The latest health insurance statistics reveal that almost half of the population has private coverage. Still, most policyholders do not completely understand what they are paying for or what their coverage includes.
To help you make sense of it all, we put together some of the most relevant stats and facts on health insurance in Australia and answered the most important questions.
Seven Most Important Health Insurance Statistics
- $16.7 billion (27.8%) are private health insurers
- Less than 20% of the population is insured for all conditions.
- In the year ending December 2021, the health insurance industry was worth $25 billion.
- The five top insurance companies in Australia hold about 80.4% of the market.
- The average health insurance cost per month in Australia is around $166.
- More than half of 65 to 69-year-old Aussies have private health insurance.
- Over 20,000 young people have stopped getting private health insurance since the pandemic started.
General Health Insurance Statistics in Australia
1. What is the percentage of people who have private health insurance?
(Department of Health)
It is estimated that around 13.6 million people in Australia, or 53% of the country’s population, have private health insurance.
2. How does private health insurance work in Australia?
(ACCC)
Two types of private health insurance are available in Australia: hospital and general treatment cover (also known as ancillary or extras). In June 2020, 43.6% of Aussies held hospital only or combined health insurance, while 9.4% had extras treatment only policies.
There are out-of-pocket costs, namely gap payments, i.e. the amount you have to pay when the procedure costs more than what your insurance covers. For example, average gap payments for hospital coverage stood at $289.75 between June 2019 to June 2020, while average gap payments for extras treatment reached $50.25.
3. How many people in Australia don’t have health insurance?
(The Conversation)
Less than 20% of the population is insured for all conditions. As of April 2020, there are three levels of healthcare in Australia—Gold, Silver, Bronze or Basic. Just 41% of Australians had insurance at Gold level, which covers hip replacements, pregnancy and birth, and pain management (these conditions are only covered at Gold level).
4. Does Australia have universal healthcare?
(MoveHub)
Medicare is Australia’s universal health care insurance system. Medicare does not cover:
- Ambulance services
- Pirate hospital treatments
- Most of dental care, physiotherapy, audiology, ophthalmology, and occupational therapy
- Home nursing for the elderly, critically ill or disabled individuals
- Cosmetic surgery
Medicare is funded by tax, which comes out to 2% of the taxable income for most people. Persons who earn less than $26,668 pay a lower amount, although even jobs that do not require experience pay more than that a year.
On the other hand, if you earn over a certain income or don’t have the appropriate level of private hospital insurance, you will have to pay the Medicare Levy Surcharge (MLS) on top of the 2%.
The MLS ranges from 1% for singles who earn from $90,001 to $105,000, or $180,001 – $210,000 for families. MLS can go as high as 1.50% for singles who get over $140,001 or families that make more than $280,001.
5. Is private health insurance worth it in Australia?
(SBS, The Guardian)
There are plenty of benefits of private health insurance in Australia. It gives users access to services that Medicare does not cover. It also helps them avoid long wait times for elective procedures and offers a choice of doctor or hospital. More importantly, it takes the pressure off the public health system.
However, 43.7% of Aussies find it difficult to understand what their private health insurance actually covers. Older generations tend to see more value in having private coverage as 83.8% of those born before 1946 believe health insurance is about knowing you will be covered in case of big medical expenses. On the other hand, only 56.5% of Gen Z feel the same.
Health Insurance Industry in Australia
6. The health insurance industry in Australia was worth $6.7 billion in Q3 2021.
(APRA)
In the year ending December 2021, the health insurance industry was worth $25 billion, the latest Australian insurance market statistics reveal.
Premium revenue went up by 5.8 compared to the previous year, driven by a combo of membership growth and an increase in premium rates, even though the private health insurance average premium growth of 2.74% was the lowest on record since 2001. Gross (17.2%) and net margins (7.7%) also rose, whereas claims decreased by 1.2% due to COVID-19 restrictions.
7. Health insurance companies paid out less in benefits in 2020 than in 2019.
Private health insurers paid $15 million in hospital coverage, health insurance statistics from 2020 reveal, which is 0.9% less than the previous year. Extras treatment benefits came out to $4.9 million, marking a 6.4% decrease compared to 2019.
8. How is private health insurance funded in Australia?
(Bupa)
Services accessed through the private system are funded by government and private entities, such as health insurance premiums (paid by customers), private health organisations, patients paying directly for private treatment, government incentives and other government and private funding. On the other hand, the services in the public system are funded by local, state and federal governments.
9. Who is the best health insurance provider in Australia?
International health insurance company Bupa is the biggest health insurance provider in the country, making up 26.3% of the total market share. In 2020, this company insured around 3.57 million members.
10. Who are the top 5 health insurance companies?
Medibank is the second biggest health insurance company after Bupa, holding 26% of the market. It is followed by HCF with a 12.3% stake, while health care fund NIB and Perth-based HBF round off the top five with 8.7% and 7.1% of the market, respectively.
These five top insurance companies in Australia hold about 80.4% of the market, with Bupa and Medibank covering half of the Australian consumers with private health insurance.
Health Insurance Cost
11. What is the average cost of health insurance in Australia?
The average health insurance cost for policyholders in Australia is about $2,000 for hospital treatment cover, and $850 for general treatment cover a year.
12. How much is private health insurance a month?
The average health insurance cost per month in Australia is around $166. Stats show that Victoria is the most expensive state for health insurance, where policies go up to $251.45 a month. On the other side of the spectrum is the Northern Territory, where the monthly private health insurance cost is estimated at $189.11.
13. How much does health insurance cost?
(APH)
Total spending on health is around $81.8 billion, or around 16.3% of the government’s total expenditure.
14. Does Australia have free healthcare?
Australia provides free healthcare through Medicare at all public hospitals, as well as some of the cost of physiotherapy and basic dental care for children. It also covers 100% of MBS (Medicare Benefits Schedule) costs if they come from a GP and 85% if they come from a specialist, as well as some of the cost of prescription medication, provided they are on the PBS (Pharmaceutical Benefits Scheme) list.
15. Families that get $280,000 and upwards do not qualify for rebates.
(PHA)
Rebates is the amount the government pays towards the cost of your private hospital health insurance premiums. The amount depends on your income and family status. Thus, singles who earn $90,000 or less, like video game designers and tour guides, could get between 24 and 32% (depending on age), while families or couples that make more than $280,001 are not entitled to any rebates.
Demographics of Health Insurance Policyholders in Australia
16. More than half of 65 to 69-year-old Aussies have private health insurance.
(Australian Institute of Health and Welfare, Statista, APRA)
Private health insurance coverage is lowest among adults between 25 and 29—26% of females and 21% of males from this age group were covered, data from 2019 indicates.
Conversely, the rate of private insurance coverage was the highest among people aged between 65 and 69. As of June 2019, 55% of females and 57% of males in this age bracket had hospital treatment insurance.
What’s more, in 2021, hospital treatment membership increased the most among the 50+ age group (by 119,425), whereas only 61,372 more persons aged 20 to 49 got hospital coverage.
In terms of territory, people living in Western Australia came out on top. 70.6% of the Western Australia population had general private health insurance, compared to the Northern Territory, where less than half (44.1%) were covered.
17. Dental procedures are the most common area covered by health insurance.
(Australian Institute of Health and Welfare)
In terms of extras, dental and optical were the two biggest areas of expenditure, accounting for 53% and 17% of all benefits paid by private health insurers, respectively. Physiotherapy, chiropractic and natural therapies services cost $433 million, $298 million and $214 million each.
In hospital coverage, anaesthesia was the largest area of expenditure (25%), followed by medical specialists (9.2%), pathology (7.2%), orthopaedic services (6.9%) and correctional surgeries (5.6%).
Impact of the Covid-19 Pandemic on the Health Insurance Industry
18. Australian insurance companies could get up to $5.5 billion as a result of the coronavirus pandemic.
(ABC Australia, ACCC, The Australia Institute)
Research from The Australia Institute shows that the Australian private health insurance companies might get between $3.5 billion and $5.5 billion as more insurers paid for services they did not need during the pandemic. More specifically, the study believes that each policyholder paid between $500 and $750 for services they were not able to use.
The government was also estimated to save $1 billion to $1.5 billion due to a reduction in rebate payments.
Nevertheless, private health insurers insisted that they did not profit from the COVID-19 crisis and returned more than $500 million to members, including over $150 million in hardship provisions.
19. Over 20,000 young people have stopped getting private health insurance since the pandemic started.
More than 20,000 young people dropped their hospital coverage in 2020. This translates to 4.6% of the 25–29 and 3.2% in the 30–34 age group. A similar decline of 2.2% was reported among 40–44 and 55–59-year-olds.
On the other hand, health insurance statistics from 2020 point out that the number of people from the older age groups (70–74, 75–79 and 80+) getting private hospital coverage increased by 3.9%, 6.1% and 4.7%, respectively.
The trend of dropping hospital coverage by younger generations was partly fueled by the economic uncertainty surrounding the Covid-19 pandemic, and partly by the fact that more people started to appreciate the public health system as the coronavirus spread across the country.
Bottom Line
We hope that these health insurance statistics and facts helped you better understand how the public and private health insurance systems in the country work and gave you insight into what and how much your policy covers.
- ABC Australia
- ACCC
- APH
- APRA
- APRA
- Australian Institute of Health and Welfare
- Bupa
- Department of Health
- PHA
- SBS
- Statista
- The Australia Institute
- The Conversation
- The Guardian
