Private health cover for retirees – is it worth it?

February 2026

As people age, their need for health care generally increases. Unfortunately, premiums for private health insurance also rise with age, leading many retirees to ask: is private health cover still worth it?

There’s no universal answer. We encourage clients to reflect on their financial situation, health needs, and personal preferences, because what feels like good value for one person may not for another.

In Australia, Medicare ensures everyone can access essential healthcare regardless of income. This includes GP visits, treatment in public hospitals, and certain medications.

Public hospitals prioritise urgent and life‑saving care, ensuring critical needs are addressed first. As a result, non‑urgent surgeries and specialist appointments can involve long wait times due to strong demand and limited resources.

Medicare also does not cover dental, optical, physiotherapy, and many other allied health services.

This is where private health cover can provide additional benefits:

Benefits of Private Health Cover

1. Shorter waiting times for elective surgeries:  Private patients can generally access non‑urgent surgery faster than through the public system.
2. Choice of doctor and hospital: Private cover allows you to choose your surgeon or specialist and, in many cases, your hospital. A private room is also more likely compared with the public system.
3. Access to services not covered by Medicare: “Extras” policies can help reduce costs for dental, optical, physio, chiro, and a range of allied health services.

Drawbacks to Consider

1. High and rising premiums: Premiums have been increasing over time, with April 2025 seeing the largest average annual rise in seven years.
2. Out‑of‑pocket expenses still apply: Even with cover, patients may face gap payments for surgeons, anaesthetists, hospital stays, or items not included in their policy.
3. Complexity and exclusions: Policies vary widely, often with exclusions, waiting periods, and excesses that make navigating the options difficult.

Which option is better for you?

Ultimately, the decision comes down to your budget and your willingness to pay for choice, control, and faster access to care.

If having top‑level health cover is a priority and non‑negotiable for you, you may need to adjust other areas of your lifestyle to accommodate the cost.

If you do pay for insurance, it may help to view it as a savings plan—smoothing the cost of elective procedures or unexpected health needs over time.