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Last Updated on 7 October 2019

Two Become One: Health Insurance Guide for Newly Married Couples

Getting married is a huge milestone in any couple’s life. It’s a time to talk about joint finances and future plans, which means it’s also time to think about combining your health cover.

To switch or not to switch? That is the question. Is it worth your effort to switch health funds? What’s the point of couple’s cover, anyway? Now that we’re married, do we really need to have the same health fund? We’ve put together some information that will help you answer these questions.

Key Points
  • Married couples do not need couple’s health insurance, but there are many benefits to having joint cover.
  • Couples planning to start a family should organise health cover in advance, as they may need to serve waiting periods of 12 months before being eligible for maternity coverage.
  • Getting married changes the way the government determines your income, which can impact your Medicare Levy Surcharge or Health Insurance Rebate.

What’s Included in Couple’s Health Insurance?

Health insurance is generally made up of three different types of cover. You can opt for just one of these, or a combination of whatever suits you best.

Hospital Cover

No surprises here! Hospital cover does just what it says on the box, and covers you for hospital stays and in-hospital medical procedures. You’ll have the advantage of choice and flexibility, with the ability to choose your doctor and bypass waiting lists in public hospitals.

Recovering in hospital as a private patient may be a more pleasant experience. Think about how you feel when you’re ill at home. Not exactly keen to spend time with strangers, right? Hospital cover may give you access to private rooms, providing an element of control over your experience.

Ambulance Cover

Hospital cover does not always include ambulance cover, which many people don’t realise until they’re hit with a bill. Adding ambulance cover to your policy provides peace of mind. You won’t have to make an on-the-spot decision on whether you can afford an ambulance service, should one be required.

General Cover

Also known as extras, general cover offers health services that may fit well with your family’s lifestyle. Depending on your policy, you may be covered for consultations, treatments, and materials that fall into these categories and more:

  • Optical
  • Dental
  • Remedial massage
  • Acupuncture
  • Chiropractic treatment
  • Podiatry
  • Psychology

Do Married Couples Need Couple’s Health Insurance?

There’s no rule that says married couples have to switch to a joint health insurance policy. That decision is up to you and your spouse, and your answer will depend on your situation. The cost of a couple’s premium is roughly the same as you would pay for two single policies.

On top of that, there are benefits to a couple’s policy that you might not have considered, so here are some things to think about.

Benefits of a Couple’s Policy

We’ve said that a couple’s policy isn’t necessarily cheaper than two single policies, so why bother switching? Here are a few reasons why.

It’s also nice to know that you’re covered for the extras you use regularly, whether that’s dental, acupuncture, psychology or something else.

Will Switching to a Couple’s Policy Mean Re-Serving Waiting Periods?

If you’ve ever served a waiting period for health insurance, it’s understandable that you wouldn’t want to do it again. It’s a set period of time you must wait before you are eligible to claim on your hospital and extras cover.

Good news: If you’ve already served a waiting period for your current cover, you should be off the hook for this one.

Portability Rules

Portability rules are in place to protect you from being trapped into your hospital cover. As long as you’re switching to a policy with an equal or lesser level of hospital cover, you aren’t required to repeat the waiting period.

Although general cover doesn’t fall under the same laws, many funds will allow you to transfer cover without sitting a new waiting period – providing you switch to equivalent benefits with your new fund.

Keep in mind that if you’re moving to a higher level of cover, you may have to serve a waiting period before becoming eligible for the new higher benefits.

Starting a Family

You just got married! Isn’t it a bit soon to talk about starting a family? Actually…no. When it comes to health insurance, it might be smart to think ahead. In fact, if you’re considering having a baby within the next couple of years, the time to think about family cover is now.

Planning Ahead

Many couples think of family cover as something that kicks in when your little ones arrive, but that’s not the case. Family cover often offers a range of services that start before you even become pregnant, such as prenatal care or fertility treatments.

While you may be able to add pregnancy and birth related services to an existing couple’s policy, you could run into restrictions if you discover the need for fertility treatments. Locking in a family policy in advance means you can be covered for whatever comes your way.

Waiting Period

The other reason for starting early on family health insurance is that pesky waiting period. Most funds require a 12-month waiting period before you can claim for pregnancy and childbirth, which means you’ll need the right level of cover before you even start trying to conceive.

What Else is Covered?

Family health insurance can cover any emergency medical services your baby may need after the birth. If you haven’t switched to a suitable plan, a medical emergency could leave you out of pocket at a very stressful time.

How Marriage Affects Health Insurance Taxes and Rebates

Getting married changes the way your income is defined for health insurance taxes and rebates. Instead of considering your individual income, you’ll need to look at your household income.

Medicare Levy Surcharge

Most Australian taxpayers pay a 2% Medicare Levy. If you don’t have eligible private health insurance, you could be subject to an additional tax, known as the Medicare Levy Surcharge. The amount you pay as a married couple will depend on your household income.

Use the Medicare Levy Surcharge calculator to determine how much extra you’ll owe the government if you don’t have private health insurance.

Medicare Levy Surcharge Calculator

The Medicare Levy surcharge is an additional fee paid on top of the 2% Medicare Levy Surcharge that most Australian taxpayers pay. You can avoid the surcharge if you have Private Health Insurance (Hospital Cover).

The exact surcharge level you'll need to pay depends on your income level and relationship/family status. Use the slider and dropdown menu below to determine what surcharge you're liable for if you don't have private hospital cover.

Your Medicare Levy Surcharge is 0.00% of your income, or $0.00
Singles ≤ $90,000 $90,001 - 105,000 $105,001 - 140,000 ≥ $140,001
Families ≤ $180,000 $180,001 - 210,000 $210,001 - 280,000 ≥ $280,001
Medicare Levy Surcharge
Standard Tier 1 Tier 2 Tier 3
All Ages 0.0% 1.0% 1.25% 1.5%

Health Insurance Rebate

Now for some good news—government rebates may be available to subsidise the cost of your hospital and extras cover. These rebates are based on your age, family status, and income level. As a couple, you may be eligible for a rebate up to a combined household income of $280,000.

Use the Health Insurance Rebate calculator to determine how much you could claim as a rebate.

Depending on your age, family status, and income level, you may be entitled to a Government Rebate on your private health insurance policy. Use the sliders and dropdown menu below to calculate your rebate.

Your Rebate is 0
Singles < $90,000 $90,001 - 105,000 $105,001 - 140,000 > $140,001
Families < $180,000 $180,001 - 210,000 $210,001 - 280,000 > $280,001
Base Tier Tier 1 Tier 2 Tier 3
Age < 65 25.059% 16.706% 8.352% 0%
Age 65-69 29.236% 20.883% 12.529% 0%
Age 70+ 33.413% 25.059% 16.706% 0%

Shopping as a Couple: Asking the Right Questions

Here are a few questions to keep in mind as you compare health insurance policies.

Couple’s insurance is a convenient, cost-effective way for a married couple to manage their health insurance. You’ll only have to deal with one policy and one premium, plus enjoy the peace of mind that comes with knowing you’re covered for private treatment.

Frequently Asked Questions About Health Insurance

There are three types of health insurance in Australia. They are:

  • Hospital Cover
  • Extras Cover (also known as general or ancillary cover)
  • Ambulance Cover

Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital.  Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.

Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:

  • Dental/oral health
  • Glasses and contact lenses
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • Hearing aids
  • Travel vaccinations

Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.

Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.

There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.

Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).

Policy: An insurance plan. In other words, it is the type of insurance you choose to select.

Policy Holder: The owner, or ‘holder’ of a policy.

Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)

Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.

This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.

The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.

Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.

Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.

The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.

Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.

Disclaimer: The above information is correct and current at the time of publication

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