Expert warns about health insurance costs as family gets hit with $9,300 bill: ‘Absolute disgrace’

Navigating the complex world of health insurance can be daunting, especially when faced with the potential for hefty annual bills that seem to offer little in return.

This is a reality for many Australians, including one family that pays a staggering $9,300 a year for private health insurance.

With cost-of-living pressures squeezing budgets tighter, it's no wonder that more Aussies are considering downgrading or even dropping their health insurance cover.



The case of Fiona's family, who reached out to finance expert Scott Pape, also known as the Barefoot Investor, highlights the dilemma many face.

Fiona questioned if health insurance was ‘necessary in Australia’, considering the country has ‘good public health care’.

She pondered whether the substantial amount spent on insurance premiums would be better invested elsewhere.


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Barefoot Investor Scott Pape highlighted the problems of health insurance costs. Credit: Shutterstock


Pape's response was clear: while he described private health insurance as 'an absolute disgrace’, he warned against hastily dropping the policy.

‘It’s incredibly complicated and increasingly unaffordable, which is why people are opting out of the system in droves. But not you,’ Pape wrote in his weekly column.

‘As a higher income earner, the government has a gun pointed at your head. If you don’t hold private health insurance, they’ll hit you with a penalty tax called the “Medicare Levy Surcharge”, which will cost more than shutting up and just buying private health insurance.’

This surcharge applies to singles earning over $97,000 and families earning over $194,000 who do not have an appropriate level of hospital cover.

It's an additional charge on top of the standard Medicare levy, which is 2 per cent of taxable income.

The surcharge rates range from 1 to 1.5 per cent of income, depending on your earnings bracket.



However, Pape also pointed out that Fiona was ‘paying way too much’ for her family's health insurance and suggested that she could save thousands by taking a few simple steps.

He recommended visiting the government's privatehealth.gov.au website to compare policies using her policy ID number.

It could also be worth selecting 'hospital-only cover' since ‘most people don’t get much value from extras cover’.

‘If you’re unsure, ask your fund for a claims benefit statement. And if you’re done having kids, you could downgrade from Gold to Silver or Bronze and save thousands—just check the exclusions,’ he said.



Finally, Pape said to compare what the website says and her current policy.

‘These are the exact steps I take every year when my premium is due. It only takes a few minutes, but it can save you thousands,’ he said.

Private Healthcare Australia reported that over 216,000 policies were downgraded in the first half of 2024 alone. With 55 per cent of the Australian population holding some form of health insurance, the financial stress is palpable.

Finder revealed that 22 per cent of insured Australians consider health insurance one of their top three stressful expenses, with the average policy costing $214 per month.

Moreover, private health insurance premiums saw an average increase of 3.03 per cent in April, adding to the financial strain on policyholders.
Key Takeaways
  • A family paying $9,300 annually for private health insurance was advised by finance expert Scott Pape to compare their policy or consider downgrading to save money.
  • Fiona, the customer in question, questioned the need for private health insurance in Australia due to the presence of good public healthcare but was warned against dropping the policy because of tax penalties.
  • The Medicare Levy Surcharge imposes additional costs on higher-income earners without private hospital cover; therefore, maintaining health insurance could be less expensive than facing the tax.
  • With more than 216,000 policies downgraded in the first half of 2024 and premiums increasing, Australians are feeling the pressure of health insurance costs, which are becoming a top stressful expense for many.
Have you faced similar challenges with your health insurance? What steps have you taken to manage the costs? Share your stories and tips in the comments below!
 
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I pay $360 a month for my health insurance I've been thinking of seeing the difference in cost just to gave hospital cover.

After seeing how friends and family have been treated by not having health insurance it makes me nervous to drop it.

My daughter needs surgery and if she goes through the public hospital she could be waiting 18 months to 2 years.
If she goes private she can have surgery next week.

She isn't in a health fund , she actually only dropped it 1 year ago.
So going private she will be out of pocket about $7000 being $2000 for surgeon and $5000 for one day stay in hospital.

It was only 6 months ago her 4 year old daughter needed grommets put into her ears and that day surgery cost her $5000

They say our medical system doesn't discriminate but it definitely does. If you are in a health fund or can pay for the procedure you will get it done awhole lot sooner
 
As expensive as it is, if you can afford it have it. Seven years ago I became very ill. I spent three months in hospital after needing surgery, then six months in rehab to learn the basics - to speak, eat, move my arms and walk. Without health cover I would not have had the care I needed. I was considering before this that I was wasting money on health care - but was there when I needed. So glad I did not opt out. I had few out of pocket costs and the health insurance covered nearly all of it. As you get older I think it is so essential. I have had my money's worth for all the years paying and it saved my life.
 
Private health is definitely worth having but you need to shop around or as my wife says you will pay a loyalty tax they keep upping your premiums and if you pay they don’t care there’s is no such thing as a loyal customer anymore. We pay about 180 a fortnight for the two of us but if you need surgery you can still go public but if it’s more urgent you go private.
 
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Private Health Insurance what an absolute rip off it is, we pay our Premiums only to be hit with a bill for just about everything. Years ago if you had P/H you walked out with nothing to pay. I'm with HCF and seriously looking at changing they have down graded once again what you get for your money, they say you get unlimited cover for Preventative Dental and only cover you for 1 Fluoride treatment, if that isn't preventative I don't know what is it is a disgrace. My dentist if I had no cover it would cost about $250 for a check up and clean, get 2 of those $500, then glasses you can get 2 pair at Specsavers for $200, that is all I use in extras so compare that to what you pay in Premiums and I think we are All getting Ripped off by Health Cover
 
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Reactions: deni67
Private Health Insurance what an absolute rip off it is, we pay our Premiums only to be hit with a bill for just about everything. Years ago if you had P/H you walked out with nothing to pay. I'm with HCF and seriously looking at changing they have down graded once again what you get for your money, they say you get unlimited cover for Preventative Dental and only cover you for 1 Fluoride treatment, if that isn't preventative I don't know what is it is a disgrace. My dentist if I had no cover it would cost about $250 for a check up and clean, get 2 of those $500, then glasses you can get 2 pair at Specsavers for $200, that is all I use in extras so compare that to what you pay in Premiums and I think we are All getting Ripped off by Health Cover
stop grizzling. it is your choice. i never pay anything extra with mine.
 
A family with kids especially should have basic health cover. Ambulance transportation is very expensive as well. For me to travel 6km to Hospital during a heart attack cost $504, previously the hospital would notify your health fund but now it's up to you to notify your health fund & if you don't get your original notification from the ambulance service then your get another notice from services NSW to pay or then then 3rd notice for payment will include the Sheriff. I experienced this.
 
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I dropped my health insurance years ago and have never regretted it
My daughter has had three bouts of oral cancer over the last 17 years, with three major operations, radiation and chemo and all these years of after care. There has never been any waiting list, she received immediate excellent care in our public health system

My husband was extremely ill and spent four months in Royal Perth Hospital. He was admitted immediately and also received excellent care.

There is no waiting list if you need emergency care, only for elective surgery.

I have a friend who had health cover, when she had breast cancer they had to remortgage their home to cover all the gap costs involved.
She didn't receive any better treatment than my daughter
She did have a private room, which some people want, but my daughter was also given a private room in the public hospital.
So much for health insurance.
 
Private Health Insurance what an absolute rip off it is, we pay our Premiums only to be hit with a bill for just about everything. Years ago if you had P/H you walked out with nothing to pay. I'm with HCF and seriously looking at changing they have down graded once again what you get for your money, they say you get unlimited cover for Preventative Dental and only cover you for 1 Fluoride treatment, if that isn't preventative I don't know what is it is a disgrace. My dentist if I had no cover it would cost about $250 for a check up and clean, get 2 of those $500, then glasses you can get 2 pair at Specsavers for $200, that is all I use in extras so compare that to what you pay in Premiums and I think we are All getting Ripped off by Health Cover
That’s why you don’t go for the absolute top cover leave all those things off go to spec savers and use Medicare
 
My wife and I have never had health insurance all the time we've lived here. Don't even know what benefit we would get with it and when I've seen the cost I wouldn't bother with it. We just rely on Medicare.

I had a broken bone in my neck a couple of years ago. My doctor sent me straight to local public hospital. Had various scans with no payment. Ended up staying in about 3 days. No payment. I think they do both public and private there?

Recently had to pay about $4k for some dental treatment, including a dental surgeon.

If anything crops up then we'd just pay for it.
 
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Don't be so rude, everybody is entitled to their opinion.
You should advise everybody which plan you have, I'm sure they would all be extremely interested in getting a plan with no gap costs.
Well said, that was what I was wondering telling me to suck it up and not saying who he was with. Some people think this is just an outlet for them to be as rude as they want because they are faceless. Thank you
 
I considered Private Health Cover a necessity when I was working. I felt it was akin to paying annual insurance.
Then, I had a 2 day hospital stay in a private hospital that was required because of 24hr drip infusions. It was a pleasant place, a share room with another person, own shower, and, good meals. I thought, well that was OK until I was sent a bill for the GAP. Just for the stay and the medication, I had to fork out an additional $2800.
That's when I dropped the private hospital cover.
I had no qualms staying on the basic cover, and did make use of the Extras.
Then, I had to leave my job to care for my ailing hubby.
The pension is not enough to cover private health insurance. So, I made the choice to keep the Extras but could not afford the hospital cover. Hubby was on a pension, so was covered on the public system.
It's been some 25 years and I still have the Extras cover. I have done the maths and find the uses I get out of optical aids, podiatry, chiro and physio are well covered by the Extras. I was using it for dental before I got the full set of dentures.
There are different levels of cover. It is probably a good idea to have a really good look at what you need, and, what is being wasted. No provider is the same as another.
If, as a pensioner, I still opted to have private cover, I would want to make darn sure it covered the bulk of the costs.
In the end, it is our choice.
 

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