A guide to health cover for over 50s

Published June 2023 | 5 min read
Words by Carolyn Tate

Growing older can bring unique health priorities and challenges like chronic diseases, weight management and joint issues. Here’s how to maximise your health cover to get the best value in your 50s and beyond.

As you hit the milestone age of 50, it's important to make sure you have the right level of health cover to meet your needs. Later life looks different for everyone – you could be married or single, have younger children or older children and grandchildren. You might be working full time, part time or be retired.

Whatever your personal circumstances, your health needs will be different than they used to be, and your health cover should reflect this. Whether you feel as energetic as you did at 25, or you’re thinking about the future and more targeted care, it’s important to be proactive about your changing needs. Having the right level of health cover will support your health journey, and provide more value for your healthcare along the way.

The benefits of health cover for older people

Medicare can help with some of your over-50 healthcare needs, including some of the costs of seeing a GP or specialist, and treatment and your stay in public hospitals. However, public hospitals can also have long waiting lists for elective surgeries, and you don’t always get to choose who treats you and where. With private health cover you can choose your hospital and specialist, and cut down the time you need to wait for surgery compared to others on a public hospital waiting list.

Your health cover can also help you ride easier in an emergency. Ambulance services are covered by governments in some states and territories, but not others, so it’s worth checking if you need cover, to avoid unexpected out-of-pocket costs.

What is the best health cover for over 50s?

The first thing to consider with health cover over 50 is whether you’ve got the right level of cover for your personal health needs.

What to consider

As a guide, here are some things to consider when choosing health cover in your 50s and later life.

• What life stage are you in, and what specific health concerns do you have? For example, if you’re approaching retirement or are already retired, you may want to consider policies that provide a higher level of coverage for things like heart surgery or rehabilitation after procedures or treatment. Check if you’re covered for health issues that become a risk factor as you age, like heart conditions, cataract surgery or joint replacements or any family history risk factors you may have.
• Check you’re getting the best value from your cover by making sure you’re not paying for any services you don't need. It’s important to make sure you’re not paying for inclusions that aren’t relevant to your lifestyle or life stage.

We’re happy to help you navigate your cover and guide you to the programs and services that are right for you. Call us on 13 13 34.

Pre-existing conditions and senior health cover

Pre-existing conditions can be a significant concern, because as you age, you’re more likely to have experienced a health challenge or two already. A pre-existing condition is any ailment, illness or condition that you had or experienced signs or symptoms for, within the last six months before you took out health cover. A pre-existing condition can range from minor issues like allergies to more serious illnesses like cancer or heart disease. Pre-existing waiting periods apply to new members and members who are upgrading their cover to a higher level.

Many health insurance policies will still allow you to insure against your pre-existing conditions, but they will most likely require you to serve a waiting period of up to 12 months before you can claim any benefits.

Having a pre-existing condition doesn’t mean you should dismiss private health cover as an option. After you've served your waiting periods, your health cover can still provide significant benefits for your overall health and wellbeing, like access to programs and services to keep you healthy and more choices in terms of specialists and hospitals.

How to get the most value from your cover

For many people over 50, managing your finances and keeping to a budget is important, and we want you to get the best value for your money from your health cover.

If you have extras cover, make sure you use your benefits throughout the year. Our HCF Dental and Eyecare Centres give members easy access to high-quality, affordable healthcare. And depending on your level of cover, you can also get 100% back on a dental check-up and a pair of prescription glasses or sunglasses from a selected range when you visit any of our centres^*.

If you aren't close to an HCF Dental or Eyecare Centre, eligible members can still get 100% back for dental check-ups or a range of prescription glasses through a provider in our No-Gap network (subject to your annual limit)^{^}. You can also get 100% back on a first visit to a physio, chiro and osteo, and podiatrist when you see a provider in our No-Gap network (up to your annual limit and depending on your cover)^{^}.

To find providers in our network, use our Find a Provider tool. Our industry first search tool lets you enter the type of doctor or More for You program provider you’re looking for in our network, and your preferred hospital or location. Once you find providers near you, you can read their biography, locations, contact details and what your out-of-pocket costs for some services are likely to be.

Our health and wellbeing programs help you get proactive about taking care of your health. We offer eligible members access to programs to help you to be your healthiest self, including mental health support and sleep support.

We offer our weight-management programs which can help you improve your quality of life. Healthy Weight for Life is available to members who are overweight and have osteoarthritis⁺ or are at risk of developing a chronic condition^#. We also offer The COACH Program®, a four to six month phone-coaching support program provided at no extra cost for eligible members^** with heart conditions or diabetes that can help improve your health.

If you need hospital treatment, we offer access to some at-home hospital treatments if you are eligible^{^^}. These at-home treatments are called hospital-substitute treatment (or HST) because the treatment substitutes the treatment you would have had in hospital.

Where your doctor permits it and if you're eligible^{^^}, you could have the following treatments at home:

• intravenous therapy antibiotics
• complex wound care with negative pressure wound therapy
• rehabilitation after a hip or knee replacement
• IV chemotherapy.

Do you need health insurance in aged care?

If you're moving into aged care, you may still benefit from holding on to your private health cover, although you might want to review your level and type of cover to allow for your new circumstances to make sure you’re not paying for cover you don’t need.

While some of your healthcare needs may be taken care of by your aged care facility, private cover can still be useful to cover services like elective surgeries and essentials like new glasses, hearing aids or dental care. It can help if you talk to your facility or ask your family to help with those discussions about what they do and don’t cover, so you have a clear picture of the gaps you need to fill.

Rebates for over 50s on health cover

If you’re over 50 and taking out hospital cover for the first time or have had a break from being covered, you may need to pay the government’s lifetime health cover loading (LHC). While this loading can add to your premiums, you may find the benefits of private health cover still outweigh the cost.

You also become eligible for an increased rate of the government’s health insurance rebate as you get older, with the rebate amount being means tested, based on your taxable income, age and relationship and parental status.

Ready to take charge of your healthcare?

We’re happy to help. Visit us in one of our branches, or give us a call on 13 13 34, so we can answer any questions you may have, and find the best level of cover for you.