Private health insurance in Victoria

Two of the biggest influences on the hospital premiums you’ll pay are where you live and the level of cover you choose. Here are the average costs for private patient hospital cover by tier compared to the national average.¹

These figures are for a single-only hospital policy with an excess of $750 that provides an exemption from the Medicare Levy Surcharge. They don’t include any rebates, loadings or discounts. For convenience, we’ve grouped plus tier policies into their base tier (e.g. Bronze Plus is included under Bronze).

Unlike hospital insurance, extras cover policies don’t have standardised levels of cover, so health funds get to choose what health services they include, the annual limits they set and more. Because of this, the cost of extras cover can vary greatly.

With that said, in August 2024, the average monthly cost for extras cover in Victoria was $87.35, which is slightly above the national average of $83.73.¹ Keep in mind that these figures are only a rough guide and don’t account for differences in coverage.

No, ambulance services aren’t free in Victoria. When you call an ambulance as a Victorian resident, you’ll be charged a fee based on the emergency status of your call, your location and the mode of transport.

If you want to be covered for ambulance services in Victoria, you can take out an ambulance cover policy from a private health fund or get a membership direct from Ambulance Victoria.

If you’re a resident of Victoria and you hold a Health Care Card or Pensioner Concession Card, you’ll be able to receive free ambulance services when they’re deemed to be clinically necessary. If you’re transported from a private hospital, the facility is usually responsible for the costs, which may be passed onto you in some cases. If you’re not sure if you’re eligible for free ambulance services, you can check with Ambulance Victoria.

When you visit a hospital emergency room, you’ll usually be assessed by a nurse and assigned a triage category depending on the urgency of your symptoms. These categories are:³

• Resuscitation – Immediate
• Emergency – Within 10 minutes
• Urgent – Within 30 minutes
• Semi-urgent – Within an hour
• Non-urgent – Within two hours.

This table shows the average wait times to be treated in a public hospital in Victoria per triage category.³

Before you can receive an elective surgery in a public hospital, you’ll need to join a public waiting list. These waiting lists will depend on the urgency of your condition and the hospital where you’re treated.

The following table shows the typical wait times for some common surgeries in Victoria and the percentage of people who waited longer than a year on a waiting list.⁴

When you’re treated as a private patient for a procedure that’s included on your policy, Medicare and your private health insurance cover 100% of the Medicare Benefit Schedule (MBS) fee for your treatment. Your health insurance will also pay some or all the hospital fees (e.g. room fees).

However, when you’re treated privately, your doctors may charge above the MBS fee. The difference between the MBS fee and what your doctors charge is called the gap, which you’ll be required to pay unless it’s covered by your fund’s no-gap cover scheme.

For healthcare received out of hospital that’s not covered by Medicare, like dental check-ups and physiotherapy, an extras cover policy could cover some of your costs. Extras policies will pay either a flat dollar amount or a percentage of your total costs for included healthcare services, up to your annual limits. Other types of limits can also apply, such as group limits, sub-limits and lifetime limits.