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The health insurance premium increase will be an industry average of 4.41% and will occur from 1 April 2026. However, depending on your specific health fund or policy, you may experience a higher or lower premium rise, or your policy price may even stay the same.

All policyholders need to know what their premium adjustment will be, as it’ll help them prepare financially and decide whether their current policy still suits their needs. The below table offers an insight into how premium rises can affect your total costs, based on the industry average.²

Worried about how the rate rise will affect your premiums? Many policyholders manage to save money by either prepaying their annual premiums before 1 April or switching to another policy that offers a better deal. Compare today through our free online comparison tool or give us a call to chat to one of our friendly team-members at our Brisbane-based contact centre.

The below table shows the average rate rise for each health fund in 2026. Remember, these are the overall averages of all policies offered by each fund, meaning your policy may experience a different premium adjustment.

Over the last decade, the industry average for health insurance premiums has risen every single year, which can greatly increase the cost of existing policies.¹ The graph below shows the health industry rate increase by year for the last decade:

Some of the key reasons for these consistent premium rises include:

• Increase in doctor/specialist fees
• Rising treatment and service costs
• Higher costs for medical equipment
• Wage increases for healthcare workers

In general, premiums for specific policies with different health funds increases from 1 April annually, although this did fluxuate a little during the COVID-19 pandemic.

The cost of private health insurance in Australia depends on:

• The type of policy
• Your level or cover or tier
• The state or territory where you live
• The rebates and discounts you receive based on your age or income
• Your Lifetime Health Cover loading (LHC).

Private health insurance in Australia is community rated, meaning that you’ll never be charged a higher base premium than someone else for the same policy based on risk factors such as age, race, gender, pre-existing conditions or any other reason. However, several factors can still affect how much you pay in premiums or for premium increases, such as your level of cover, state of residence, rebates, discounts and LHC loading.

For hospital cover, policies are divided into four tiers (Basic, Bronze, Silver and Gold) which are priced accordingly. Taking out a higher level of hospital cover will naturally cost you more, although you can often reduce your premiums by agreeing to a higher excess instead. Extras cover levels are decided by the insurer and aren’t regulated by the government like hospital cover is.

Your premiums will also be influenced by your eligibility for an age-based discount, the Australian Government’s rebate and if a Lifetime health cover (LHC) loading applies.

• Age-based discount. Some insurers will offer an age-based discount of up to 10% if you take out a policy before you turn 26. The discount you may be entitled to is reduced by 2% for each year after the age of 25 that you don’t take out a policy. By holding continuous hospital cover with a policy that lets you retain your aged-based discount, you can enjoy the discount until the age of 41. From the age of 41, the discount is phased out by 2% each year until it reaches zero.
• Government rebate. If you qualify, the Australian Government’s private health insurance rebate helps reduce the cost of your premiums depending on your age and income. For example, if you qualify for the highest tier of the rebate, you can potentially receive a premium refund of 32.385%.
• LHC loading. If you don’t take out hospital insurance before the 1st of July following your 31st birthday, you may have to pay an increased premium due to the LHC loading. This is to encourage Australians to take out a hospital insurance policy earlier in life to reduce the strain on the public system.

Shopping around and comparing your policy annually can also help you reduce your health insurance premiums. Of those we surveyed, those who have been with the same provider for a single year pay an average of $237.84 in monthly premiums.¹ Those who’ve remained with the same health fund for over a decade pay an average of $306.88 per month, 29% more than those who switched to a new fund.

While not tax deductible, private health insurance can still have an impact on your tax.

The private health insurance rebate is available to anyone who holds an eligible Medicare card and falls within the set income thresholds with a hospital or combined hospital and extras health insurance policy. It can be claimed each year via your tax return. Alternatively, you can also choose to claim the rebate as a discount on your premiums instead.

Also, if you earn more than $101,000 as a single or $202,000 as a couple or family and don’t hold sufficient private hospital insurance, you could incur the Medicare Levy Surcharge (MLS). The MLS is a government surcharge added onto the taxable income of high-income earners who don’t hold private hospital cover. It is applied as a percentage of your annual income (e.g. 1-1.5%), which you’ll need to pay for the number of days in the financial year that you and your family didn’t hold suitable hospital coverage.

When you’re admitted to hospital as a private patient, you may have to pay a lump sum to your private health insurer, which is known as the excess. This could be in the form of a payment per hospital admission, but may only be for the first admission of the calendar, financial or membership year per person, depending on your insurance provider and policy. Choosing a higher excess may allow you to pay lower premiums.

You may also have to pay a co-payment, which is a set amount you’re required to pay each day you’re in the hospital. This is typically capped per hospital stay.

Each eligible hospital treatment has a Medicare Benefits Schedule (MBS) fee, a price the government believes is fair. Medicare pays 75% of this fee, while your health insurer pays the remaining 25%.

If your specialist charges above this fee, you may have to pay the extra amount not covered by Medicare and your private health insurance. Alternatively, your health fund may pay some or all of this gap.

For extras services, gap cover simply means that the health care provider doesn’t charge above your extras benefits limit and rebate, which results in no out-of-pocket costs.

Your insurer may have agreements with certain providers to eliminate or minimise out-of-pocket expenses. Be sure to check with your insurer before seeking treatment to understand what costs you may incur.

For more information, check out our page explaining gap payments.

You might want to consider private health insurance if you value having more choice when it comes to your healthcare, such as:

• Avoiding public waiting lists for elective surgeries. When you’re treated through the private system, you may be able to avoid often lengthy public hospital waiting lists by being treated in a private hospital. Once you’ve served your waiting periods, you could receive treatment in a matter of days or weeks. The waiting period will depend on the procedure, as well as the availability of the treating doctor and hospital.
• Choosing your own doctor and stay in a private room. Depending on availability, you may be able to choose your own treating doctor and recover in a private room when you’re admitted to a private hospital.
• Getting cover for out-of-hospital treatment. With an extras cover policy, you can claim benefits for some out-of-hospital treatments that Medicare doesn’t cover. This includes services like dental, physio and chiro.

In Australia, there is a hybrid healthcare system that combines Medicare, which is a public healthcare system that provides free or subsidised treatment, and private health insurance, which is optional and allows you to choose your own available doctor and hospital. Extras cover also helps cover the cost of out-of-hospital services that Medicare doesn’t cover, such as dental and optical.

Private health insurance can be purchased in a few different forms. Private hospital cover gives you the option of being treated in hospital as a private patient, so you can choose your own available doctor, stay in a private room (when available) and potentially avoid long public hospital waiting lists, among other perks. Hospital cover is available in four tiers: Basic, Bronze, Silver and Gold. Your hospital cover, in combination with Medicare, will cover you for 100% of the Medicare Benefit Schedule (MBS) fee if you are admitted to hospital as a private patient. You may still have a gap payment, which is the difference between the MBS fee and the cost of your medical treatment if your doctor or surgeon charges above the MBS fee.

If you had a medical issue before taking out your hospital policy, it may be considered a pre-existing condition. Luckily, you won’t have to pay any more for your policy than someone without a medical history would, but you may have to serve up to a 12-month wait before you can claim on any relevant treatments.

Extras cover helps pay for many out-of-hospital treatments that Medicare does not  cover, like  dental, physiotherapy and optical. For extras services, your insurance provider will pay either a percentage of the total cost or a set dollar amount. The amount you can claim may be subject to limits, such as lifetime, annual or sub limits.

Some government incentives and surcharges can affect your health insurance premiums. These are:

• Private Health Insurance Rebate: An income and age-tested government rebate to help cover the costs of health insurance premiums.
• Lifetime Health Cover (LHC) Loading: A government initiative designed to encourage Australians to take out hospital cover sooner. If you take out hospital cover for the first time later in life, there will be a 2% loading to your premiums for each year you are aged over 30.
• Medicare Levy Surcharge: If you’re a high-income earner (earning over $101,000 or earning over $202,000 as a couple/family), you’ll have to pay an additional 1-1.5% tax if you don’t have private hospital cover.

Always check your policy brochure before making a claim, as limits, exclusions, and waiting periods apply.

For hospital cover, there are four tiers of cover: Basic, Bronze, Silver and Gold. The following is the minimum clinical categories each tier must include:

• Basic: 3 restricted clinical categories
• Bronze: 18 clinical categories and 3 restricted clinical categories
• Silver: 26 clinical categories and 3 restricted clinical categories
• Gold: 38 clinical categories

Though health funds are required to meet the minimum requirements of each tier, they can also add additional clinical categories through what’s known as ‘Plus’ products. For example, a Silver-plus policy could include a clinical category that’s usually only included in Gold tier, such as joint replacement. This could potentially allow you to get the cover you need without paying the higher premium of a higher tier.

Extras cover is also often available in different levels of cover. However, unlike hospital cover, there aren’t government-mandated minimum requirements for extras cover. This means health funds can create their own levels of cover and what these levels include.

Extras cover helps you pay for services that aren’t covered by Medicare, like dental treatment and physiotherapy. In some areas, such as optical treatment, Medicare and private health insurance work together. Medicare can pay for your eye check and consultation with the optometrist, while your private health insurance helps you pay for your prescription glasses or contact lenses.

Cover for pregnancy and birth-related services is included in Gold hospital insurance policies and some ‘plus’ policies (like Silver Plus). Hospital cover for pregnancy and birth has a 12-month waiting period, so you need to have it before you get pregnant.

Private hospital insurance with pregnancy cover can help you to pay for:

• Private inpatient pregnancy admissions
• Labour and post-natal care
• C-sections
• In-patient obstetrician care
• A private hospital room (if it’s available).

Some private hospital policies also cover assisted reproduction services, such as infertility testing, in-vitro fertilisation (IVF) and gamete intro-fallopian transfer (GIFT). However, hospital insurance only pays a benefit towards in-patient care (i.e. the treatment you receive as a patient admitted in the hospital).

Dental cover is usually only available through extras cover, but private hospital policies can help pay for dental treatment and operations you have in hospital. What’s covered by your policy depends on your level of cover, but generally dental check-ups are standard.

Your health insurance provider will usually set annual limits on how much you can claim for dental. You can check this in your policy documents.

Optical services and products can be included on either hospital or extras policies, depending on your needs. Treatments you get in hospital will come under hospital cover, while extras cover can help pay for eyewear.

Depending on your policy, your extras health insurance might help you pay for other services such as:

• Psychology services
• Physiotherapy
• Gym memberships
• Remedial massages
• Occupational therapy
• Hearing devices and audiology
• Podiatry
• Sleep studies
• Dieticians
• Chiropractic services
• Natural remedies.

When looking at potential policies, consider which services you’ll need and likely use. Knowing which services you want will help you determine the right level of cover for your needs.

The best fund for you depends on your unique circumstances. Thanks to our handy private health insurance comparison service, we make it even easier to find health insurance. With our free tool, it takes only minutes to compare policies side-by-side to find great-value cover that suits your family’s needs. Our partner funds are:

We do not compare all health funds in the market, or all policies from our partner funds, and at times certain funds or products might be unavailable. Learn more.

• AIA Health
• Australian Unity
• Bupa
• Frank Health Insurance
• GMHBA
• HCF
• HIF
• nib
• Qantas Insurance
• see-u by HBF

Below is a list of all registered health funds in Australia. Policies are sometimes sold under secondary brand names or by another company, which aren’t included in this list.

• ACA Health Benefits Fund
• ahm health insurance
• AIA Health Insurance Pty Ltd
• Australian Unity Health Limited
• Bupa HI Pty Ltd
• CBHS Corporate Health Pty Ltd
• CBHS Health Fund Limited
• CDH Benefits Fund
• CUA Health
• Defence Health Limited
• Doctors’ Health Fund
• GMHBA Limited
• GU Health
• HBF Health Limited
• HCF
• HCi
• Health Insurance Fund of Australia Limited
• Health Partners
• Latrobe Health Services
• Medibank Private Limited
• Mildura Health Fund
• National Health Benefits Australia Pty Ltd (onemedifund)
• Navy Health Ltd
• nib Health Funds Ltd
• Peoplecare Health Insurance
• Phoenix Health Fund Limited
• Police Health
• Queensland Country Health Fund Ltd
• Reserve Bank Health Society Ltd
• rt health – a division of The Hospitals Contribution Fund
• St.Lukes Health
• Teachers Health
• TUH Health Fund
• Westfund Limited

The information provided is current as of August 2025 and sourced from the Private Health Insurance Ombudsman. This list is subject to change.

Cataract surgery

• The typical specialists’ fee for cataract extraction was $2,100⁴
• 42% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $480
• The typical hospital fee for this procedure was $2,500

Cystoscopy with biopsy

• The typical specialists’ fee for a cystoscopy with biopsy was $1,200⁵
• 27% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $350
• The typical hospital fee for this procedure was $1,400

Cholecystectomy

• The typical specialists’ fee for a cholecystectomy was $3,100⁶
• 19% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $500
• The typical hospital fee for this procedure was $4,700

Total knee replacement (single)

• The typical specialists’ fee for a total knee replacement was $5,200⁷
• 18% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $1,000
• The typical hospital fee for this procedure was $18,000

Femoral or inguinal herniorrhaphy

• The typical specialists’ fee for an inguinal herniorrhaphy was $2,200⁸
• 27% of patients had no out-of-pocket costs for their doctors
• Those with an out-of-pocket cost typically paid $500
• The typical hospital fee for this procedure was $3,900

Total hip replacement (single)

• The typical specialists’ fee for a total hip replacement was $5,600⁹
• 16% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $1000
• The typical hospital fee for this procedure was $20,000

Abdominal hysterectomy

• The typical specialists’ fee for an abdominal hysterectomy was $3,100¹⁰
• 20% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $670
• The typical hospital fee for this procedure was $7,200

Total prostatectomy

• The typical specialists’ fee for a total prostatectomy was $9,800¹¹
• 4% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $6,000
• The typical hospital fee for this procedure was $12,000

Septoplasty

• The typical specialists’ fee for septoplasty was $2,500¹²
• 23% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $650
• The typical hospital fee for this procedure was $2,500

Myringotomy

• The typical specialists’ fee for a myringotomy was $1,600¹³
• 16% of patients had no out-of-pocket costs
• Those with an out-of-pocket cost typically paid $520
• The typical hospital fee for this procedure was $1,300