Private health insurance in Western Australia

Some of the largest factors in the total premium you’ll pay for private hospital cover are your state of residence and your level of cover. Here are the average costs of private 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 (i.e. Bronze Plus is included under Bronze).

As extras cover doesn’t have a standardised level of cover, the cost of these policies will vary a lot depending on the health services covered, your annual limits and more.

At the time of writing, the average cost of extras cover in WA was $83.70, while the national average was $84.73.¹ These figures are exclusive to single-only policies and don’t account for differences in coverage.

Unlike some other states, ambulances aren’t free in WA. All ambulances in WA are managed by the St John WA ambulance service, which charges either a fixed rate or a variable fee based on distance.

If you live remotely, your fee will be based on the distance travelled and you’ll be eligible to join the Country Ambulance Benefit Fund, which covers these costs for a subscription fee.

If you live in a metropolitan area, ambulance services are charged at a flat rate based on the urgency of your emergency. Metropolitan ambulance services can only be covered by private health insurance, as there is no benefit fund available.

If you’re over the age of 65 and receive a government pension concession, you’re entitled to free emergency ambulance services and non-urgent transport that is deemed medically necessary. If you’re over 65, but don’t receive a pension, you may still be able to claim a discount on your ambulance costs depending on your circumstances.

When you go to a hospital emergency room, your symptoms will be assessed by a nurse, and you’ll be assigned a triage category based on your health needs. These categories all have a maximum recommended waiting time. These are:³

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

The following table demonstrates the average time it takes to receive medical treatment in a public hospital per triage category.

To receive an elective surgery in the public healthcare system, first you’ll need to join a public waiting list. These waiting lists are prioritised by the type of surgery and the severity of your symptoms. Because the demand and availability for surgeries varies between states, so will your wait times.

The following table outlines the typical wait times for common surgeries and the percentage of people who waited longer than a year.⁴

When you’re treated as a private patient, Medicare will only cover 75% of the Medicare Benefits Schedule (MBS) fee for your doctors, and none of the hospital fees. With a sufficient level of hospital cover, your health fund can cover the remaining 25% of the MBS fee, and some or all of your hospital costs.

When you’re treated privately, your doctors can charge above the MBS fee, in which case you may be responsible for paying the difference between what your health fund and Medicare covers as an out-of-pocket expense. This difference is known as the gap, and it can be avoided or reduced if your doctors participate in your fund’s no gap or known gap scheme.

When you upgrade your cover or take out cover for the first time, you’ll have to serve a waiting period before you can claim on your hospital insurance. These waiting periods are standardised across health funds, so all funds will have the same waiting periods for the same clinical categories.

For out-of-hospital healthcare that’s not covered by Medicare, an extras cover policy could pay some of your costs. This includes services like dental check-ups, physiotherapy and orthodontics. On an extras policy, you’ll have an annual limit on the amount you can claim per service. Other types of limits may also apply, such as group limits, sub-limits and lifetime limits.

Extras cover will also come with waiting periods. Unlike hospital cover, these waiting periods will differ between funds and policies. For the full details on the limits, exclusions and waiting periods that apply to an extras policy, refer to the relevant policy documents.