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What to Look For in a Seniors Health Insurance Policy

What to Look For in a Seniors Health Insurance Policy

Many senior Australians are still very active in the workforce. Others are entering their retirement years. Whether you’re still working or retired, or whether you’re single or living as a couple, there are specific private health insurance policies designed to suit seniors and their health care needs.

What Does Seniors’ Health Insurance Cover?

 A private health insurance policy that is suitable for seniors will cover the health needs of ageing Australians. These policies will target those who are 50+ years, or at retirement age (65 and up).

By having private health cover that’s suitable for your senior needs, you’ll have peace of mind in knowing you’re covered for health conditions that are more common among older people. Additionally, this cover means that you mightn’t have to rely on the public health system either.

Why Do You Need Seniors’ Health Insurance?

Australia has a comprehensive public health system whereby there’s a bulk-billing process for seniors attending doctors’ appointments. They also receive discounted prescription medications through the Pharmaceutical Benefits Scheme (PBS).  They receive other health-related discounts, especially if they hold a Seniors Health Care Card.

With such a good public health system, one may ask the question “What’s the point of private health cover?” Importantly, many hospital procedures are not deemed an emergency under the public health system. For example, you could be in great need of a total hip replacement. But this is elective surgery. Elective surgery under the public health system often has long waiting periods and you’re therefore living with pain for a long time. This impacts your quality of life and can therefore lead to other health complications. But if you have a private health insurance policy, you’re unlikely to endure lengthy waiting periods for procedures such as joint replacements or eye surgery. You’ll also get to choose your surgeon, and stay in a private hospital.

hospital bed in ward

Another point to raise is if you don’t have private hospital cover and you’re deemed to be on a high income, you’ll pay a Medicare levy surcharge which can be up to 1.5% of your income. The Medicare levy surcharge was bought in to alleviate the burden on the public health system by urging people to join private health cover.

Can Over 65s Get Covered For Common Ageing Conditions Without Relying on The Public System?

Common ageing conditions can be covered under your private health insurance. But there are certain points to be aware of. For example, private consultations with your doctor/ specialist get covered only by Medicare, and therefore your private health cover doesn’t cover these costs.

Hospital cover under your private health insurance covers you for hospital bills when you’re a privately admitted inpatient in hospital. While you’re an inpatient in hospital, your health insurance will cover you for doctor’s bills (shared between Medicare and private health insurance up to the Medicare fee). However, if your services are non-medical while you’re an inpatient, the coverage of these services is under extras cover. It’s therefore a good idea to look into having both hospital + extras cover on your health insurance policy.

Mr Saini , the Product and Pricing Manager at CUA Health clarifies this by stating, “Hospital policies are classified as Gold, Silver, Bronze or Basic based on services they cover. There is a set minimum number of services that must be covered at each level, so it can help you figure out what sort of policy will be the right one for what you are looking for.” He also notes that while the classifications on hospital does not change, “extras” services are designed by health funds and can vary from fund to fund.

Does Seniors’ Health Insurance Cover Aged Care?

Currently, in Australia, private health insurance doesn’t cover you for aged care. In saying that, most types of aged care have government-subsidies. Aged care services are different to private health cover. Private health cover’s designed to cover you for hospital admissions and services, and extras such as allied health services.

Aged care on the other hand, offers a range of services to meet the care needs and care goals. Aged care support services fall under home care, care within the community and residential aged care in an aged care facility. For more information regarding aged care support services, contact My Aged Care on 1800 200 422.

elderly patient in hospital bed holding hands

Do you get a pensioner discount for seniors’ health insurance?

Aged Care Prepare sought expert advice from CUA Health to understand if recipients of the Australian Government Aged Pension received a discount on their health insurance policies, and unfortunately the answer is no. The only allowed discounts are for people under the age of 30. The introduction of this rule by the Australian Government occurred in April of this year.

Although pensioners can’t receive a discount on their health insurance premiums, Aged Care Prepare recently found that some private health funds do offer discounts for direct debit payments. Keep this in mind when you’re comparing the costs of health insurance policies. For example, at CUA Health you can get a 4% discount if you pay your health premiums by direct debit from a CUA bank account.

Do you get a government rebate for seniors’ health insurance?

Most Australians with private health insurance currently receive a rebate from the Australian Government. This helps to cover the cost of their premiums. The health insurance rebate’s income tested and applies to hospital, general treatment and ambulance policies.

Senior citizens do get a rebate from the Australian Government. However, depending on their age and income level, the rebate they receive is typically higher than that for younger Australians. Harmeet Saini, the Product and Pricing Manager at CUA Health told Aged Care Prepare, Depending on their age and Income, the rebate will be higher than for younger Australians. In fact, when at least one person on the policy is over 70, the rebate could be as high as a third of the total premium.” This is a significant rebate.

Other Considerations for Your Seniors Health Insurance Policy

When you’re shopping around for a private health insurance policy there are some important items to consider. Firstly, do you want hospital cover and extras cover? This will impact on what services you can receive, but it will also impact on the cost of your premiums.

Furthermore, does the policy you’re considering cover you for common ageing-related health conditions? For example, will the policy cover you for cataract surgery? Will it cover you for renal dialysis, joint replacements, cardiac surgery or palliative care to name a few?

When you’re looking for a seniors health insurance policy, take your time to choose the policy that’s right for you. Don’t feel as though you have to take up the first policy that you look at. Ask lots of questions and thoroughly read what the policy will cover you for.

Finally, if you didn’t have hospital cover in the past, you might have to pay a lifetime health cover loading. This loading will apply for 10 years if you haven’t had private hospital cover previously. However, once you have a policy for 10 consecutive years, this loading gets removed. Therefore, your premiums will reduce in cost. Be sure to speak with the health insurance providers about this when you’re searching for a seniors’ health insurance policy.

Author: Renae Diggles/ Editorial Director/ Aged Care Prepare
Expert Contributor: Harmeet Saini/ Product & Pricing Manager/ CUA Health

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