What are the biggest health funds in Australia?

In the vast and competitive realm of private health insurance, choosing the best health coverage can be a daunting task. With over 40 insurers in the market, it's surprising that only a handful are widely recognised. Dominating the landscape are major players such as Medibank Private, ahm, Bupa, HCF (including RT Health), NIB Health, and HBF Health. Understanding the nuances of each provider is crucial for making an informed decision about your private health insurance. In this detailed exploration, we'll delve into the pros and cons of some of the leading private health insurance plans, shedding light on key aspects like complaints ratings, out-of-pocket costs, and unique offerings.

Medibank Private: Balancing Act

Medibank Private, boasting a 27.4% market share, is a significant player in the Australian private health insurance scene. Let's weigh the pros and cons of choosing Medibank as your health coverage provider.

Pros:

1. Complaints Rating: Medium, indicating a reasonable level of customer satisfaction.
2. Out-of-pocket Rating: Average in various regions, ensuring a fair balance between coverage and costs.
3. Special Benefits: No excess for children on hospital and combined policies, providing financial relief for families.
4. Student-Friendly: Free cover for full-time students under 31 on family policies, catering to the younger demographic.
5. Extended Family Policies: Families with adult children under 31 can benefit from extended coverage.
6. Discounts: Attractive discounts for individuals joining under the age of 30.

Cons:

1. Discount Limitations: Lack of direct debit or prepayment discounts may be a drawback for some customers.
2. Regional Variations: Out-of-pocket ratings vary, with below-average scores in South Australia, Queensland, and well below average in Western Australia.

Bupa: A Comprehensive Coverage Choice

With a substantial 24.7% market share, Bupa is another major player in the Australian health insurance market. Let's explore the pros and cons of choosing Bupa for your health coverage.

Pros:

1. Complaints Rating: Medium, indicating a reasonable level of customer satisfaction.
2. Out-of-pocket Rating: Varied, with above-average scores in some regions and average scores in others.
3. Excess Waiver: No excess for children on most hospital and combined policies, making it family-friendly.
4. Student Benefits: Free cover for full-time students under 32 on family policies, catering to the educational demographic.
5. Extended Family Coverage: Families with adult children under 32 can benefit from extended coverage.
6. Discounts: Attractive discounts for individuals joining under the age of 30.

Cons:

• Discount Limitations: Similar to Medibank, Bupa lacks direct debit or prepayment discounts.

HCF: The Nonprofit Choice

As a nonprofit health fund, HCF holds a 12.4% market share. Let's examine the pros and cons of choosing HCF for your health insurance needs.

Pros:

1. Nonprofit Status: HCF operates as a nonprofit, potentially aligning with customers seeking socially responsible options.
2. Complaints Rating: Medium, reflecting a reasonable level of customer satisfaction.
3. Out-of-pocket Rating: Average in most regions, ensuring a balanced approach to coverage and costs.
4. Excess Waiver: No excess for children on most hospital and combined policies, providing family-friendly benefits.
5. Student Benefits: Free cover for full-time students under 31 on family policies, catering to the educational demographic.
6. Extended Family Coverage: Families with adult children under 31 can benefit from extended coverage.
7. Premium Lock-In Option: The ability to prepay and lock in premiums for 18 months, offering stability in costs.

Cons:

1. Discount Limitations: Similar to the previous insurers, HCF lacks direct debit or prepayment discounts.
2. Age-Related Discounts: No discounts for individuals joining under the age of 30.

NIB: Balanced Coverage with Discounts

NIB Health, capturing a 9.4% market share, is known for its balanced coverage options. Let's delve into the pros and cons of choosing NIB for your health coverage.

Pros:

1. Out-of-pocket Rating: Average in various regions, ensuring a fair balance between coverage and costs.
2. Excess Waiver: No excess for children on hospital and combined policies, providing family-friendly benefits.
3. Student Benefits: Free cover for full-time students under 31 on family policies, catering to the educational demographic.
4. Extended Family Coverage: Families with adult children under 31 can benefit from extended coverage.
5. Discounts: Attractive discounts for individuals joining under the age of 30.
6. Direct Debit Discounts: Additional discounts for customers opting for direct debit payments.

Cons:

• Regional Variations: Out-of-pocket ratings vary, with below-average scores in some regions.
• Discount Limitations: Similar to other insurers, NIB lacks prepayment discounts.

HBF Health: Nonprofit Stability

HBF Health, with a 7.3% market share, stands out as a nonprofit health fund. Let's assess the pros and cons of choosing HBF for your health insurance needs.

Pros:

1. Nonprofit Status: As a nonprofit, HBF may appeal to customers seeking socially responsible options.
2. Complaints Rating: Medium, indicating a reasonable level of customer satisfaction.
3. Out-of-pocket Rating: Varied, with above-average scores in Western Australia and average scores elsewhere.
4. Excess Waiver: No excess for children on hospital and combined policies, providing family-friendly benefits.
5. Student Benefits: Adult children under 25 are covered on family policies for free if they're full-time students or earning up to $24,500 per year.
6. Discounts: Direct debit and prepayment discounts available.
7. Premium Lock-In Option: The ability to prepay and lock in premiums for 18 months, offering stability in costs.

Cons:

1. Discount Limitations: HBF does not offer discounts for individuals joining under the age of 30.
2. Extended Family Coverage: Unlike some competitors, HBF does not provide extended family policies.

Best Funds for Low Out-of-Pocket Costs

For those prioritising low out-of-pocket costs, two standout options are Bupa and HBF. These insurers offer at least average gap protection in all states and above-average protection in one or more states. The gap rating, reflecting the likelihood of incurring out-of-pocket costs, plays a crucial role in assessing the overall value of health insurance plans.

Gap (Out-of-Pocket Costs) Ratings:

• Bupa:
  • Above average in Queensland, South Australia, and Victoria.
  • Average everywhere else.
• HBF:
  • Above average in Western Australia.
  • Average everywhere else.
• HCF:
  • Average in the ACT, NSW, Queensland, the Northern Territory, Victoria, and Tasmania.
  • Below average in South Australia and Western Australia.
• Medibank:
  • Average in NSW, Victoria, the Northern Territory, Tasmania, and the ACT.
  • Below average in South Australia and Queensland.
  • Well below average in Western Australia.
• NIB:
  • Average in NSW, South Australia, Tasmania, and Western Australia.
  • Below average in the ACT, the Northern Territory, Queensland, and Victoria.

These gap ratings are essential indicators, representing the percentage of procedures in hospitals where members of the fund paid out-of-pocket costs (the gap payment). Choosing a plan with a lower gap rating can significantly reduce the likelihood of unexpected expenses.

Navigating the landscape of private health insurance in Australia requires a careful consideration of various factors. The choice between Medibank, Bupa, HCF, NIB, and HBF depends on individual preferences, budget constraints, and specific coverage needs. 

Understanding what's on offer for each provider will empower you to make an informed decision about your private health coverage. Our team is here to assist you with your enquiry about private health cover.  Feel free to call us at 1300 861 413 or email us at hello@health.compare