see how private health insurance could save you time and money.
Key Insights
- Private health insurance typically saves $2,000-$5,000+ annually for families with extras coverage
- Shorter waiting times reduce stress and allow faster return to work
- Gap cover can reduce out-of-pocket costs by up to 80%
- Access to preferred specialists and hospitals improves care quality
Quick Takeaways
- Private health insurance slashes waiting times for surgeries and specialist appointments.
- It gives you the freedom to choose doctors, hospitals and sometimes even rooms.
- By covering part of the "gap" you pay less out‑of‑pocket for medical services.
- Extra perks like dental, physiotherapy and ambulance cover add real value.
- People with chronic conditions, families and those who value speed benefit most.
When you hear the phrase private health insurance, the first thing most Australians think of is a higher premium. But the biggest upside isn’t the extra coverage-it’s the speed and comfort you get when you actually need care.
What Private Health Insurance Is
Private health insurance is a voluntary, fee‑based system that supplements the public health scheme by covering services that Medicare doesn’t fully pay for. In Australia, it typically includes hospital cover, extras (dental, optical, physiotherapy) and ambulance cover. You pay a regular premium, and in return the insurer reimburses part of the cost when you use a private hospital or a chosen specialist.
Why Speed Matters: Cutting Waiting Times
One of the most tangible benefits is the ability to bypass the long waiting list that many public patients face for elective surgeries and specialist appointments. According to the Australian Institute of Health and Welfare, the median wait for a publicly funded hip replacement in 2024 was 12 months, whereas private patients typically wait under three months.
Shorter waits mean less pain, faster return to work and lower risk of complications. For a 55‑year‑old with a torn rotator cuff, moving from a 9‑month public queue to a 4‑week private slot can be the difference between a full recovery and chronic shoulder dysfunction.
More Choice: Specialists, Hospitals and Even Rooms
With specialist consultation covered under most hospital policies, you can pick the doctor you trust rather than being assigned to the first available public clinician. This matters for complex cases where continuity with a particular surgeon improves outcomes.
Private cover also unlocks access to a broader network of hospitals, including private facilities that often have newer equipment and shorter emergency department queues. Some policies let you choose a private room or even a suite, which can make a hospital stay much less stressful.
Lowering Out‑of‑Pocket Expenses
Public care is free at the point of service, but it doesn’t mean you won’t pay anything. Many services-like dental work, physiotherapy, or certain imaging-aren’t covered by Medicare, leading to hefty out‑of‑pocket expenses. Private health insurance steps in by reimbursing a percentage of these costs.
Take the example of a family of four needing orthodontic treatment for their children. Without private cover, the total bill could easily exceed $10,000. A standard extras policy that reimburses 80% of orthodontic fees reduces that to $2,000-a savings most families can actually afford.
Extra Perks: Gap Cover and Ancillary Services
When a private hospital bills for a procedure, the amount may be higher than the Medicare Benefit Schedule (MBS) fee. The difference, called the "gap payment", is typically the patient’s responsibility.
Some policies include gap cover, meaning the insurer pays part or all of that extra amount. This can turn a $2,000 surgery into a $1,500 out‑of‑pocket bill, a noticeable relief for many.
Beyond hospitals, most private plans bundle "extras" like dental, optical, chiropractic, and even travel insurance. These add‑on services often offset the cost of paying for them separately.
Who Gains the Most?
People with chronic conditions-such as diabetes, arthritis, or heart disease-often need frequent specialist visits, imaging and physiotherapy. Private cover reduces the cumulative out‑of‑pocket spend and keeps waiting times short.
Young families benefit from kids’ dental and orthodontic coverage, plus the ability to schedule urgent paediatric specialist appointments without months of delay.
Working professionals value the faster return to work after surgery. A 2‑week reduction in recovery downtime can translate into thousands of dollars in retained earnings.
How to Pick the Right Plan
- Identify your main health needs: hospital cover, extras, or both.
- Calculate the average annual cost of the services you’ll use (e.g., $1,200 for dental, $800 for physiotherapy).
- Compare premiums against expected reimbursements; a rule of thumb is the plan should return at least 30% of its premium in savings.
- Check the insurer’s network of hospitals and specialists to ensure your preferred doctors are covered.
- Look for gap cover or “no gap” policies if you anticipate high‑cost surgeries.
- Read the fine print on waiting periods-most policies enforce a 12‑month waiting period for pre‑existing conditions.
Using this checklist helps you avoid over‑paying for coverage you’ll never use while ensuring you have the safety net you need.
Side‑by‑Side Comparison: Private vs Public
| Aspect | Private Health Insurance | Public System (Medicare) |
|---|---|---|
| Waiting times for elective surgery | Typically 4-12 weeks | 6-12 months (median) |
| Choice of specialist & hospital | Patient‑selected within network | Assigned based on public availability |
| Out‑of‑pocket costs for extras (dental, optical) | Partially reimbursed (70‑80%) | Generally not covered |
| Gap payment handling | Often covered by gap policies | Not applicable (public fees fixed) |
| Flexibility for overseas travel | Included in many plans | Limited to emergency care abroad |
Frequently Asked Questions
Does private health insurance really speed up surgery?
Yes. Private patients are placed on a separate queue with shorter waiting periods. Data from the AIHW shows private hip replacements average about 10 weeks, whereas public patients wait around 12 months.
What is the ‘gap’ and how does gap cover work?
The gap is the difference between a hospital’s charge and the Medicare Benefit Schedule fee. Gap cover policies reimburse part or all of that extra amount, reducing your out‑of‑pocket bill.
Can I claim dental work under private health insurance?
Only if you have an "extras" or dental component in your policy. Most plans cover a percentage of routine check‑ups, fillings and orthodontics up to a yearly cap.
Do I lose my private cover if I move to another state?
No. Private health insurance is nationally regulated, so your coverage travels with you. However, you should confirm that your preferred local hospitals and specialists are still in‑network.
How can I tell if the premium is worth it?
Calculate your expected annual health expenses and compare them to the premium. If the insurer reimburses at least 30% of the premium in savings, you’re likely getting value.
