Health insurance: What you can cut and keep for every life stage

WITH health insurance fees set to rise — again — on April 1, ensure you’re only paying for what you need with our handy checklist.

IT’S that time of year when private health insurance companies review their rates.

This year, private funds are introducing an average rise of 3.95 per cent – so families will pay an extra $2.75 and singles about $1.40 each week.

“People should look at their policy every few years to ensure they’re getting what they expect and to reassess their individual needs,” Steve Mickenbecker, a health insurance expert at Canstar financial comparison site, says.

“As our needs change, our health insurance policy needs change.”

Here’s what you can cut and keep for every life stage, according to the pros.

IF YOU’RE...YOUNG & SINGLE

YOU DON’T NEED: Top-level cover, unless you have a specific health problem or family history, and you won’t need obstetrics unless you plan to start a family in the next year. Nor will you require cardiac, joint replacement or cataract cover. If you’re a student and under 25, you can usually still be covered by a family policy.

YOU MAY NEED: Hospital cover in case of an unexpected diagnosis or injury.

“Consider cover for shoulder or knee investigations that can result from sports injuries. With accidents, you can get emergency treatment in a public hospital, but private cover looks after ongoing care,” Lorraine Thomas from HCF says.

You can save money on your health insurance by catering it to your needs. Picture: iStock

IF YOU’RE...PLANNING A FAMILY

YOU DON’T NEED: Cardiac, joint replacement or cataract cover or cover for treatments such as dialysis, unless your health has changed.

YOU MAY NEED: Obstetrics added to your hospital cover if you’re planning to start a family, and this should be done it at least 12 months before you conceive.

“There’s a range of pregnancy-related cover with some policies, including treatment for IVF should you need it,” Thomas says.

Play sports? Consider reconstructive plastic surgery cover. While the public system will treat your injury, any reconstructive surgery in public hospitals may involve a waiting period.

IF YOU’RE...A FAMILY WITH YOUNG CHILDREN

YOU DON’T NEED: Obstetrics cover, if you’ve now completed your family. If you’re in good health, you also still won’t need cardiac, dialysis, joint replacement and cataract cover.

YOU MAY NEED: To look at your extras policy. While children are covered for basics on a family policy, they may need additional dental and optical care, podiatry and physiotherapy – and waiting periods can be one to two years.

“Look for a policy with at least one dental visit per person per year,” Thomas says.

Parents also benefit from shoring up extras, Dwayne Crombie, managing director of health insurance at BUPA, says.

“They can need more dental treatment such as fillings and crowns.”

Depending on what stage you are in your life, you might not need full hospital cover. Picture: iStock

IF YOU’RE...AN EMPTY NESTER

YOU DON’T NEED: A family policy if your children are working and/or over 25. If that’s the case, amend your cover to a couple or single-person policy. You may also no longer need extras such as orthodontics.

“Trim back extras so you can spend on hospital cover,” Crombie says. However, if you need help losing weight or quitting smoking, look for cover that offers that – it will save you money (and your health) in the long run, Thomas adds.

YOU MAY NEED: To consider upgrading to a mid- or top-level hospital cover as the chances of chronic disease and being hospitalised increase with age, Crombie says. Introduce cardiac cover as the risk of heart disease rises in mid-life and beyond.

While you’re at it, review your excess – you may have a high excess that benefited you when you were younger, but not anymore.

“As you get older, take out a lower excess or excess waiver so you pay less each time you access hospital care,” Thomas says.

IF YOU’RE...A SENIOR

YOU DON’T NEED: A policy that subsidises gym membership if you’ve now gravitated towards gentler exercise such as walking or swimming. Also use this time to review your other extras.

“If you’re not going to claim it, don’t pay for it,” Mickenbecker says.

YOU MAY NEED: To consider increasing your hospital cover to the highest level you can afford, as it will deliver speedier access to treatment.

“This will bring you choice and control over how to manage any health situations that arise,” Thomas says.

Also ensure you have ambulance cover, separately or as part of your policy, as call-out fees can be up to $1000 depending on where you live. Cardiac and joint replacement cover is also important now, as are cataract cover and preventative screening procedures such as colonoscopies, Thomas says.

Most insurers have a 12-month waiting period for pre-existing conditions and a two-month wait for psychiatric care, rehabilitation or palliative care.

It is time to get your life admin tasks in order and take a closer look at your health insurance.

NOT COVERED YET?

IF YOU earn more than $90K a year and don’t have private health insurance, you’ll pay the Medicare levy surcharge – about 1 per cent of your income.

If you don’t take private hospital insurance before the age of 31, you’ll also pay lifetime health cover loading.

This means you’ll pay a bit more for private health cover when you do take it out, amounting to about 2 per cent per year for each year you’re not covered.

CHANGING FUNDS? ASK THESE QUESTIONS

✔ Which hospitals does this fund include?

✔ Can I choose my own doctor?

How long do I have to wait before I’m covered?

✔ What will this give me that Medicare won’t?

✔ What level of hospital and medical benefits are paid for under this cover?

What out-of-pocket expenses do I have to pay?

✔ Is ambulance cover included?

✔ Can I take out top-level dental cover for my children and not for my partner and myself?

Does the fund protect against rate increases?

* Checklist from Private Health Insurance Australia

Originally published as Health insurance: What you can cut and keep for every life stage