Premiums up, rebates down, and a new tiered system – what the private health insurance changes mean
- Written by Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University
If you have private health insurance, or are considering getting it, a series of changes coming into effect on April 1 are worth knowing about.
These include the annual premium increase, a small decrease in rebates, the introduction of a new tiered system designed to simplify things for consumers, and some premium discounts for young people.
This year’s premium increase is quite small compared to recent years, and the reforms are generally sensible. But cost pressures and confusion in private health insurance cannot be fixed overnight.
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A modest increase in premiums
Private health insurance premiums will increase by an average of 3.25% in 2019. These increases are relatively modest, as premiums have been rising at between 4% and 6% per annum for more than 10 years.
However, compared to consumer price index inflation of 1.8% and wage inflation of 2.3%, premiums are still rising substantially in real terms for Australians.
But in the current environment, above-inflation premium rises are not unexpected.
For comparison, consider the public health system, where spending increased at nearly 7% per year in the decade to 2017.
Out-of-pocket spending by patients also had an above-inflation trend of 5.1% per year over the past decade.
So both public and private expenditure on health are increasing substantially. Driving this is the increased usage and price of health care. Hospital visits are growing at 4% a year, and health price inflation is a further 2% per year.
Many hospital procedures such as cardiothoracic surgery, colonoscopies, hip and knee replacements, are increasing in volume by over 5% a year. So as patients use their health insurance more, it’s reasonable for the price to rise.
Rebates continue to decrease slowly
Most Australians with private health insurance receive a rebate from the Australian government to help cover the cost of premiums.
Means testing of rebates along income tiers was introduced in 2012. This sees individuals and households with higher incomes receive lower subsidies.
From 2014, the government began indexing rebates every year, using a formula that is calculated as a difference between the consumer price index, and the industry weighted average increase in premiums.
As a result of indexation, rebate entitlements have been gradually falling.
From shutterstock.comFor example, this means in 2013/14, a person aged 65 or below earning less than $88,000 (base tier) would have received a 30% rebate. Today, a person of the same age in the base tier would receive a rebate of just over 25%.
From April 1, rebates will decrease between 0.1% to 0.5% from their levels in 2018/19, depending on the income tiers that people fall into.
For a typical family policy that covers both hospital and extras (with premiums approximately A$140 a fortnight), the decrease in the rebate translates to a very small rise in premiums of A$1 a fortnight.
Basic, bronze, silver or gold?
One key initiative starting on April 1 is the introduction of four tiers of private health insurance coverage: basic, bronze, silver, and gold. This is distinct to the income tiers we talked about above.
In this case, each tier mandates the minimum set of treatments (defined by clinical categories) that insurers must cover.
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For instance, policies in the “basic” tier are required to cover rehabilitation services, hospital psychiatric services, and palliative care.
Insurers can include other types of treatments which are not mandatory under the basic tier, if they choose to do so. Each additional tier covers a wider range of treatments, in addition to services mandated in lower tiers.