How the answer is built
Methodology
Three short notes on the calculation: where the numbers come from, what we model, and what we deliberately don’t. Read this before you decide we’re right.
The data
Every policy on this site comes from the Private Health Open Listing (PHOL), the Australian Government’s official directory of currently-available health insurance products, published by the Department of Health and Aged Care via data.gov.au under Creative Commons Attribution 4.0. We refresh it periodically; the date stamp at the foot of every page is the version we served you.
(A note on names: the Private Health Insurance Ombudsman (PHIO) is a separate agency that handles consumer complaints and operates privatehealth.gov.au. We don’t use the PHIO complaints data; we use the product directory only. They’re sometimes confused; they shouldn’t be.)
We don’t take affiliate fees, kickbacks or referral commissions from any fund listed. We are not a broker. We don’t hold an Australian Financial Services Licence; this is a calculator, not advice.
What the calculator models
For every policy that matches your eligibility (state, cover type, household, fund access), the calculator works out two numbers over the time horizon you choose:
- Premiums paid. The published monthly premium, multiplied through your horizon, with the government rebate applied (if you claim it, at the tier your age and income put you in).
- Benefits returned. For each service you’ve told us you expect to use, the calculator walks the policy’s benefit schedule and caps: per-visit rebate, annual limit, shared sub-limits, yearly claim limits (“two check-ups a year”, counted per person) and waiting periods. It pays you back up to the policy’s rules, no further.
Waiting periods. A service only counts if its waiting period ends before your time horizon does. A 12-month wait on a 12-month horizon leaves no time to claim, so that service pays nothing in the answer. When the wait does end in time, we assume you book those visits after it, so a 2-month wait on physio still pays every visit you enter for the year.
Who it compares. Only policies sold for your household: single cover for one person, couples cover for two, family or single-parent cover when there are dependants. Cover sold only to overseas visitors is left out, since Australian residents can’t use it and it gets no rebate.
The headline answer (“you’re $X ahead”) is simply benefits minus premiums, with premiums after the rebate. The ranking is by that net number, best first.
The rebate tiers, in full
The Australian Government rebate is income-tested and age-banded. For every eligible Australian resident, the calculator derives the right rate from the household income and oldest-person age you enter, then applies it to every premium in the answer. Tier 3 earners get 0%; the rebate phases out above $164,000 (singles) or $328,000 (families).
These are the rates the calculator currently applies (ATO rates for 1 April 2026 to 31 March 2027, with the 2026-27 income thresholds):
| Tier | Singles income | Family income | <65 | 65–69 | 70+ |
|---|---|---|---|---|---|
| Base | ≤ $105,000 | ≤ $210,000 | 24.118% | 28.139% | 32.158% |
| Tier 1 | $105,001 – $123,000 | $210,001 – $246,000 | 16.079% | 20.098% | 24.118% |
| Tier 2 | $123,001 – $164,000 | $246,001 – $328,000 | 8.038% | 12.058% | 16.079% |
| Tier 3 | > $164,000 | > $328,000 | 0% | 0% | 0% |
Family thresholds increase by $1,500 for each dependent child after the first. Single-parent households use family thresholds (ATO treatment). The ATO updates these rates on 1 April each year; we refresh the table when they do.
What we deliberately don’t model
A calculator that pretended to model everything would be more confident than it should be. We hold ourselves to the estimates we’re sure about and call out the rest:
- Lifetime and per-tooth limits. Major dental and orthodontic benefits often carry lifetime caps, per-tooth limits or sub-limits that aren’t published in a form we can apply. We use the benefit amounts and annual limits that are published, so treat a large major-dental or orthodontic figure as a ceiling. Where a fund says a sub-limit applies but doesn’t publish it, we leave that service out of the total and say so.
- What hospital treatment is worth to you. The hospital calculator prices the surcharge, the loading and the premium exactly, but it doesn’t put a dollar figure on treatment you can’t plan. See hospital cover below.
- Provider network discounts. Many funds pay more at their preferred providers. We use the policy’s published “100% back” or set-benefit schedule; your actual benefit may be higher at a network clinic.
- Loyalty bonuses. Annual limits that grow with years of membership aren’t projected; we use year-one limits unless the policy publishes the full ladder.
- Promotions and waived waiting periods. Insurers periodically waive waits during switching campaigns. We don’t model these because they aren’t in the published data; check the fund’s current offer.
Hospital cover
Extras are about usage you can predict. Hospital cover is insurance against treatment you mostly can’t, so the hospital calculator only counts what can be worked out exactly, and says plainly that the rest is up to you.
- The Medicare Levy Surcharge. Without hospital cover, income above the threshold attracts a surcharge of 1%, 1.25% or 1.5% of income for surcharge purposes, on the same income tiers as the rebate table above (2026-27). Because you give an income band, we show the surcharge as a range across that band, and compare against the middle of it. Every open hospital policy in the data counts as cover for the surcharge.
- Lifetime Health Cover loading. If you take out hospital cover after the 1 July following your 31st birthday, the hospital premium carries a loading of 2% for every year you’re over 30, up to 70%, for 10 years. On a couple or family policy it’s the average of the two adults’. The rebate isn’t paid on the loading. If you already hold cover we add no new loading, since we can’t know what you already pay.
- Age-based discount. Some funds take up to 10% off the hospital premium for people who join aged 18 to 29. We apply it only to policies whose data says the fund offers it.
- What a policy covers. Each policy lists all 38 treatment categories as covered, restricted (public hospital rates only) or not covered. A treatment you pick has to be fully covered; restricted doesn’t count. Waiting periods are shown for what you pick: usually two months, twelve for pregnancy and for most pre-existing conditions.
- The ranking. Policies that meet your tier, excess and treatments, cheapest first, priced for a year: the listed premium, less the age-based discount where it applies and the rebate, plus the loading. Funds round and apply these slightly differently, so treat the price as an estimate to the dollar.
Visitor cover (Overseas Visitors Cover and Reciprocal Health Cover) is left out, as for extras. What we don’t price: out-of-pocket gaps on doctors’ fees, what a given treatment would cost you as a private patient, and how much shorter waits are worth to you. Those are real, but they aren’t in the government data, and guessing would make the answer look surer than it is.
How to read a ranking honestly
The ranked list shows policies that match your eligibility, sorted by their net outcome for the usage you entered. The top of the list isn’t the “best” policy in general; it’s the best one for the inputs you gave. Change the inputs (more dental, fewer physio visits, a longer horizon) and the ranking changes.
A negative net outcome isn’t a bug. For many people, Extras cover doesn’t pay for itself. We’ll tell you so, with the actual numbers.
Anything that materially affects the answer (a waiting period blocking a service, an annual limit you’ll hit early, a sub-limit that caps a category below the headline number) is surfaced in the expanded per-policy detail. That’s the working you’d ask a broker to show you.
Verify, always
Treat the answer as a well-informed starting point, not the final word. Before you switch or sign anything, confirm the specific product, premium and limits with the insurer directly. Our job is to narrow your field; theirs is to sell you the contract.