Private health insurance after Age Pension age

What are the consequences of giving up private health insurance once you receive the Age Pension?

Health insurance being ripped from a piece of paper

With the Government having signed off on private health insurance premium increases that will start from 1 April, Tom would like to know if it's worthwhile having cover now he's on the Age Pension.

Q. Tom
I am wondering if I should keep my health insurance cover now that I receive the Age Pension. With the increases adding about $75 to what I'm paying already, I'm not sure I can afford to remain covered. If I cancel it, I would like to know the consequences in regard to my healthcare entitlements and the Age Pension.

A. It’s always a good idea to review your insurance cover regularly, as your health and financial positions do change. However, giving up health insurance altogether could prove to be a costly mistake. Without private health insurance you will only be entitled to healthcare as provided by the state. This can often mean long waiting lists, care in public hospitals and limited access to extras such as dental, physiotherapy and podiatry. Which services you lose will depend on the level of cover you currently have. 

As pensioners, you can use your Pensioner Concession Card to access low cost prescriptions under the Pharmaceutical Benefits Scheme, and Medicare will also entitle you to bulk billing for many services. You can also access screening programs and special health services. For further details, you should visit the Department of Human Services.

If you do decide to give up your private healthcare, you may find it difficult to get cover at a later date due to pre-existing medical conditions and waiting lists. Before you give up your cover, it is worth working out what areas you think you will need in future and which ones you can do without. Many policies cover things such as prenatal and maternity, alternative therapies and expensive extras which you may never use. 

There are many websites around that will enable you to compare the different policies available but be careful, as many will ask for a contact number and then bombard you with phone calls. The best one to start with is and once you're sure of the cover you need and the insurer you want, you can then ask for a direct quote. 



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    Interested lady
    13th Mar 2017
    I have thought about giving up our health insurance however events over the last 3 months have changed my mind. My husband had a grand mal seizure in December and was taken to a major Sydney hospital who sent him home with bleeding on the brain twice.As it was over the Christmas New Year period I was unable to get any specialist help. When I was able to see our own neurosurgeon he was put into a private hospital within a week for major brain surgery. He is now in rehab and has been there for four weeks. If I needed to rely on the public system where would we be now?
    13th Mar 2017
    In the last 4 years I have had 2 bouts of cancer and 1 series of Chemotherapy tests, and all this happened through the public health system with absolutely minimum waiting eg I was being operated on 6 days after the cancer was discovered. Since then I have seen a number of hospital specialists for various things, again with minimum waits. I have had private health insurance for my choice of doctor in a public hospital but none of the private specialists here that I would need will operate at our public hospital. So when BUPA increased my premiums from $113/month to $123/month I decided to cancel my insurance. That 10% increase was the straw that broke the camel's back in my case! My advice to others is to not believe all the doom and gloom from the government and private health insurers and do your own research as to what is best for you.
    13th Mar 2017
    We dont have health insurance. Havnt had a problem with the public system. Over the last few years my wife and myself, have had several health issues and have been seen straight away. They are not going to sit back and watch you die. If you need treatment they do it.
    13th Mar 2017
    I had Private cover for many years since I was about 20 -- when my Husband got thermally ill in 1987 we had just moved and had NO money and I had to give up work to look after him -- every time he went to hospital it was costing a fortune which I could not afford the gaps -- or the charges for every medication and treatment he was given -- I was advised to either drop out or tell them I was not covered -- I tried to upgrade but it was not going to cover him anyway -- he got 1st class treatment as he had a very rare thing and they were interested in doing everything they could to investigate it -- they even trained me in Palliative care and gave me all the drugs and other things I would need and I was able to nurse him at home till he had to have more hospital treatment off and on and they always kept me in the loop with everything they did.
    I have never been in private health care since and I could not afford it now as I would also have to pay a 70% loading as well -- and seeing a Friend have to find a large amount every month and it STILL costs him a heap for gaps and extra payment for the Anesthetist etc there is NO way I could afford it -- and the only benefit is you can choose your own Dr and maybe get in to get things done a bit quicker -- but still have to wait months anyway.

    Years ago it used to cover everything -- NO gaps at all
    13th Mar 2017
    I recently had a heart attack, and even though I have private health insurance, I was treated in a public hospital and got exactly the same treatment as anyone without health insurance, I got the same doctor, the same nurses, the same medication and the same food, so what benifit did I get as a private patient, I got a free newspaper and a free tv. I have been in health insurance for over 50 years and I am reluctant to drop out, now my wife and I are in our 70,s I keep thinking that I am going to need it more, but I can't honestly say that I can think of a good reason to stay in, but I probably will.
    13th Mar 2017
    My husband and i reviewed our health insurance after retiring and knowing we couldn't continue to afford full cover with one of the big 2 insurers we opted for hospital cover only with excess with a "not for profit " insurer and cancelled our extras. We just pay a fraction of what we did and save a bit monthly for dental checkups and glasses as needed. I'm reluctant to drop out totally after seeing my sister in law have to pay well over $30,000 for a knee replacement because she didn't want to wait years. Also my uninsured adult son has been waiting 2 years in constant pain for a spinal operation and now been told he will probably have permanant nerve damage because of the wait.
    It seems you need to have life or death circumstances to get help straight away
    13th Mar 2017
    I have thought of giving up private health insurance but I have wacky health problems and may need further hip operations. Ins South Australia the l public waiting list for hip surgery will increase and our hospitals are in crisis. With current bulk billing then having private health insurance is manageable and gives you peace of mind.
    13th Mar 2017
    My daughter had health insurance . When she had my grandson she shared a room with another expectant mother, who had no insurance. Same room same doctor and nurses, same food. First thing she done when she came out was to cancel her health insurance. That was 19 years ago. I might add she is a theatre nurse.
    13th Mar 2017
    If you think you will need anything done that is non-life threatening, but debilitating, like a hip or knee replacement, then its best to keep the private health cover, as it can take years for these things to get done in the public system. However, if you have cancer or a serious flare up of a chronic illness, like emphysema or heart failure, access and medical care is the same, if not better, in the public system. Though you may not get the fancy meals and champers that the best private hospitals offer.
    13th Mar 2017
    Private Health Insurance only covers you if you are ADMITTED,in otherwords you are given a Bed.
    Most Cancer treatments(personal experience) are Day Care,and not covered by Private Health Insurance.Same applies to a lot of Heart Problems.
    Knees and Hips are different BUT beware of Gaps etc.they will wrek havock on your Bank Balance.

    13th Mar 2017
    health cover is good to have if you can afford it

    extras on the other hand dont make sense to me - I'm better off saving the extra's premium and using it for dental when I need it

    i dont use all the other rubbish like massages, manicures and pedicures
    17th Sep 2017
    I've always had health insurance cover and so did my parents. Years ago my Mother and I had a very serious car accident and although I was injured my Mother suffered breaks and crushing to most of her bones and ended up in hospital and rehab for over 3 months. The day of the accident because she had private cover they called in a top orthopaedic surgeon to operate on her. They said if she didn't, the hospital registrar would have had to do the operation. If that had happened she probably would never have walked again as her injuries to her legs were so extensive. After that came rehab, blood clots in the lungs so expensive X-rays, multiple ambulance transfers, pharmaceutical, the list goes on and on. I figure if it's possible to afford it, and not everyone can, it's invaluable. The waiting lists are getting longer all the time and after our experience you never know what's around the corner. Your life and health can change in the blink of an eye.
    17th May 2018
    My family and I, have had private health cover since 1980. Now, it's just me, and I wouldn't be without it. Since that time, there have been health incidents, operations needed, teeth were covered, bouts with cancer, cataracts, broken limbs.....long periods also, when we were very fund has something called' gap saver'.....when you're not using the fund, funds accumulate for any gap. I would think it a false economy to leave it, now I'm over 70!
    17th May 2018
    never had it never will! Major Hospital visits for Cancer Renal Devenation ,Hypertension,Cardiomyopathy,No waiting ,all free! top specialists.
    My brother was in a Bad Car accident and had better treatment as a Public patient and he didn't need to use his Private Health cover.
    No Gap fees.
    If you are treated as a day patient Private Heath Cover won't help you AND if you do get admitted you are going to be Out of Pocket for Hundreds of Dollars.
    3rd Mar 2019
    Day surgery is covered. There are a few who also do not charge the excess.

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