What are the best health insurance funds in Australia?

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Is there a best health insurance fund in Australia?

How can I compare health insurers if there isn’t an overall best health fund?

Which health insurers are available in Australia?

What is a restricted health fund?

What are the fast facts on these health insurers?

Which health insurance provider is most likely to pay all of my claim?

How do health insurers’ gaps compare between hospital cover and extras policies?

Which health insurers are customers happiest with?

So, who is the best health insurer in Australia?

Long story short

The best health insurance fund is the one that works for you

This can include how much you get back on hospital and extras claims, so you get value for money on your premiums.

Many health funds cover 87% or more of hospital services

That means there’s a good chance you could have no gap to pay for an in-hospital treatment, like surgery.

Many Aussies stayed with their insurer for 2 years or more

The industry average for hospital cover membership retention was 85.32%, with some health funds scoring even higher.

Is there a best health insurance fund in Australia?

While it would sure make things simpler, there just isn’t a ‘best’ health insurance fund as health cover isn’t one-size-fits-all. Instead, you need to align your health care needs and budget with a policy (including type and level of cover) and health insurer that delivers value for you. For instance, in 2024–25, HBF had the best track record for no-gap claims, while Teachers Health had the highest member retention. Either of these (or other) measures might be more important to you, depending on your priorities.

How can I compare health insurers if there isn’t an overall best health fund?

To find your health insurer perfect match, it’s about more than just price; rather, think about which insurer suits your individual needs, whether that’s just your own or the whole family’s needs. You wouldn’t want to score a low premium but end up with a policy that doesn’t fit well.

Which health insurers are available in Australia?

As of the 2024–25 financial year, Australia has 29 private health insurance companies, although some of them have sub-brands, which can make the marketplace seem even more crowded. Depending on your unique situation, you might not be able to take out health insurance with all these funds, as some have restricted memberships. However, unrestricted funds tend to have a bigger share of the market – for instance, BUPA and Medibank together account for over 50% of the market.

To help keep things straightforward, in this article we’ve narrowed the list down to health funds with at least a 1% slice of the 2024–2025 financial year market share pie. That’s 10 funds in total, and they sell 92.6% of health insurance policies in Australia.¹Commonwealth Ombudsman – State of the Health Funds Report, p15

Did you know that ahm is actually a part of Medibank and Frank is a part of GMHBA? The figures we’ve used throughout this page incorporate sub-brands into their parent brands. That means ahm’s stats have been rolled into Medibank’s and Frank’s into GHMBA’s.

This table gives you an idea of the scale of each fund in terms of membership, as of the 2024–25 financial year.

Market share of the 10 largest health funds in Australia

Note: These figures reflect the market share of Australian health funds in 2024–25 financial year, based on data from Commonwealth Ombudsman. Internal calculations have been applied to this data.

What is a restricted health fund?

What is a restricted health fund?

A restricted health fund is a health insurer that only lets people (and usually their close family members) from certain groups, industries or professions take out cover, like teachers or doctors. If you’re a member of one of these groups, you don’t have to take out cover with a restricted health insurer; however, you might find that a health fund that caters just for your industry might offer policies that give you better value.

On the flipside, unrestricted health funds don’t have membership limits are open to the general public to sign up.

What are the fast facts on these health insurers?

Get to know the 10 biggest health insurers in Australia in less time than it takes to make a cup of tea, including if they’re restricted and not-for-profit, as well as how many Aussies had cover with them in the 2024–25 financial year.

Which health insurance provider is most likely to pay all of my claim?

In the 2024–25 financial year, out of the 10 biggest health funds, HBF, Australian Unity and BUPA were the most likely to have services with no gaps, with each fully covering at least 89% of private hospital cover claims. But the industry average was 87.1%, and most health funds hit similar numbers.

When you’re comparing health insurers, it can be helpful to look at how many medical services they cover without a gap (also called ‘no-gap’ services). The greater the percentage, the more value you could get when you make a claim (and the more peace of mind you could have if you’re worried about needing hospital treatment).

Something to note is that these figures only apply to in-hospital medical services as a private patient at a public or private hospital. We’ll get to extras charges, like for a dental check-up or chiropractic or physiotherapy treatment, in a later section. Don’t forget, too, that there are different levels of hospital cover with higher tiers covering more services. These figures don’t take into account these levels, so some funds might fully cover more common or low-cost surgeries, like those on bronze hospital cover, rather than the expensive treatments you’d see on gold-tier policies.

Percentage of hospital services fully covered by each health fund

Note: These figures reflect the proportion of hospital cover services provided with no gap in Australia in 2024–25, based on data from the Commonwealth Ombudsman. Actual percentage of hospital services without a gap may vary depending on your circumstances, including chosen policy.

How do health insurers’ gaps compare between hospital cover and extras policies?

Gaps can occur whether you’re claiming for hospital cover or extras cover; however, the gap tends to be bigger for extras. For instance, the industry average for hospital-related charges covered in Australia in the 2024–25 financial year was 89% compared to 50.7% for extras charges covered on average.¹⁴Commonwealth Ombudsman – State of the Health Funds Report, p21

In the 2024–25 financial year, HBF, Medibank and Australian Unity covered the highest percentage of hospital-related charges, like accommodation, operating theatre fees and doctors’ fees. However, the majority of the 10 health funds with the largest market share had hospital cover that covered more than the industry average for these costs.

For extras charges covered, nib, HBF, Medibank and BUPA covered the most, covering at least 51.3%. The other 6 health funds we looked at were below the industry average of 50.70%, and there was a lot more variety in how much extras health insurance was covered by each fund compared to the percentage of hospital charges covered.

If gaps are a big factor for you when you’re picking a health insurer, you might want to drill down into hospital gaps and extras gaps separately. For instance, if you tend to be a heavy extras user, you might want to choose a fund that covers more extras charges. However, keep in mind that annual limits can come into play with extras cover. You might have a smaller out-of-pocket cost in theory, but if you’re reaching your annual limit quickly, you might not actually be getting all that much value out of your health insurance premium.

Health funds that covered the highest proportion of hospital charges

Note: These figures reflect the proportion of hospital charges covered in Australia in 2024–25, based on data from the Commonwealth Ombudsman. Actual percentage of services covered may vary depending on your circumstances, including chosen policy.

Health funds that covered the highest proportion of extras charges

Note: These figures reflect the proportion of extras charges covered in Australia in 2024–25, based on data from the Commonwealth Ombudsman. Actual percentage of services covered may vary depending on your circumstances, including chosen policy.

Which health insurers are customers happiest with?

From the 10 biggest health funds in 2024–25, smaller restricted and not-for-profit health funds had the greatest member retention; for instance, Teachers Health, CBHS and Defence Health all hit above 90%. Membership retention is a handy way to look at how happy customers are with their health insurance company (it can be a bit tricky to ask every single customer their honest opinion on their health insurer); after all, unhappy customers tend to vote with their feet!

However, you don’t necessarily have to look to a restricted membership option to find a health fund with a higher retention rate. For instance, the industry average for membership retention was 85.32% and HBF, BUPA and Medibank scored above this (88.4%, 86.1% and 85.4% respectively). Notably, BUPA and Medibank are both for-profit companies, further bucking the trend.

Health funds with the highest membership retention rates

Note: These figures reflect membership retention in Australia for hospital cover that was active for at least 2 years as of 2024–25 financial year, based on data from the Commonwealth Ombudsman.

Helpful tip

Being happy with your health insurer could be about more than premium costs and getting money back. Depending on your circumstances, you might be more concerned about other factors and how they fit with your health needs, like short waiting periods, including for pre-existing conditions; if ambulance cover is conveniently bundled with your hospital and extras cover; and/or the health fund has an agreement with the hospital near you that always has private rooms available.

There’s a lot to consider when you’re comparing health insurance!

Andres Gutierrez

General Manager – Health

So, who is the best health insurer in Australia?

The best health insurer for you is the one that offers cover that works with your life stage and coverage needs. The information above may have helped you start a shortlist, or you might want to do further research to keep narrowing things down.

Remember, although price can certainly be a factor, having a policy that offers you value is key. This could mean getting more extras services covered, having fewer gaps on hospital visits, or something else entirely.

If you’re feeling overwhelmed, don’t worry – we’re here to save you time and effort. Using our online comparison tool, you can tailor a search to see how a range of different policies and providers shape up. Alternatively, you can speak with one of our health insurance comparison experts on 1800 784 772 to be guided through the process.