Health Insurance Broker: Navigating Australia’s Private Health System
We are lucky to have Medicare, but for many Australians, the public system is no longer enough. Long waiting lists for elective surgery, lack of choice of doctor, and significant tax penalties for high earners have made Private Health Insurance a necessity. However, with over 30 funds and thousands of policy combinations, finding the right cover is a minefield.
At Assurance Life Pro, we cut through the confusion. As your dedicated Health insurance broker, we don’t just look for the cheapest price; we look for the right medical coverage. We help you compare health insurance across the market—from the major players to the smaller, member-owned funds—to ensure you aren’t paying for clinical categories you don’t need, or missing out on the ones you do.
Why You Need a Medical Insurance Broker
Many people rely on online comparison sites that are owned by the insurance companies themselves. These sites often push featured products rather than the best solution for you.
A medical insurance broker works for you. We understand the fine print of the Australian system. We know which funds have the best “No Gap” networks for surgeons, which ones offer generous dental rebates, and which ones are notorious for claim delays. We act as your guide, ensuring your health plan evolves as your life changes.
Who Needs to Compare Health Insurance? (It’s Not Just for the Sick)
High-Income Earners (Tax Avoidance)
If you earn over the threshold (currently $97,000 for singles, $194,000 for families), you are likely liable for the Medicare Levy Surcharge (MLS). This is a tax of up to 1.5% of your income. We help high earners find cost-effective hospital policies that exempt them from this tax, often costing less than the tax itself.
Growing Families & Couples
If you are planning a family, you need to check your cover now. Pregnancy and birth usually have a 12-month waiting period. We help couples compare hospital cover to ensure they are on a “Gold” or “Silver Plus” tier that covers obstetrics and IVF well before they need it. For established families, we look for “Extras” packages that cover the high costs of orthodontics (braces) and kids’ dental.
Seniors & Retirees
As we age, our health needs shift from “sports injuries” to “joint replacements” and “cataracts.” Many seniors are stuck on old “Legacy” policies that are expensive and outdated. We review your cover to ensure it prioritises heart, lung, and joint health, while removing pregnancy or IVF cover you no longer need.
Key Benefits: Saving Money & Avoiding "Junk" Policies
The cheapest policy is often the most expensive mistake. Many “Basic” policies are known as “junk insurance”—they exist solely to avoid tax but cover almost nothing in a private hospital.
Our health plan brokers ensure you get:
True Value: We balance the premium against the benefits.
Portability: If we switch you to a new fund, we ensure you do not re-serve waiting periods for conditions you are already covered for.
Access to Restricted Funds: We can often introduce you to not-for-profit or “restricted” industry funds (e.g., for teachers, transport workers) that offer lower premiums and higher rebates than the big-name brands.
Understanding the Tiers: Gold, Silver, Bronze & Basic
The government simplified private health into four tiers, but the details remain complex. We help you choose:
Gold: The ultimate cover. Includes everything: Pregnancy, Joint Replacements, Dialysis, and Psychiatry. Essential for seniors and growing families.
Silver / Silver Plus: The “sweet spot” for many. Covers heart, lung, and common surgeries, but excludes expensive items like Pregnancy and Hip Replacements.
Bronze: Entry-level cover for healthy people. Covers broken bones and appendix, but not much else.
Basic: Accident only. Generally used only to avoid the tax man.
The Process: How We Find Your Best Health Plan
We make switching funds painless:
The Health Audit: We ask about your life stage. Do you need glasses? Are you planning a baby? Do you have a bad knee?
The Comparison: We compare health insurance policies from our panel, filtering out those that don’t match your clinical needs.
The Savings Check: We calculate the potential tax savings (MLS) versus the cost of the premium.
The Switch: We handle the paperwork. We contact your new fund, who then contacts your old fund to transfer your “clearance certificate.” This guarantees your waiting periods are honoured.
Eligibility & Application Steps
Anyone with a Medicare card is eligible for private health insurance.
Age Loading: If you are over 31 and don’t have hospital cover, you may pay a “Lifetime Health Cover” (LHC) loading of 2% for every year you are over 30. We can calculate this for you.
Waiting Periods: Be aware that all funds have a 2-month waiting period for general items and 12 months for pre-existing conditions and pregnancy.
Don’t let rising premiums eat into your budget.
FAQs on Health insurance broker
If I switch funds, do I have to re-serve waiting periods?
No, provided you switch to an equivalent or lower level of cover. This is a government rule called "Portability." If you have served your 12 months for a knee replacement with Fund A, and you switch to Fund B, you are covered immediately. However, if you upgrade your cover (e.g., from Bronze to Gold), you must serve the waiting period for the new services (like Pregnancy) only.
What is the Medicare Levy Surcharge (MLS)?
The MLS is an extra tax (1% to 1.5% of your income) charged to high earners who do not have private hospital insurance. If you earn over $97k (single) or $194k (family), getting a basic hospital policy is often cheaper than paying the tax. As your medical insurance broker, we can do this calculation for you.
What is the difference between "Hospital" and "Extras"?
Hospital Cover pays for your room, theatre fees, and doctors while you are an inpatient in a private hospital. Extras Cover (Ancillary) pays for out-of-hospital services that Medicare doesn't cover, such as Dentist, Physio, Optical (glasses), and Chiro. You can buy them separately or combined.
Why do I have a gap to pay for surgery?
Private health insurance covers the "Medicare Schedule Fee." However, many specialists charge above this fee. The difference is your "Gap." We help you Compare Hospital Cover to find funds with extensive "No Gap" or "Known Gap" schemes, where participating doctors agree to charge you $0 or a max of $500 out of pocket.
Is ambulance cover included?
It depends on your state. In QLD and TAS, the state government covers ambulance. In VIC, NSW, WA, and SA, you need private cover. Most private hospital policies include emergency ambulance, but some budget ones do not. We check this essential detail for you to ensure you aren't hit with a $1,200 ambulance bill.