Should I use private health insurance in a public hospital?

Public hospitals ask patients whether they would like to use their private health insurance during a hospital admission.

For many people, this can be confusing, particularly during an unexpected hospital visit or emergency admission.

This article explains what it means to use private health insurance in a public hospital, when it might apply and some of the things to consider before agreeing to use your cover.

Key Points

• Using private health insurance in a public hospital is your choice.
• Being admitted as a private patient in a public hospital does not mean faster or better treatment.
• There may be out-of-pocket costs depending on your treatment and doctor.
• Public hospitals bill the accommodation and theatre fees to your private health insurer instead of Medicare.

Why do public hospitals ask patients to use private health insurance?

When a patient chooses to use private health insurance in a public hospital, the hospital can bill accommodation and theatre fees to the patient’s health insurer instead of funding the admission through the public hospital system.

This shifts some of the cost of treatment from the public hospital system to private health insurers.

Using private health insurance in a public hospital does not automatically result in faster treatment, a different hospital experience or better outcomes for the patient.

What does it mean to be a private patient in a public hospital?

When you’re admitted to a public hospital, you may be asked whether you want to use your private health insurance or be treated as a public patient.

If you choose to use your private health insurance, you are admitted as a private patient.

If you choose not to use your private health insurance, you are treated as a public patient through the public hospital system.

Using private health insurance in a public hospital doesn’t change the treatment you receive and in some situations you may incur additional charges.

Do you have to use your private health insurance?

No. Using private health insurance in a public hospital is your choice.

Public hospitals cannot force you to use your private health insurance or pressure you into being admitted as a private patient.

You can choose to be treated as a public patient through the public hospital system instead.

Are there benefits to using private health insurance in a public hospital?

In some situations, using private health insurance in a public hospital may provide access to benefits such as choosing your doctor or requesting a private room where available.

However, these benefits are not guaranteed and can depend on the hospital, your treatment and doctor availability.

Using private health insurance in a public hospital also does not automatically result in faster treatment or a different hospital experience.

Can there be out-of-pocket costs?

Yes. In some situations, using private health insurance in a public hospital can still result in out-of-pocket costs.

This can include costs such as hospital excesses, co-payments, private room accommodation charges or medical charges above the Medicare Benefits Schedule.

Out-of-pocket costs depend on the treatment you receive, your level of cover and the doctors involved in your care.

If possible, ask the hospital and your doctor about any expected costs before agreeing to use your private health insurance.

What questions should you ask before agreeing to use your private health insurance?

Before agreeing to use your private health insurance in a public hospital, it’s important to understand how your admission will work and whether there could be any additional costs.

• Will I have any out-of-pocket costs?
• Will I be treated any differently if I use my private health insurance?
• Can I choose my doctor?
• Is a private room guaranteed?
• Will I need to pay an excess or co-payment?

Where can I get more information?

You can learn more about the difference between public and private hospital treatment in our article on Public vs Private Hospitals.

If you’re planning a hospital admission, you can also learn more about Agreement Hospitals or use our Find a Hospital tool.