Medibank private health insurance review: Everything you need to know

There should be no surprises if you recognise the name – Medibank is one of the largest and most well-known health insurance providers in Australia. With a wide range of health insurance policies to meet the ever-changing needs of its members, you might be ready to join the more than 4 million other Aussies who’ve chosen Medibank for their private health insurance.

But before you jump head-first into a new policy, it’s important to understand exactly what you’ll get from Medibank. So let’s take a look at how the insurer operates and what you can expect as a member.

Medibank was established by the Australian government in 1976 as a not-for-profit organisation to deliver affordable health insurance to the public. Over time, it became one of the country’s leading health funds. In 2009, Medibank transitioned to a for-profit entity and in 2014 it was privatised, becoming a publicly traded company on the Australian Securities Exchange (ASX).

Today, Medibank serves more than 4 million Australians with a wide selection of health insurance products – both through its main brand, Medibank, and its subsidiary, ahm (Australian Health Management).

The insurer is currently a publicly listed company on the ASX, meaning it is ‘owned’ by shareholders who’ve bought stock in the company. The transition to a publicly traded company happened over a decade ago in 2014 when the Australian government sold Medibank through an initial public offering (IPO). As a result, Medibank is now a for-profit organisation, unlike its earlier not-for-profit set-up.

Despite this big shift – or perhaps partly because of it – Medibank continues to be a big player in the Australian health insurance market, servicing a large segment of the population.

As you’d expect, Medibank offers a huge range of health insurance products, including both hospital and extras cover. You can buy these products individually or combined, depending on your needs.

With hospital cover, you’ll get protection against the potentially high costs of hospital stays, surgeries and other in-patient services. Medibank cover comes in all the different tiers, including Basic, Bronze, Silver and Gold.

Deciding which one is right for you will depend on your budget and your current circumstances. Gold tier, for example, is the most comprehensive level of cover and includes services like joint replacements, heart surgeries and maternity care, while the Basic tier has more limited cover focused on just the essential services.

Extras cover through Medibank, on the other hand, is all about benefits for non-hospital services – but ones that are still ‘essential’ to everyday life. Think dental, optical, physiotherapy and chiropractic care. Because these services aren’t covered by Medicare, having extras cover can be extremely helpful for reducing all of those out-of-pocket expenses for routine healthcare needs.

If you think both types of cover have their benefits, you can always bundle hospital and extras cover together to enjoy the best of both worlds with Medibank.

Let’s get down to brass tax. If you’re comparing private health insurance and only really want to know the specifics of what is and isn’t covered, here’s a breakdown of what you will get from Medibank:

• Hospital-related charges covered: 90.0%
• Medical services with no gap: 83.8%
• Medical services with no gap or known gap payment made: 96.5%
• General treatment (extras) charges covered: 52.6%

As you can see, Medibank provides a substantial amount of cover for hospital-related expenses and a high percentage of medical services without requiring members to pay a gap, which is the difference between what Medicare covers and the actual cost of the service. However, as with most other providers the cover for extras is on the lower end, so you’ll need to factor that into your budget plans.

Making a claim on your Medibank health insurance policy is straightforward and can be done in any of the following ways that you prefer:

1. Online or via the Medibank app: You can submit claims for a large portion of services through Medibank’s online portal or mobile app. It’s a convenient way to claim for things like dental, physiotherapy and optical treatments. All you need to do is log into your account, enter the details of your claim and submit any receipts or documentation that’s needed.
2. In person: You can also lodge your claim in person by visiting a Medibank store. While it’ll take a bit more time, it might be the best solution if you’re making multiple claims or need help with the whole process.
3. On the spot: For some services, such as dental and physio, you can claim on the spot if your provider has HICAPS or another electronic claiming system. You’ll only have to pay the gap fee (if any) at the time of service.
4. Mail: If you prefer, you can always go with snail-mail to send your claim forms and receipts directly to Medibank. Just bear in mind that everything will take longer to process, so you won’t necessarily be reimbursed quickly.

If you decide to cancel your Medibank health insurance, the process is relatively simple:

1. Contact Medibank: You’ll need to notify Medibank of your intention to cancel – either call their customer service line or visit a Medibank store. Some policies might allow you to cancel via the Medibank online portal, so make sure you read your policy’s PDS for specifics.
2. Give them all the necessary information: When cancelling, you’ll need to provide things like your membership details and the date you want the cancellation to take effect. If you’re cancelling due to switching to another provider, just make sure there’s no gap in your cover.
3. Confirm cancellation: After you’ve submitted your cancellation request, Medibank will process it and send you a confirmation (e.g. via email or post). Keep this paperwork for your own records, especially if you plan to claim any rebates or avoid the Medicare levy surcharge.
4. Final payments: Depending on your payment schedule, you might have a final premium payment to settle before your policy is officially cancelled.

Everyone will have different preferences for what they want out of their private health insurer. But the bottom line is that Medibank is one of Australia’s largest and most established health insurance providers for a reason – and with millions of customers, they are clearly offering something the people want.

Whether you’re after the highest tier of cover for your family or just basic protection as a young, healthy single person, Medibank has flexible plans with lots of benefits that might suit your exact needs right now.