What You Can Claim Back from Health Insurance – Understanding Your Coverage
Published December 11, 2025
Whatever amount you are shelling out on health insurance, you naturally wish to ensure you are getting good value for your money. If you are considering what you can claim back from health insurance and wondering whether the amount you’re receiving is enough, here is what you need to know.
Like any other form of Insurance, health insurance is ready to help you financially when you need proper healthcare. But what really makes health insurance different is the amount of events you can claim for. Generally, you only make a claim on home insurance for unlikely but very costly events, such as fires, floods, or damages. How much you claim with health insurance depends on your purchased type of cover, including Hospital & Ambulance.
There is a good deal of reasons one might need to claim-everything from a simple ambulance call-out to cataract surgery, fertility treatments, rehabilitation, weight loss programs, hearing aids, and so on. You can’t really expect to claim back more on health insurance than you pay in premiums.
How much you get back on Health Insurance?
As per the data from Private Healthcare Australia, the apex body for the health insurance industry, for every dollar Australians spend on health insurance premiums they gain around tentatively 84 cents back. That’s only an average – some years you might get back more, while other years you might claim back nothing at all, depending on your level of cover and health requirements. And the older you get, the more likely you are to claim. But ultimately, unless you have a very expensive form of surgery, the amount you spend on health insurance over your lifetime will generally be more than you get back in claims.
So, how do you know if you’re getting enough back from your policy? Let’s break it down by policy type.
How much you can expect from Hospital Cover?
Hospital cover is for hospital procedures where you are admitted to hospital as a private patient. Most healthy people won’t claim on their Hospital cover very often, so instead of looking at how much money you are getting back, think about how valuable it would be to have private hospital treatment if you needed elective surgery including knee replacement.
If you are willing to wait a long time in the public hospital system, Hospital cover might not be as valuable to you. To quote a renowned health economist professor, Luke Connelly from the University of Queensland, Hospital Cover provides the best value on average when you’re in your mid-50s and older, and therefore more likely to claim but there are no guarantees.
How much should you get back from Extras Cover?
Extras Cover is for health treatments outside hospital, by dentists and allied health professionals-think physiotherapists, chiropractors, and optometrists. Extras Cover is the form of health insurance where you need to claim back more than you spend on premiums to make it worthwhile. So, take a look at how much you claimed back in the last year and compare it to your annual premiums
Switching Your Health Insurance Policies
If you are of the opinion that your health insurance is not offering good return relative to your premiums and claims, it’s time to look for a better policy. At Utility Market, we have made this quick & easy. Our calculator searches every policy from every insurer in Australia in minute, giving you all of your options so you can make the perfect choice. Seek for a new health insurance policy or compare your current policy with others.
To make sure you are getting the most from your coverage, it’s important to understand what you can claim back from health insurance. At Utility Market, we make it quick and easy to compare health insurance policies from a wide range of insurers in Australia. Explore your options today and take the next step toward better value and smarter cover.
Frequently Asked Questions
It depends on your cover. On average, Australians get back around 84 cents for every dollar spent, but this varies by policy and yearly claims.
Extras Cover is worthwhile only if you claim more than you pay in premiums. Check your past claims to see if the benefits outweigh the cost.
Compare your yearly claims, premiums, and benefits. If your cover no longer fits your needs, it may be time to compare policies and switch.
