Simplifying out of pocket expenses

Even though Australians have access to Medicare for many essential and vital health care services, there are out-of-pocket expenses for some treatments both in and out of hospital. Private health insurance offers us a way of being covered for these non-Medicare services. This helps to reduce our out-of-pocket expenses.

There are many out-of-pocket health expenses that you as a consumer might be faced with paying. To avoid this, it’s a good idea to get health insurance. Once you have health insurance, you can cut any unexpected out-of-pocket costs even further by looking at the funds ‘extras structure’. Most of your out-of-pocket costs will come from not being covered for extras you are probably going to want or need (like physio, optical, dental and natural therapies). If your fund provides you with clear information on their extras structure, then you know exactly where you stand and you are much less likely to be caught off-guard with extra health expenses down the track.

A good health fund will aim to reduce out of pocket expenses for you. They will provide a lot of information on their extras structure, explaining it in simple terms so it’s really clear and easy to understand. Extras cover many areas, from dental, travel vaccines and ambulance cover (yes, calling or taking an ambulance costs money! This is not covered by Medicare, which many people don’t realise). Extras also include some prescription medications, psychology, diet therapy and rehabilitation services.

A good health fund will provide you with clarity on what extras they offer. If you are looking at a particular health insurance package, they will have a list of every single extra that package covers. Their list will also show you any limits on the extras you are interested in (i.e., how much you can claim on that extra before you are not covered). Even better, look to see if the fund provides a list of any waiting periods that are attached to the extra you are interested in.

There is a second way you can reduce your out-of-pocket expenses. Have a look and see if the health insurance provider provides a list of hospital services you are covered for under their various packages. Again, there are services in hospital that Medicare covers, but there are some that aren’t. You will have to pay for that service unless you are covered for it.

Take a look at the insurance provider and see if they provide a list of what hospital services you would be covered for by the package you are interested in. For example, they will tell you if you are covered for things like wisdom teeth removal, pregnancy services, heart surgery or joint replacements. Even specialized areas like fertility treatments and colonoscopies can be covered. A good fund will even provide a bit of extra info. For example, if you are interested in fertility treatment coverage, what does the fund actually offer? A good fund will tell you exactly which fertility treatments (by name) you would be covered for. Again, if you want to be covered for joint replacements, the fund will tell you exactly which joints you are covered for!

At, we do our bit to give you clarity on out-of-pocket health expenses and provide simple, easy to understand information on exactly what hospital and extras services you will be covered for.