The Short Version
Understanding the costs and coverage of private health insurance in Australia can be confusing. Many believe that Gold cover is always the best option, but this isn’t necessarily true. Your ideal cover depends on your individual health needs and budget, not just the policy’s tier. Consulting with a health insurance advisor can help you find the best cover without overpaying. Contact Fair Health Care Alliance for a tailored, unbiased comparison and save on your health insurance today.
Your Comprehensive Guide to Gold, Silver, and Bronze Hospital Cover
You’ve likely heard terms like “top cover” and “fully covered” thrown around a lot by insurance companies. They want you to believe that you can’t switch your policy without losing something essential. You might think that your Gold cover is superior to your friend’s Bronze cover or that you’re on the highest level of cover possible and secured for basic hospital care. However, this isn’t necessarily true. The best insurance depends on your individual needs and budget.
What do we all seek when we purchase insurance? Is it just a private room, hospital payments, or the choice of doctor? While these are important, the real value lies in knowing that if something goes wrong with our health, we can quickly get the best treatment without paying exorbitant amounts out of pocket.
So, what level of cover do you have? Is your hospital cover and product tier appropriate? Let’s explore the differences of Gold vs. Silver vs. Bronze vs. Basic hospital cover to find out.
Understanding Tier differences in Private Health Insurance
As of April 1st, 2020, legislation changes required all Australian Private health insurers to label all policies with basic, bronze, silver, and gold tiers:
“The Australian Government has introduced reforms to streamline private health insurance by mandating insurers to classify hospital cover into four tiers: Gold, Silver, Bronze, or Basic, based on minimum standard clinical categories. This classification system ensures clarity on coverage, simplifying policy comparison for consumers to choose the cover that best suits their needs.”
Basic
The Basic category is primarily for those who need insurance for tax purposes or have minimal health concerns. It only includes three restricted services: Psychiatric Hospital, Rehabilitation, and Palliative care.
There’s no requirement to cover any private hospital services, making it less useful for those who might need broader medical care.
Bronze
Bronze cover adds thousands of procedures recognized by Medicare and is the minimum level I recommend. It includes essential services like the Male Reproductive System, Hernia and Appendix, Skin, and Cancer treatments (Chemotherapy, Radiotherapy, and Immunotherapy).
While it covers more than Basic, it still might not include critical services needed by individuals with specific health issues.
Silver
Silver cover includes additional services beyond Bronze, such as the Heart and Vascular System, Lungs and Chest, and Back, Neck, and Spine. It’s ideal for people over 40 or those with heart issues.
Silver cover can be more expensive, and while it offers more services, it still might not be as comprehensive as Gold for those needing specific, extensive care.
Gold
Gold cover includes all clinical categories, ensuring comprehensive coverage for any medically necessary treatment listed on the Medicare Benefits Schedule (MBS). It’s perfect for those needing extensive medical care, including private psychiatric hospital services, pregnancy and birth coverage, or weight loss surgery.
It is the most expensive tier, and many people might find they are paying for coverage they do not need.
*Above table sourced from the Australian Government: Department of Health and Aged care
Portability
Don’t re-serve waiting periods when you switch to a new health fund or policy
“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”
Common Misconceptions About Gold Cover
It’s a common misconception among many Australians that Gold cover is always the best choice. People often believe that having a Gold policy is more beneficial than having Silver or Bronze cover, thinking it ensures higher payouts for specific clinical categories. However, this is not true. Whether you have Bronze, Silver, or Gold cover, the out-of-pocket expenses will be the same if two people go to the same doctor for the same procedure with the same insurer.
One reason many Australians believe they need Gold cover is because they are told that certain treatments like Cataracts, Joint Replacements, and Dialysis are only covered under Gold policies. While these treatments do fall under Gold cover, this doesn’t mean you must have Gold cover to get the necessary treatment.
In reality, insurers can include Gold-level categories in Basic, Bronze, or Silver policies. For example, HCF Bronze covers sleep studies and palliative care, both typically considered Gold-level services. This is why it’s essential to speak with a knowledgeable Fair Health Care Alliance representative who can tailor your insurance to your specific needs.
There are specific reasons to choose a Gold policy, but it’s not a one-size-fits-all solution. If the services you need are available at a lower level, Gold cover may not be necessary. Finding the right policy can be challenging, which is why consulting an expert is crucial. They can ensure you are comprehensively covered based on your unique situation.
To understand more about what your insurer is required to pay, read our article on what private health insurance covers. Speaking with us at Fair Health Care Alliance can help you identify the clinical categories you need covered, making sure you have the ideal policy for your needs, not just one labeled as “Top cover.”
Key Points
- Gold cover is not always the best choice.
- Out-of-pocket expenses are the same across Bronze, Silver, and Gold for the same procedure.
- Cataracts, Joint Replacements, and Dialysis are often incorrectly cited as reasons for needing Gold cover.
- Insurers can include Gold-level services in Basic, Bronze, or Silver policies.
- Consult an expert to find the best policy for your specific needs.
Exceptions to the Rules
Basic:
- AHM Basic Boost: Offers $1000 for optical, suitable for those under 30, people with expensive glasses in rural areas, or those seeking tax-purpose cover.
Bronze:
- HCF Hospital Bronze Plus: One of the highest levels of Bronze hospital cover at an affordable price.
Silver:
- NIB Mid Hospital – Silver Plus: cheap overall cover with a great range of services. If you are over the age of 65 and aren’t worried about getting cataracts removed, this is a great cover.
Gold:
- Mildura Health 5 Star Hospital: Ideal for residents of Mildura, offering comprehensive coverage at a price similar to Silver covers.
- St. Lukes: Cheapest overall gold policy.
Policies to Avoid
If you have any of the following policies, it’s critical to talk to an expert about better options:
- Medibank Gold Advantage
- Bupa Healthsmart Gold policies
- NIB Mid Plus – Silver Plus
- AU Value Hospital Silver Plus
- Medibank Silver Plus Smart Options
- Medibank Bronze Plus Assured $250 Excess
- Any cover listed as Public Hospital Basic
These policies often provide minimal benefits for the price, and most people would benefit from switching to a better-suited insurer.
Speak with a Health Insurance Advisor
Get a personalized hospital product tier comparison with an advisor at Fair Health Care Alliance.
In just 15 minutes, we can provide an analysis of costs and benefits tailored to your needs. Our clients receive expert advice with impartial comparisons, helping you achieve your goals with minimal effort. Avoid the confusion caused by health insurers and acquire optimal coverage today.
