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Guides / Hospital vs Extras vs Combined Cover

Hospital vs Extras vs Combined Cover

Updated March 2026 · 8 min read

Private health insurance in Australia falls into three main categories: hospital cover, extras (also called general treatment) cover, and combined cover. Each serves a different purpose and covers different types of healthcare expenses. Understanding the difference is essential before choosing a policy.

Hospital Cover

Hospital cover pays for treatment as a private patient in a hospital. This includes accommodation, theatre fees, and doctor charges for in-hospital procedures. Without hospital cover, you would be treated as a public patient in the public hospital system under Medicare, which means you cannot choose your doctor or hospital, and may face longer wait times for elective procedures.

Hospital cover is categorised into four standardised tiers by the Australian Government: Basic, Bronze, Silver, and Gold. Gold covers all clinical categories. Lower tiers cover fewer categories and may have restrictions on certain treatments.

Key fact

Only hospital cover (not extras) satisfies the requirement to avoid the Medicare Levy Surcharge. The policy must have an excess of $750 or less for singles, or $1,500 or less for families.

Typical hospital cover premiums for a single adult range from roughly $80 to $300+ per month depending on the tier, excess, and fund. Higher excess policies have lower premiums but require a larger upfront payment if you are admitted to hospital.

Extras Cover (General Treatment)

Extras cover pays benefits towards out-of-hospital services that Medicare does not cover. This typically includes dental, optical, physiotherapy, chiropractic, podiatry, psychology, remedial massage, and sometimes ambulance (depending on your state).

Each fund sets annual benefit limits per service category. For example, a mid-range extras policy might allow $600 per year for general dental and $200 for optical. Once you have claimed up to the limit, further costs are out of pocket until the next policy year.

Extras-only cover does not help avoid the Medicare Levy Surcharge. It is designed for people who want help covering regular allied health costs but do not need or want private hospital cover.

Combined Cover

Combined cover bundles hospital and extras into a single policy. Most health funds offer a discount when you bundle rather than purchasing two separate policies. Combined cover is the most common type of private health insurance held by Australians.

With combined cover, you get the benefit of choosing your hospital and doctor for in-hospital treatment, plus rebates on dental, optical, and allied health services. The trade-off is a higher overall premium compared to holding just one type of cover.

Quick Comparison

FeatureHospitalExtrasCombined
In-hospital treatmentYesNoYes
Dental, optical, physioNoYesYes
Avoids MLSYesNoYes
LHC loading appliesYesNoYes (hospital component)
PHI RebateYesYesYes
Typical single premium$80 - $300+/mo$15 - $80/mo$100 - $400+/mo

Which Type Suits Your Situation?

Hospital only

Suitable if your main goal is avoiding the MLS, choosing your own doctor or hospital, or covering potential in-hospital costs. You do not need frequent dental or allied health services, or you prefer to pay for them out of pocket.

Extras only

Suitable if you earn below the MLS threshold (or are comfortable paying it) and mainly want help covering dental, optical, or other allied health costs. This does not cover hospital admissions.

Combined

Suitable if you want both hospital and extras benefits in a single policy. Most people who hold private health insurance in Australia hold a combined policy. The bundled discount typically makes this more cost effective than two separate policies.

Frequently Asked Questions

Can I have hospital cover from one fund and extras from another?
Yes. There is no requirement to hold both policies with the same fund. Some people find they get a better deal by splitting their hospital and extras across two different funds. However, you will usually lose any bundled discount the fund offers for combined policies.
Do I need hospital cover to avoid the Medicare Levy Surcharge?
Yes. To avoid the MLS, you must hold an eligible private hospital insurance policy that has an excess of $750 or less for singles ($1,500 for families). Extras-only cover does not satisfy the MLS requirement.
What is the difference between Basic, Bronze, Silver, and Gold hospital cover?
These are standardised tiers set by the Australian Government. Basic covers a limited set of hospital treatments. Bronze adds more services. Silver covers most in-hospital treatments. Gold covers all clinical categories recognised under the private health insurance reforms. Each tier has a defined minimum set of inclusions.
Is extras cover worth it if I rarely visit the dentist?
Extras cover includes more than dental. It can cover optical, physiotherapy, psychology, podiatry, remedial massage, and other allied health services. Whether it is worthwhile depends on how frequently you use these services and how much you would pay out of pocket without cover.
What are typical waiting periods for hospital and extras cover?
For hospital cover, waiting periods are typically 2 months for most services and 12 months for pre-existing conditions, pregnancy, and some mental health services. For extras, general dental and optical usually have a 2 month wait, while major dental can be 12 months. Waiting periods are set by each fund within regulatory limits.

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General information only. This is not financial advice. Health insurance premiums and coverage vary by fund, tier, and state. Consider your own circumstances or consult a qualified adviser. Data reflects publicly available information as of March 2026.