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Megan Fraser Updated: 29 April 2021
Currently, there are thirty-eight insurance companies registered under the Private Health Insurance Act 2007. They typically have the option to run as an open or restricted fund. Open funds offer cover to the general public while restricted funds have specific criteria that you’ll need to meet before you’ll be able to join.
To determine which companies are the 10 best insurers, you’ll need to compare the types of policies they offer, their premiums, the market share they hold as well as customer satisfaction ratings. Then, you’ll need to weigh up all of the varying factors to find the right company for your requirements.
Key Facts
- The top 5 companies by market share are Medibank, Bupa, HCF, nib, and HBF.
- Premiums for a Basic Hospital policy single adult range between $96.20 and $277.35 per month depending on the insurer you choose.
- To find the best company for your requirements look for a fund that offfers the benefits you need at a premium you can afford.
Top 10 private health insurance companies in Australia by market share
- Medibank: 26.9% market share. Has over 40 years’ experience delivering health insurance to 3.7 million customers via their Medibank and AHM brands.
- Bupa: 25.4% market share. The foreign-owned private company entered the Australian market in 2002 and currently serves over 4 million customers in Australia and New Zealand.
- HCF: 11.7% market share. A not-for-profit health fund established in 1932, now covering over 1.5 million Australians in 52 locations across the country.
- nib: 9.2% market share. Established in 1952, nib is an international health partner serving over 1.5 million customers in Australia and New Zealand.
- HBF: 7.3% market share. A not-for-profit organisation founded in 1941, providing health coverage to more than 1 million members.
- Australian Unity: 2.6% market share. A mutual company owned by its members established over 175 years ago with 185,000 private health insurance policyholders.
- Teachers Health: 2.5% market share. A private health fund exclusively for the education community in Australia which looks after 350,000 teachers, education staff and their families.
- GMHBA: 2.1% market share. Since its beginning in 1934, GMHBA has remained a not-for-profit health insurer, now protecting more than 400,000 Australians.
- Defence Health: 0.4% market share. For over 65 years Defence Heath provides coverage to the Australian Defence Force (ADF) and wider defence community and today covers over 300 000 people.
- CBHS: 0.1% market share. Since 1951 CBHS protects the health of Commonwealth Bank of Australia’s (CBA group) employees and families, with over 100,000 members today.
Source: Ombudsman.gov.au, Australian Prudential Regulation Authority 30 June 2020
2021 Private health insurance reviews and premiums Australia
When comparing major private health funds, you might also want to consider how satisfied their customers are with their service and how their premiums compare for a similar policy.
Source: Ombudsman.gov.au, Productreview.com.au, Privatehealth.gov.au, January 2021
*Take note: The above monthly premium information is based on a basic Hospital policy with a $750 Excess for a single adult living in Queensland.
How to choose the best health insurance for your requirements
Coverage
Firstly decide on the type of coverage you require. For example, a basic hospital policy will most often cover accommodation as a private patient in a public or private hospital but exclude high-cost services like pregnancy.
Benefits
Your chosen health insurance company might use dollar or percentage amounts or both to show how much you can claim for a specific service, for example, $250 per person or 75% of the total costs. Hospital cover has been categorized into four tiers – Basic, Bronze, Silver and Gold. These tiers, each with a minimum level of cover guaranteed, will make it easier for you to compare and choose the right policy that meets your requirements.
Annual limits
A limit refers to the maximum benefit payable each year for a specific service/treatment. Annual limits differ between funds and policies, so make sure that you review the company’s Standard Information Statement (SIS).
Co-payments or daily excess
In exchange for lower premiums, hospital policies generally have co-payments, also known as an excess, wherein you agree, upfront, what amount you’re willing to pay each day you’re in the hospital. Depending on the insurer you’ll typically have the choice of zero, $250 or $500 excess.
Health Insurance Reviews
Read what customers are saying about the company, how satisfied they are with their service and how many complaints the company annually receive.
Exclusions
Carefully review which services and conditions your provider does not cover. With the new health insurance reforms where hospital policies must adhere to a simplified classification system; Gold, Silver, Bronze and Basic, your health fund might decide to exclude or include specific benefits.
Premiums
A cheap policy isn’t necessarily the right policy for you. Make sure to compare funds that provide the coverage you require before reviewing cost. This way, you’ll generally be able to find an acceptable value policy for an affordable price.
Waiting Periods
Look at the length of time you’ll have to wait before you can claim a benefit, for example, when you have a pre-existing condition, you generally have to wait 12 months. Waiting periods can range anywhere from 1 day, two months to a year and are different between insurers.
Market share
If a health fund owns more of the market, it means that they have sold more policies, which could mean that more people are trusting that particular health fund.
Which type of health cover to consider?
Select Private health insurance cover helps you avoid the Lifetime Health Cover (loading) and Medicare Levy Surcharge (MLS). It’s also essential to consider having adequate health cover if you have a health condition, are thinking about becoming pregnant, have a family, or are getting to an age where more medical assistance is required.
There are many private health funds in Australia, competing for your business. However, to find the most appropriate health fund to suit your requirements, you need to be clear about the type of plan you need:
Hospital cover
Covers some or all of the costs for treatments received in the hospital. The protection you’ll receive depends on the level of hospital insurance your purchase: Gold, silver, bronze or basic.
Extras cover
Provides a benefit for treatments and services received outside of a hospital, for example, optical, dental and psychology. Depending on your fund, you generally have a choice between comprehensive, mid or basic extras.
Combined Cover
Includes both hospital and extras. Many insurers will allow you to tailor cover to suit your requirements.
Take note: You do not have to buy hospital and extras from the same company. Find what works for you, even if that means buying a hospital policy from one insurer and an extras policy from another fund.
Health Insurance Quotes
- Reduce out-of-pocket expenses
- Keep your family healthy
- Easy and convenient
- Free to use
Want to talk to a specialist? Call 1300 743 254
Top 5 cheapest companies by health insurance product tier
In April 2020 it became mandatory for Hospital cover to be categorized into four tiers – Basic, Bronze, Silver and Gold. A policy is assigned a tier based on the minimum level of cover it offers. These tiers will make it easier for you to compare and choose the right policy that meets your requirements.
Top 5 Bronze Hospital Cover Plans
| Health Insurer | Product | Monthly Premium | Excess |
|---|---|---|---|
| Medibank Private & AHM | Medibank Bronze Everyday | $117.15 | $750 per admission |
| BUPA | Bronze Plus Simple Hospital | $120.50 | $750 per admission |
| HCF (Hospitals Contribution Fund) | HCF hospital bronze | $121.00 | $750 per admission |
| NIB Health & GU Corporate Health | Bronze Hospital Plus | $121.65 | $750 per admission |
| HBF Health & GMF/Healthguard | Bronze Hospital Plus | $112.40 | $750 per admission |
Take note: The companies listed are ranked based on market share (based on insurer), and the premiums are calculated for a single person living in Queensland.
Top 5 Silver Hospital Plans Compared
| Health Insurer | Product | Monthly Premium | Excess |
|---|---|---|---|
| Medibank Private & AHM | Medibank Silver Everyday | $161.20 | $750 per admission |
| BUPA | Silver Plus Essential Hospital | $148.25 | $750 per admission |
| HCF (Hospitals Contribution Fund) | HCF hospital silver | $202.05 | $750 per admission |
| NIB Health & GU Corporate Health | Silver Hospital | $151.71 | $750 per admission |
| HBF Health & GMF/Healthguard | Silver Hospital Plus | $206.00 | $750 per admission |
Take note: The companies listed are ranked based on market share (based on insurer), and the premiums are calculated for a single person living in Queensland.
Top 5 Hospital Gold Plans Compared
| Health Insurer | Product | Monthly Premium | Excess |
|---|---|---|---|
| Medibank Private & AHM | Medibank Gold Complete Hospital | $230.10 | $750 per admission |
| BUPA | Gold Complete Hospital | $248.75 | $750 per admission |
| HCF (Hospitals Contribution Fund) | HCF hospital gold | $221.50 | $750 per admission |
| NIB Health & GU Corporate Health | Gold Top Hospital | $272.01 | $750 per admission |
| HBF Health & GMF/Healthguard | Gold Hospital | $209.90 | $750 per admission |
Take note: The companies listed are ranked based on market share (based on insurer), and the premiums are calculated for a single person living in Queensland.
How many health insurance companies are there?
There are 38 private health insurance companies in Australia for you to choose from. However, not all funds are open to the public; some are restricted to specific groups of people, for example, the Doctors Health fund generally only offers cover to members of the medical community and their families.
Funds open to the public
- AHM Health Insurance
- Australian Unity Health Limited
- Bupa HI Pty Ltd
- CBHS Corporate Health Pty Ltd
- CDH Benefits Fund
- CUA Health Limited
- GMHBA Limited
- Grand United Corporate Health
- HBF Health Limited
- HCF
- Health Care Insurance Limited
- Health Insurance Fund of Australia Limited
- Health Partners
- Health.com.au
- Latrobe Health Services
- Medibank Private Limited
- Mildura Health Fund
- MyOwn Health Fund
- National Health Benefits Australia Pty Ltd
- NIB Health Funds Ltd
- Peoplecare Health Insurance
- Phoenix Health Fund Limited
- Queensland Country Health Fund Ltd
- St. Lukes Health
- Transport Health Pty Ltd
- Westfund Limited
Funds restricted to specific members
- ACA Health Benefits Fund
- CBHS Health Fund Limited
- Defence Health Limited
- Doctor’s Health Fund
- Emergency Service Health
- Navy Health Ltd
- Nurse & Midwives Health
- Police Health
- Railway and Transport Health Fund Limited
- Reserve Bank Health Society Ltd
- Teachers Health
- TUH Health Fund
Frequently asked questions
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Which health insurance company is the best in Australia?
There is no best health insurer for every person. As the saying goes ‘you can’t please all people all of the time’. Each person and family unit is different, with specific health requirements and budget. The best private health insurance provider for you should be one that you can afford and provides the type and level of coverage you want.
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How do health insurance companies work?
In Australia, residents generally have access to free health care, called Medicare. However, to relieve some pressure off the public health system and shorten waiting times, you are encouraged to take out private health insurance, if you don’t, you’ll usually have to pay an LHC loading and MLS fee. In exchange for paying a premium, the private health insurance company pays a portion of your medical expenses.
Medicare generally pays up to 75% of your medical treatments under the Medicare Benefits Schedule (MBS). Your private health insurance must then pay at least 25% of the MBS fee. You are then responsible for the remainder of the costs. However, the private health insurance company you choose can pay more than the required 25%.
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Can health insurance companies exclude pre-existing conditions?
No, health insurance companies cannot exclude pre-existing conditions, for example, asthma, cancer, or diabetes, because the Australian Federal Government prohibits it. Private health insurers may not refuse to let you buy health coverage or even to charge you a higher premium because you have a pre-existing condition. They can, however, have strict waiting periods associated with pre-existing conditions.
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How much does health insurance cost in Australia?
The premium you’ll have to pay for your health insurance policy depends on various factors, including the state you live in, the type of plan you want (hospital, extras or combined), the co-payments you’re willing to make and the level of coverage you require (comprehensive, medium or basic). Remember, premiums rise every year on the 1st of April.
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Who are the top 5 health insurance companies?
There is no ‘one best private health fund’ that will satisfy everyone’s requirements all the time. It’s up to you to compare offerings and premiums from the list of health insurance companies available in Australia. However, the top 5 private health insurance companies in Australia by market share are:
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Which health insurance company offers the best cover for overseas visitors?
Each overseas visitor has their own unique requirements, for example, your budget, the number of family members travelling with you and the state(s) you’ll be visiting. It is generally worth getting OVHC quotes from a variety of providers to determine which one best meets your particular requirements.
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Which company offers the best cheap health insurance?
To meet your requirements, it is advisable to compare the various policies on offer. In Australia, the most affordable health insurance plans are generally the Basic Extras only cover options, which usually only pays for essential general treatments received outside of the hospital.
Health Insurance Quotes
- Reduce out-of-pocket expenses
- Keep your family healthy
- Easy and convenient
- Free to use
Want to talk to a specialist? Call 1300 743 254
Medibank, BUPA, HCF, NIB and HBF
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