5 key questions to ask when choosing your hospital cover
Choosing hospital cover isn’t just about ticking a box – it can help you get faster access to treatment, choose your own doctor, and have more say in where you’re treated. But with different tiers, exclusions and costs to weigh up, it can feel overwhelming choosing the right hospital cover for you and your family.
Whether you’re comparing options for the first time or reviewing your hospital policy, these five questions can help you feel confident in your choice.
1. What’s covered in each tier?
When you’re comparing hospital cover, a good place to start is by looking at what hospital services are actually included. In Australia, hospital policies are grouped into four main tiers – Basic, Bronze, Silver and Gold – and each one offers a different level of cover, from the essentials through to more comprehensive care.
Tier | Common inclusions | Who it’s suited to |
|---|---|---|
Basic | Cover for accidents and emergency. | People getting cover just to avoid the Lifetime Health Cover loading or Medicare Levy Surcharge. |
Bronze | Cover for basic hospital services like joint reconstructions, ear nose and throat, with some additional services like dental surgery. | Younger, healthy people wanting affordable cover. |
Silver | More comprehensive cover – the same includes as Bronze with additional services such as heart and vascular, lung and chest. | People managing a health condition or wanting peace of mind. |
Gold | The most comprehensive cover which includes pregnancy, birth, joint replacements, and more. | People planning for a family or those with more complex health needs. |
Understanding which treatments are covered in each tier helps you choose the right plan based on your needs and budget.
2. Are there any exclusions or restrictions?
Not all policies cover the same services – and even if something is listed, there might be limits or conditions.
Things to check:
Exclusions: Some policies don’t cover things like pregnancy, cataracts or joint replacements.
Restrictions: You might be covered for a treatment, but only in a public hospital. For example, if hip or knee replacements are restricted on your health cover and you go to private hospital for one of these procedures, your health cover will only pay a small part of your hospital costs. You'll have to pay considerable out of pocket expenses towards your treatment.
Waiting periods: There’s often a 12-month wait for things like pregnancy, pre-existing conditions or joint surgery.
Pre-existing conditions: If your condition meets the pre-existing condition definition, in most instances a 12-month waiting period applies from the date of joining or upgrading your hospital cover.
Good to know: If you're switching from another policy, you usually won’t need to re-serve waiting periods for the same level of cover.
3. How much will I need to pay if I need to go to hospital?
Private health insurance doesn’t always cover everything. Here’s what to look for:
Excess: The amount you pay upfront if you’re admitted to hospital. Choosing a higher excess can reduce your premium – but make sure it’s affordable if you need it.
Out of pocket expenses or ‘Gap’ fees: This is the difference between what your insurer covers and what your doctor charges. Ask whether your insurer has agreements with certain hospitals or doctors to reduce these fees.
Private vs public care: If you’re choosing a private hospital over a public hospital, make sure your policy covers the difference, especially for non-Medicare treatments.
How to reduce your out-of-pocket costs with nib
If you're with nib, there are a few ways you can help keep hospital costs down:
Choose an agreement hospital: nib has agreements with a wide network of private hospitals across Australia. Going to an agreement hospital can help reduce or even eliminate some of your hospital-related out-of-pocket expenses. You can search for agreement hospitals using the Find a Provider tool.
Ask if your specialist participates in MediGap: MediGap is a scheme that helps reduce or eliminate gap fees charged by doctors. If your doctor participates in MediGap, they’ve agreed to charge nib members No Gap or a Known Gap of up to $500 for inpatient services. It’s always worth asking your specialist upfront if they’ll treat you under the MediGap scheme.
Tip: Before you go to hospital, you can ask for a breakdown of any potential costs. That way, you won’t be caught off guard by unexpected bills.
Recommended: 6 secrets to reducing your out of pocket hospital costs
4. Is your cover just for tax – or your health too?
Some people take out hospital cover just to avoid extra costs like the Medicare Levy Surcharge or the Lifetime Health Cover (LHC) loading.
LHC loading adds 2% to your premium for every year you don’t have hospital cover after you turn 31.
The Medicare Levy Surcharge applies to higher income earners who don’t have eligible cover.
If that’s your main reason for getting insured, Basic or Bronze might suit you. But if you're looking for real protection or planning for the future, it’s worth choosing a level of cover that supports your health goals too.
Tip: Based on your income, having nib health cover may help you avoid the Medicare Levy Surcharge. Use our MLS calculator to see the extra tax you might pay.
5. Does it match your current – and future – health needs?
There’s no one-size-fits-all when it comes to hospital cover. Think about what you might need now, and what’s on the horizon. Some questions you might want to ask yourself:
Planning a family? You’ll need Gold cover for pregnancy and birth – and to serve the 12-month waiting period before your due date.
Dealing with a chronic condition? Make sure your policy includes relevant treatment categories like cardiac, diabetes or joint care.
Healthy but cautious? A Silver or Bronze Plus policy might strike the right balance between value and protection.
Take your time and choose the policy that’s right for you.
By asking the right questions about what’s covered, any exclusions, potential out-of-pocket costs, waiting periods and how the policy aligns with your health goals, you’ll be in a better position to choose cover that supports your health and budget.
Whether you’re new to nib or reviewing your existing policy, we’re here to help you make a confident choice.
New to nib? Get a quote in minutes and explore Hospital cover options that suit your needs.
Already with us? Log in to the nib App or your member account online to review your current Hospital cover and see if it still matches your lifestyle.
Prefer to talk to someone? Give us a call on 13 16 42.
The information shared in this article is general and not meant to guide specific financial choices. Always consult with a professional who understands your personal situation before making any financial decisions.