Australian Private Health Insurance Statistics
Published January 9, 2026
In a bid to keep you fully informed about the status of the Australian Health Insurance sector regarding who’s got the cover, what funds have the biggest market share, and what type of policies people choose, let’s delve deep into some of the most significant statistics.
Who has health insurance privately in 2026?
Private health insurance cover remains relatively buoyant, despite the current cost of living crisis, in large part due to a marked increase in policy uptake during and following the COVID-19 pandemic.
According to the latest figures from APRA, 54.9% now have extras cover – that is, private health insurance that covers non-hospital services like dental, optical, physio and chiro services. Meanwhile, 45.2% have hospital cover, designed to insure the cost of inpatient services like surgery and management of chronic diseases. Most with private health insurance have a combined policy of hospital and extras.
Who’s most likely to have hospital cover by age group?
Data indicates that the older the Australian, the more likely he or she is to have hospital insurance. The 75-79 age group has the highest percentage of members, which can be understood as this age group needs more health care in later years of their life. On the other hand, young adults aged 25-29-year-old show the least likelihood for holding hospital cover, and there is a reason for that:
- They are no longer covered under their parents’ family policy.
- They usually have an income less than the Medicare Levy Surcharge threshold of $101,000.
They have not yet become affected by the Lifetime Health Cover loading which starts at age 31 years.
These trends suggest that many younger Australians only think about getting hospital insurance when financial or tax incentives make them do so.
class=”mb-3″Are Australians getting value for money?
Recently, a private health insurance report issued by ACCC stated that “insurers paid 5% more in hospital benefits per policyholder” compared with the previous year and that “the average amount paid out by insurers to policyholders for extras benefits increased by 8.4% per policyholder”.
Although this is evidence enough that most health funds are continuing to pay out more and more benefits each year for both hospital and extras cover, many Australians remain concerned about the value for money they are getting. The ACCC was also swamped with nearly 3,500 complaints for private health insurance in 2022-23, a massive increase from the previous year, and represents a point in a few years where rather than a reduction, an increase in complaints was noted. The ACCC stated in its report that complaints related to:
- Service: Customer service advice, delays in services, overall services issues, premium payments problems.
- Benefits: General treatment (extras or ancillary benefits), delays in payments, exclusion and restriction on hospital.
- Membership: Cancellation, continuity, clearance
- Waiting period: Pre-existing conditions, general
- Incentives: Lifetime Health Cover
- Information: Advice given verbally, no notifications.
Rise of Combined Policies
The great majority of those that hold private insurance in Australia have joint cover, which means that they hold cover that extends to both hospital care and extras. This not only makes it easier for most people, but it also ensures that they can get rebates on services which might be critical to them.
In a nutshell,
The current trend is evident: although the number of people holding private healthcare cover remains steadily on the rise, Australians are increasingly being penny-wise and wise when it comes to the giants.
When selecting health insurance for 2025, consumers face the dilemma of whether to choose on the basis of price and the level of cover offered against bigger branded convenience or the possibility of better value from smaller health mutuals. However, there are no straightforward answers to this question, but comparisons conducted by Fair Health Care Alliance can assist in making better value decisions concerning health care insurance needs.
Australian Private Health Insurance Statistics 2026 highlight significant shifts in coverage trends, consumer behaviour, and value concerns across the national market. Utility Market regularly analyses official APRA and ACCC data to simplify complex health insurance insights for Australian households and policyholders. Follow our LinkedIn profile for ongoing updates, policy comparisons, and expert commentary on private health insurance premiums and the broader utility market.
