According to Compare the Market research nearly one in five Australians said that dealing with unexpected or unplanned expenses was their biggest concern with health care. This was followed by paying for dental visits and covering the cost of short but expensive specialist appointments.
A full metallic crown can cost up to $1650 while a colonoscopy runs about $200 out of pocket for private patients based on their coverage level. Hospital fees are not included in that price. A physio appointment might cost more than $110 in some areas of the country. These prices are not surprising.
Yet while some of these concerns could be fully or partially covered by an appropriate private health insurance policy almost one in three Australians said they do not think it is worth having. The data from February shows a significant portion of the population remains unconvinced about the value of private health coverage. Many Australians continue to question whether the benefits justify the ongoing costs associated with maintaining a policy. This skepticism exists despite the potential financial protection that private health insurance can provide against unexpected medical expenses. The coverage options available through private policies often extend beyond what public healthcare systems offer. The reluctance to invest in private health insurance reflects broader concerns about affordability and perceived value. Some people believe that the public healthcare system provides adequate coverage for their needs without requiring additional private insurance payments. Others worry that even with private health insurance the out-of-pocket expenses and gap payments can still be substantial. The complexity of policy terms and conditions also contributes to confusion about what is actually covered. Insurance providers face the challenge of demonstrating clear value to potential customers who remain doubtful. The industry must work to simplify policy structures and communicate benefits more effectively to address these concerns. Consumer attitudes toward private health insurance continue to evolve as healthcare costs rise & policy features change. Understanding these perspectives is essential for both insurers and policymakers who aim to improve healthcare accessibility & affordability across Australia.
Top five health bugbears
| Health Pet Peeve | Proportion of Responses (per cent) |
|---|---|
| Unexpected or unplanned expenses (such as a toothache, injury, sudden illness, etc.) | 16.4 per cent |
| Paying for the dentist | 11.9 per cent |
| Paying a lot of money for a specialist, only to see them for a quick period | 10.0 per cent |
| Paying to go to a doctor for a recurring script or medical certificate | 9.5 per cent |
| GPs always running behind | 8.9 per cent |
It feels terrible to accept that we already struggle with so many bills & expenses. When a health problem appears on top of everything else it can feel like a punch to the stomach. Nobody wants to think about getting sick or injured while also worrying about money. But medical issues do not wait for a convenient time to show up. They arrive without warning and bring their own costs along with them. The reality is that health problems create financial pressure in multiple ways. There are doctor visits to pay for and medications to buy. Sometimes people need tests or procedures that cost even more. If the problem is serious enough it might mean missing work and losing income at the exact moment when extra money is needed most. Many people find themselves in a difficult position when health issues arise. They might delay getting care because they worry about the cost. This often makes the problem worse over time and leads to even higher expenses later. It becomes a cycle that is hard to break. Insurance helps but it does not cover everything. There are deductibles to meet and copays to handle. Some treatments or medications might not be covered at all. People discover that even with insurance they still face significant out of pocket costs. The stress of managing both health concerns & financial worries takes its own toll. It affects sleep and relationships and overall quality of life. People feel trapped between needing care and being able to afford it. Planning ahead can make a difference even though it requires effort and discipline. Building an emergency fund specifically for medical expenses provides a cushion when problems arise. Understanding what insurance actually covers helps avoid surprises. Shopping around for care and medications can sometimes reduce costs. The combination of health issues & money troubles is something many people face. It requires patience & practical thinking to navigate both challenges at the same time.
Getting medical help from private specialists can be expensive for Australians who are already struggling with rising living costs. Some doctors charge very high fees for appointments and this creates a serious problem for people who need healthcare but cannot afford it. When specialist consultation fees are too high they stop people from seeing doctors even when they really need medical attention. This is particularly difficult now because many Australian families are dealing with increased expenses for housing and food and other basic necessities. The combination of expensive healthcare & general cost-of-living pressures means that some people have to choose between getting proper medical treatment and paying for other essential things. Many Australians find themselves in a tough situation where they know they should see a specialist but the cost makes them hesitate or delay their appointment. This can lead to health problems getting worse over time because people wait too long before seeking help. The financial burden of specialist fees adds another layer of stress to households that are already stretched thin by everyday expenses. The issue affects different groups of people in various ways. Families with children may struggle more because they have multiple people who might need medical care. Older Australians who often require more frequent specialist visits face ongoing costs that can quickly add up. People with chronic conditions need regular appointments and the expense becomes a constant worry. Some specialists charge fees that are much higher than the Medicare rebate which means patients have to pay large out-of-pocket amounts. These gap payments can range from moderate to very substantial depending on the specialist and the type of consultation. For many people these costs are simply too much to manage alongside rent or mortgage payments & grocery bills and utility costs. The situation highlights a growing problem in the Australian healthcare system where access to specialist care increasingly depends on financial capacity rather than medical need. This creates inequality because people with more money can get the care they need quickly while others have to wait or go without treatment altogether.
I interviewed Dr. Rachel David who runs Private Healthcare Australia. Since then I have been using her suggestions when I visit medical professionals. Now I ask specialists and dentists upfront about any extra costs I will need to pay beyond what insurance covers. Dr. David explained that many patients don’t realize they can ask these questions before agreeing to treatment. She encouraged people to be more direct about discussing fees. This helps avoid surprise bills later on. I found that most doctors are willing to discuss their charges when asked directly. Some even offer payment plans or can suggest more affordable alternatives. The key is asking before any procedures are scheduled rather than waiting until after the work is done. This approach has helped me budget better for medical expenses. It also makes the whole process less stressful because I know what to expect financially. Other patients might benefit from taking the same approach when dealing with healthcare providers.
# Understanding Healthcare Costs
When my friend shared her perspective with me, she made a compelling point about how we approach professional services. She explained that we need to examine the fees that doctors and other healthcare providers charge with the same level of scrutiny we naturally apply when hiring a plumber or consulting with an accountant. Most people don’t hesitate to ask a plumber for an estimate before fixing a leaky pipe. We routinely compare rates between different accountants before choosing one to handle our taxes. Yet when it comes to medical care, many of us accept whatever bill arrives without asking questions beforehand. This hesitation makes sense on some level. Healthcare feels different from other services because our health and wellbeing are at stake. We might worry that questioning costs seems inappropriate or that it could somehow affect the quality of care we receive. There’s also an emotional component since we’re often seeking medical help during stressful or vulnerable moments. However, healthcare is still a service we pay for & understanding those costs matters for our financial health. Medical bills can significantly impact household budgets, & unexpected expenses can create serious financial strain. By asking about prices upfront, we can make informed decisions about our care and avoid surprising bills later. The comparison to plumbers and accountants highlights an important principle. These professionals provide valuable expertise just like healthcare providers do. We respect their skills while still expecting transparency about what their services will cost. The same standard should apply across all professional services, including medical care. Taking this approach doesn’t mean doubting the value of healthcare or disrespecting medical professionals. It simply means being an informed consumer who understands the financial aspect of the services being provided.
I find it surprising how often specialists and dentists are willing to offer discounts when I simply ask if they can provide a better price. Many healthcare providers will negotiate their fees if patients take the initiative to request a lower rate. This willingness to adjust pricing happens more frequently than most people realize. The key is being direct and asking the question. Medical and dental professionals often have flexibility in their pricing structures and may reduce costs for patients who inquire about payment options.
I have usually felt somewhat nervous about doing this in the healthcare industry but it is always valuable to ask the question.
Finding a health insurance policy can help reduce financial stress since some plans will cover a portion or even all of your medical expenses for specific treatments.
We know that a record number of Australians currently have some form of private health cover. However not everyone is getting the best value from their policy.
Health insurance price shock on the horizon
# Health Insurance Costs Set to Climb Again
Experts say private health insurance premiums will go up by somewhere between 3.9 and 4.4 per cent next year. This increase will add hundreds of dollars to what people pay each year for their coverage. The predicted rise means Australian families & individuals with private health insurance should prepare for higher costs in their annual budgets. Industry analysts have been examining current trends and economic factors to arrive at these estimates. This anticipated increase follows a pattern of steady premium growth in recent years. Health insurance companies typically adjust their rates annually to account for rising medical costs & increased usage of healthcare services by their members. For many households already dealing with cost of living pressures the additional expense will create further financial strain. The percentage increase might seem modest but when applied to existing premium costs it translates into significant dollar amounts over the course of a year. Policyholders should review their current coverage levels and consider whether their existing plans still meet their needs. Some people might find opportunities to reduce costs by adjusting their coverage or excess levels without sacrificing essential benefits. The health insurance sector faces ongoing challenges including expensive new medical technologies and treatments plus an aging population that requires more healthcare services. These factors contribute to the upward pressure on premiums that insurers pass on to customers. Consumer advocates recommend that people compare different policies & providers before the new rates take effect. Shopping around could help some individuals and families find better value options that suit their specific healthcare requirements and financial situations.
# Major Health Insurance Price Increases Coming for Australians
Australians with private health insurance should prepare for significant cost increases when new pricing takes effect in February next year. The changes will impact approximately 15 million people who currently hold private health coverage. The premium increases scheduled for February 18 represent one of the most substantial price adjustments seen in recent years. Industry experts are describing the upcoming changes as a considerable financial burden for households already managing rising living costs. These adjustments will affect policies across the board and apply to the majority of private health insurance customers throughout the country. The timing of the increase means many Australians will face higher monthly payments early in the new year. Families & individuals relying on private health coverage should review their current policies and budget accordingly for the additional expenses. The scale of the increase has prompted concerns about affordability and whether some people may need to reconsider their coverage options. The changes come at a time when many Australians are already dealing with increased costs in other essential areas. Healthcare advocates suggest that policyholders should compare different plans and coverage levels to ensure they are getting the best value for their circumstances. With millions of people affected by these premium increases the financial impact will be felt widely across Australian households in the coming months.
Private health insurers sent their proposed premium changes to Federal Health Minister Mark Butler for review last week. Experts at Money.com.au expect premium increases between 3.9 & 4.4 per cent in 2026. This would add about $216 each year to a family policy.
Impact on individual and family premiums
The expected premium increase of 3.9 to 4.4 percent means that single people with a combined policy will pay between $127 and $144 more each year. These figures are calculated using an average single policy cost of $3264 per year. For families the additional yearly expense would range from $191 to $216 based on an average family policy that costs $4,908 annually.
This year health insurance premiums increased by an approved 3.73 percent after Health Minister Mark Butler rejected steeper proposed increases of 5 & 6 percent. This marked the biggest annual hike since 2019. The previous year saw an average increase of 3.03 percent.
How to make the most of your health insurance
Some insurers reset their annual limits at the end of the financial year on July 1, while a small number of funds offer policies where limits reset on the policy anniversary date.
About one third of Australians surveyed said they had used some of their health insurance extras but still had benefits remaining. The survey included 1000 people and found that 15 percent had used none or very little of their available limits. Only 14 percent of Australians had used their complete entitlements this year.
Act quickly to avoid losing benefits
# Make the Most of Your Health Insurance Before Year End
Health insurance extras benefits will reset soon so Australians should book their appointments now to make sure they don’t miss out on valuable coverage. Most insurers reset their limits on January 1 & many providers have limited availability during the busy end-of-year period. If you have extras cover you may be entitled to benefits for dental checkups, optical services physiotherapy and other health treatments. These benefits typically have annual limits that don’t roll over to the next year. This means any unused portion of your entitlement will be lost when the calendar year ends. The final weeks of the year are always busy for health service providers as people rush to use their remaining benefits. Dental clinics & optometrists often get booked out quickly during this time. Waiting until December might mean you can’t get an appointment before your benefits reset. To avoid disappointment you should check your current benefit limits & book any needed appointments as soon as possible. Contact your insurer to find out how much of your annual entitlement you have left. Then call your preferred providers to schedule appointments before the rush begins. Taking action now means you can maximize the value of your health insurance and ensure you receive all the benefits you’re paying for throughout the year.
Getting a dental cleaning done or making an appointment with your eye doctor can be really helpful before the year wraps up. The same goes for scheduling that last physiotherapy session you have been putting off. These routine health visits might seem like small tasks but they can make a real difference in how you feel. Taking care of these appointments now means you start the new year without any lingering health concerns hanging over your head. Your teeth will be clean and checked for problems. Your eyes will be examined to make sure your prescription is current. Your physical therapy can be completed so you can move better and feel less pain. Many people wait until something hurts or becomes a serious problem before they see a healthcare provider. But preventive care is much easier than dealing with bigger issues later. A simple checkup can catch problems early when they are still easy to fix. If you have health insurance benefits that reset at the end of the year you should definitely use them before they expire. Some plans give you a certain amount of coverage that does not roll over to the next year. You have already paid for these benefits through your premiums so you might as well take advantage of them. Scheduling these appointments before December ends also helps you avoid the rush that happens in January when everyone else has the same idea. You can get better appointment times & not have to wait as long to be seen.
