Is Gold worth it after 60, or is Silver Plus enough?

It depends on two procedures. Gold is the only tier that must cover joint replacements, cataracts and dialysis. If any of those are realistic for you, Gold removes all doubt. But several funds sell Silver Plus policies that include joint replacements and cataracts at a price well below Gold — and since you're unlikely to need pregnancy or fertility cover, that's often the better buy. We price both.

How long is the pregnancy waiting period?

Twelve months on every fund. The waiting period must be fully served before the admission for the birth, so the practical rule is to have Gold in place around three months before you start trying — that leaves room for the pregnancy itself. Joining while already pregnant means the birth won't be covered unless the 12 months finishes first.

Does Gold mean I pay nothing in hospital?

No. You'll still pay any excess you've chosen on admission, and specialists can charge above the Medicare Benefits Schedule fee, which creates a gap. Asking your specialist for informed financial consent before the procedure — and checking whether your fund has a no-gap arrangement with them — is what actually controls that cost.

Do I need Gold for IVF?

For the hospital component of assisted reproductive services, yes — it's a Gold-only category. Much of IVF happens out of hospital, where Medicare and your own money apply, so it's worth mapping the whole cost, not just the admitted part.

Gold hospital cover

Gold hospital cover: every clinical category, no arguments

For growing families planning a pregnancy and over-60s facing joints or cataracts — the only tier that must cover all 38 clinical categories.

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Who is the cover for?

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What Gold hospital cover includes

Gold is the top of the government's tier structure. Every one of the 38 clinical categories must be covered, and the three that are restricted at every other tier — rehabilitation, hospital psychiatric services and palliative care — become unrestricted here, so you're covered in a private hospital rather than only as a private patient in a public one.

Included versus restricted, in one line

Included means the fund pays its share wherever you're treated, including a private hospital. Restricted means you're only covered as a private patient in a public hospital — which is far cheaper for the fund, and far less useful for you.

Recovery, mental health and end-of-life care

Rehabilitation — Physical recovery after illness, injury or surgery.
Hospital psychiatric services — Admitted treatment for mental health conditions.
Palliative care — Care that manages symptoms rather than curing them.

Bones, joints and muscles

Bone, joint and muscle — Fractures, tendon repairs and most orthopaedic surgery.
Joint reconstructions — Rebuilding a damaged joint — ACL repairs, shoulder reconstructions.
Back, neck and spine — Spinal surgery including disc procedures and fusions.
Podiatric surgery (registered podiatric surgeon) — Limited benefits apply — the fund pays part of the hospital cost.
Joint replacements — Hips, knees and shoulders — including revisions.

Heart, lungs and blood

Heart and vascular system — Stents, bypass surgery, pacemakers.
Lung and chest — Lung, pleura and chest wall procedures.
Blood — Treatment of blood and bone marrow disorders.

Digestive system and abdomen

Digestive system — Stomach, bowel, liver and gallbladder surgery.
Hernia and appendix
Gastrointestinal endoscopy — Colonoscopy and gastroscopy.
Weight loss surgery — Gastric banding, sleeve and bypass.

Eyes, ears, nose and throat

Eye (not cataracts)
Ear, nose and throat
Tonsils, adenoids and grommets
Implantation of hearing devices — Cochlear implants and bone-anchored devices.
Cataracts — Removing a cloudy lens and replacing it.

Brain, nerves and pain

Brain and nervous system
Pain management — Treatment for chronic pain without an implanted device.
Pain management with device — Implanted pain pumps and nerve stimulators.
Sleep studies — Investigating sleep apnoea and related disorders.

Kidney, bladder and men's health

Kidney and bladder
Male reproductive system — Prostate surgery and related procedures.
Dialysis for chronic kidney failure

Women's health, pregnancy and fertility

Gynaecology — Investigation and treatment of the female reproductive system.
Miscarriage and termination of pregnancy
Breast surgery (medically necessary) — Including reconstruction after cancer.
Pregnancy and birth — 12-month waiting period — plan roughly three months before trying.
Assisted reproductive services — IVF and related hospital treatment.

Cancer, skin, dental and reconstructive

Chemotherapy, radiotherapy and immunotherapy for cancer — Cancer treatment delivered as an admitted patient.
Skin — Removal of lesions, cysts and skin cancers.
Dental surgery — Surgical dental work in hospital — not everyday dentistry.
Plastic and reconstructive surgery (medically necessary)

Diabetes and metabolic

Diabetes management (excluding insulin pumps)
Insulin pumps

What Gold doesn't cover

There is nothing above Gold. What Gold still doesn't pay for is out-of-hospital care: GP appointments, most specialist consultations, dental check-ups, physio and optical. That's Medicare's territory, or your extras policy's.

Nothing on the government's clinical category list sits outside this tier.
What still isn't covered is out-of-hospital care — GP visits, most specialist consults, dental and physio. That's Medicare's job, or your extras policy's.

Gold is not automatically the right answer

If you're not planning a pregnancy and joints aren't on the radar, a Silver Plus policy can cover almost everything you'd realistically claim for meaningfully less. We'll tell you when that's the case rather than sell you the top of the range.

Who chooses Gold

Growing families planning a pregnancy

Pregnancy and birth is a Gold-only category with a 12-month waiting period — so you need Gold in place roughly three months before you start trying, not once you're expecting. Newborns can be added to a family policy, usually with no waiting period on the baby.

Growing families cover Pregnancy cover explained

Over-60s facing joints or cataracts

Joint replacements, cataracts and dialysis are all Gold categories, and they're the procedures most likely to matter after 60. Compare Gold against a Silver Plus policy that includes joints and cataracts before you commit — sometimes the cheaper one is genuinely enough.

Over 60s cover

What it typically costs

Gold is the most expensive tier, and the spread between funds is the widest of any tier — which is exactly why comparing it properly pays for itself.

Gold hospital cover for a single.
Gold hospital cover for a couple.
Gold hospital cover for a family. Includes pregnancy and birth. 12-month waiting period applies.

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Where to go next

Compare every tier side by side, or read the tier either side of Gold before you decide.

All four tiers compared Silver hospital cover Extras cover

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Gold hospital cover: common questions

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