Medicare provides: free or subsidised visits to bulk-billing GPs; subsidised specialist consultations (Medicare pays 85% of the schedule fee); free treatment as a public patient in a public hospital (including surgery, emergency care, and specialist care - but no choice of doctor and potentially long elective surgery waiting lists); and subsidised medications under the Pharmaceutical Benefits Scheme (PBS).

Medicare does not cover: dental (except limited emergency dental in some states); optical (glasses and contact lenses); physiotherapy, chiropractic, podiatry, and most allied health as a private patient; ambulance in most states (Queensland and Tasmania include it in state funding; other states do not); and treatment as a private patient in a public or private hospital.

There are three distinct financial calculations that drive the private health insurance decision:

• Medicare Levy Surcharge (MLS): Singles earning over $93,000 (couples over $186,000) who do not have hospital cover pay an additional 1–1.5% Medicare Levy Surcharge on their taxable income. At $100,000 income, this is $1,000–$1,500/year. Basic hospital cover typically costs $800–$1,400/year - so for higher-income earners, private hospital cover can be cost-neutral or cheaper than the surcharge.
• Lifetime Health Cover (LHC) loading: If you do not have hospital cover by 1 July following your 31st birthday, you pay a 2% loading on your hospital premium for each year you were aged over 30 without cover, up to a maximum 70% loading. Someone who takes up hospital cover at 45 pays 30% more than someone who joined at 30. The loading persists for 10 continuous years of hospital cover.
• Extras cover for genuine dental and optical costs: If you regularly spend on dental, optical, physio, or other ancillary services, an extras policy that returns more than its premium cost can make sense. This requires comparing your actual annual spend against the annual premium - many people pay more for extras than they claim back.

Hospital and extras are two distinct types of private health insurance:

• Hospital cover: Covers in-patient treatment at a private hospital (or as a private patient at a public hospital) - including surgery, accommodation, and theatre fees. Allows you to choose your own specialist. The out-of-pocket cost after insurance (the 'gap') can still be significant - always check whether your specialist participates in your insurer's no-gap or known-gap arrangement.
• Extras cover (ancillary): Covers out-of-hospital services - dental, optical, physio, chiropractic, podiatry, psychology, and similar. Has annual per-category limits (e.g., $500/year for dental) and often waiting periods for major items (up to 12 months for major dental).
• The 'basic' hospital tiers: Australian hospital policies must comply with the government's Gold, Silver, Bronze, and Basic tiers. Gold covers all 38 clinical categories. Bronze covers a minimum set. Basic covers little beyond psychiatric services, rehabilitation, and palliative care. Compare what is covered before price.
• Ambulance cover: Not covered by Medicare in most states. Some private health insurance policies include ambulance, or you can purchase standalone ambulance cover via your state ambulance service. Queensland and Tasmania residents already have state-funded ambulance - standalone or included ambulance cover is not needed.

Comparing health insurance requires looking beyond the premium:

• Use privatehealth.gov.au: The federal government's official health insurance comparison tool (privatehealth.gov.au) lists and compares all registered policies without commercial bias. This is a better starting point than commercial comparison sites that receive commissions.
• Check waiting periods: Most policies have waiting periods - 2 months for general hospital, 12 months for pre-existing conditions and obstetrics, 2 months for most extras. If you need treatment soon, check the waiting period carefully before joining.
• Gap cover arrangements: Ask insurers which specialists in your area participate in their no-gap or known-gap arrangements. A cheaper premium that results in large out-of-pocket specialist gaps is not actually cheaper.
• Annual limits and per-visit caps on extras: An extras policy with a $500 dental limit that costs $600/year in premiums requires $500 in dental claims just to break even. Model your actual expected claims against the premium.
• Review annually at 1 April: Health insurance premiums typically increase 1 April each year. This is the best time to compare and switch - switching between registered insurers does not reset most waiting periods for previously covered conditions.

If you earn over $93,000 single (or $186,000 combined): Hospital cover is likely cost-neutral versus the MLS - get at least Bronze hospital cover to avoid the surcharge. Compare premiums versus the MLS amount for your income bracket.

If you are turning 31 this financial year: The LHC loading kicks in after 31 July following your 31st birthday. If you do not have hospital cover, get at least a basic policy before this date - the 2% per year loading is cumulative and expensive over a lifetime.

If you earn under $93,000 and are under 31: Private health insurance is not compulsory and Medicare provides solid coverage for most needs. The government rebate on premiums reduces cost for lower incomes, but the net cost still needs to be justified by expected claims or preference for private hospital access.

Health costs extend well beyond insurance premiums - prescriptions, pharmacy purchases, and health products all add up. Roopon membership includes partner discounts that reduce everyday health and wellness spending, and the weekly cash prizes (per campaign terms) giveaway gives members a financial boost that goes wherever it is needed most. At $4.99/week, Roopon is built to return more than it costs. ABN: 89 656 278 830 | 88 Anzac Parade, Kensington NSW 2033