Hospital Cover Explained: Tiers, Excess & How to Choose
What Is Hospital Cover?
Hospital cover pays for treatment as a private inpatient in a hospital. It covers accommodation, theatre fees, and some medical costs. Since April 2019, hospital policies must be sold in four tiers: Gold, Silver, Bronze, and Basic. Each tier guarantees minimum inclusions and excludes certain services.
The Four Tiers
Gold — The Highest Level
Covers everything — all 38 clinical categories including pregnancy, IVF, cataract surgery, hip and knee replacements, and weight-loss surgery. Gold is the only tier that covers pregnancy and IVF. Choose Gold if you're planning a family or need comprehensive coverage.
Silver — Mid-Range
Covers most common services. Silver excludes some high-cost categories like pregnancy, IVF, assisted reproductive services, and weight-loss surgery — though some funds offer Silver Plus or Silver Premium tiers that include some of these. Good for couples or older Australians who don't need maternity.
Bronze — Budget-Friendly
Covers a narrower set of categories. Typically includes ear, nose and throat (ENT), digestive surgery, heart and vascular, and rehabilitation. Excludes pregnancy, IVF, cataract and eye surgery, hip and knee replacements, and more. Bronze Plus variants may include some extras. Suitable for young singles wanting to avoid the MLS.
Basic — Entry Level
The cheapest hospital cover. Covers very few categories — often just accident cover and maybe one or two others. Most Basic policies don't meet MLS requirements. Check carefully: some Basic policies won't count toward your Lifetime Health Cover or MLS obligations.
Understanding Excess
Your excess is the amount you pay toward your hospital stay before your fund covers the rest. Common options range from $0 to $750 (single) or $1,500 (family). Choosing a higher excess lowers your monthly premium by $20–$50 per month.
- $0 excess — No upfront cost but highest monthly premium.
- $250–$500 excess — A balance between upfront cost and monthly savings.
- $750+ excess — Lowest monthly premium; good if you rarely use hospital cover.
Waiting Periods for Hospital Cover
- 2 months — General hospital treatment for new conditions (if switching from equivalent cover).
- 6 months — Psychiatric, rehabilitation, and palliative care.
- 12 months — Pre-existing conditions, pregnancy and birth.
What Is Not Covered by Hospital Cover?
Hospital cover does not pay for GP visits, dental check-ups, glasses, physiotherapy, or other out-of-hospital services. Those are covered by extras cover. See our extras cover guide.
How to Choose
Ask yourself: Do I need pregnancy cover? Am I over 50 and likely to need joint replacements? Am I just trying to avoid the MLS? Use our guide to choosing a policy for a step-by-step approach.
What Hospital Cover Costs in 2026
A single adult hospital policy typically costs between $100 and $150 a month before the government rebate, with Bronze at the bottom of that range and Gold at the top; family policies commonly run $250–$450 a month depending on tier, excess and state. After the average 4.41% rise on 1 April 2026, those figures are a little higher than last year — which makes the excess trade-off more important than ever. Choosing a $750 excess instead of a $0 excess can cut $20–$50 a month off the premium, worth $240–$600 a year. If you rarely use hospital cover and have savings set aside, a higher excess is usually the cheapest way to hold the cover you need for MLS and LHC purposes.
How Your Tier Choice Interacts with the MLS and LHC
Two government rules should shape your tier decision. First, the Medicare Levy Surcharge: to count as appropriate hospital cover, your policy must include hospital treatment and your excess must be $750 or less per person ($1,500 per policy). Some Basic policies do not qualify, so if you are buying cover mainly to avoid the MLS, confirm compliance in writing before you pay. Second, Lifetime Health Cover: any complying hospital policy — including Basic and Bronze — stops your LHC loading clock. You do not need Gold to protect your LHC status; you need Gold only when you actually need the services it covers, such as pregnancy.
Compare Two Policies Like a Pro
- Match like-for-like: Gold vs Gold, Silver vs Silver — not a Bronze against a Silver Plus.
- Check the excess and co-payment on each; a cheaper policy often has a higher excess.
- Compare waiting periods already served if you are switching funds — they carry over for equivalent cover.
- Confirm your preferred hospital and specialist are in the fund's network, and ask about gap cover.
- Use privatehealth.gov.au to compare policies officially and free of charge.