Health Insurance Comparison in Australia
Do the Same Benefits Mean the Same Out-of-Pocket Cost? changed insurers.
I changed Insurers,
The features looked the same.
Why are my out-of-pocket costs higher for the same procedure?
Every year Australians change private health insurers believing they are making a like-for-like comparison, only to discover the difference when the first out-of-pocket bill arrives.
Why does this happen?
Most comparison tools focus on policy features such as premiums, excess levels and treatment categories.
These features describe the policy, but comparison sites generally do not show the likely out-of-pocket cost when treatment occurs. Did yours?
Two policies can look very similar on paper but produce very different patient costs. This is because insurers negotiate different prices and gap arrangements with hospitals, surgeons and medical suppliers.
The reality is simple.
Policies may look the same, but their financial performance can be very different.
Private health insurers already report benefits paid and patient gap payments to regulators through national statistics collected by the Australian Prudential Regulation Authority.
Consumers and comparison sites could compare insurers far more clearly if a simple performance score was published for each category of care:
• percentage of treatments with no patient gap
• median out-of-pocket cost for the patient
• higher-range out-of-pocket cost for the patient
Example – Joint replacement surgery (illustrative)
Insurer A
No gap: 64%
Median cost: $720
Higher range: $3,100
Insurer B
No gap: 39%
Median cost: $1,480
Higher range: $4,900
Consumers are asked to compare policies before choosing an insurer.
The real comparison they need answered is simple:
What will my out-of-pocket costs be when treatment is finished?
Email your local federal member asking for change. Sample Email
Follow the link to a sample email, just cut and paste, add your local federal members name and email address, sign off at the end. And lets get a change for the better made.