What's the actual difference between Basic, Bronze, Silver and Gold?

The government defines 38 clinical categories and sets a minimum list for each tier. Basic must cover three, in restricted form only. Bronze adds 18 unrestricted categories. Silver adds eight more, including heart, lung and spine. Gold must cover all 38, including pregnancy, joint replacements and cataracts. Funds can always cover more than the minimum, never less.

What does 'restricted' cover actually mean?

Restricted means the fund only pays benefits when you're treated as a private patient in a public hospital. You don't get a private hospital admission, and you can be left with a significant shortfall if you go private anyway. Rehabilitation, hospital psychiatric services and palliative care are restricted at every tier except Gold.

What is a 'Plus' tier, like Silver Plus?

A Plus policy meets a tier's minimum requirements and adds categories from the tier above. Silver Plus policies that include joint replacements and cataracts are often the best value option for people over 60, because they skip the pregnancy and fertility categories that make Gold expensive. Two policies both called Silver Plus can cover different things, so compare the category list, not the label.

Should I take a higher excess to lower my premium?

Often yes. The excess is only payable if you're actually admitted, most funds charge it once per membership year, and many waive it entirely for dependent children. If you'd rather not pay all year for an admission that may never happen, a higher excess is the cleanest saving available — just keep it within the government limit so you stay exempt from the Medicare Levy Surcharge.

Which tier avoids the Medicare Levy Surcharge?

All of them. Any complying hospital policy with an excess at or below the government limit exempts you — including the cheapest Basic policy. Extras-only cover does not.

Do waiting periods start again if I change tier?

Only on the categories you're adding. Anything you were already covered for at the same or a lower level carries across by law. Upgrading from Silver to Gold for joint replacements means serving 12 months on that new benefit if the condition is pre-existing.

Hospital cover tiers

Hospital cover tiers: Basic, Bronze, Silver and Gold, compared

The government defines 38 clinical categories and sets a minimum list for each tier. Below is every category, side by side, so you can see exactly where the line falls — then read the tier that matches your next few years.

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All 38 clinical categories, tier by tier

Funds can always cover more than a tier's minimum, never less — so treat this as the floor for each tier. Where a category is restricted, you're covered only as a private patient in a public hospital.

Covered in full
Restricted — public hospital only
Not covered

The 38 government clinical categories compared across Basic, Bronze, Silver and Gold hospital cover
Clinical category	Basic3 restricted categories	Bronze21 categories	Silver29 categories	GoldAll 38 categories
Recovery, mental health and end-of-life care
Rehabilitation	Restricted	Restricted	Restricted	Included
Hospital psychiatric services	Restricted	Restricted	Restricted	Included
Palliative care	Restricted	Restricted	Restricted	Included
Bones, joints and muscles
Bone, joint and muscle	Not covered	Included	Included	Included
Joint reconstructions	Not covered	Included	Included	Included
Back, neck and spine	Not covered	Not covered	Included	Included
Podiatric surgery (registered podiatric surgeon)	Not covered	Not covered	Included	Included
Joint replacements	Not covered	Not covered	Not covered	Included
Heart, lungs and blood
Heart and vascular system	Not covered	Not covered	Included	Included
Lung and chest	Not covered	Not covered	Included	Included
Blood	Not covered	Not covered	Included	Included
Digestive system and abdomen
Digestive system	Not covered	Included	Included	Included
Hernia and appendix	Not covered	Included	Included	Included
Gastrointestinal endoscopy	Not covered	Included	Included	Included
Weight loss surgery	Not covered	Not covered	Not covered	Included
Eyes, ears, nose and throat
Eye (not cataracts)	Not covered	Included	Included	Included
Ear, nose and throat	Not covered	Included	Included	Included
Tonsils, adenoids and grommets	Not covered	Included	Included	Included
Implantation of hearing devices	Not covered	Not covered	Included	Included
Cataracts	Not covered	Not covered	Not covered	Included
Brain, nerves and pain
Brain and nervous system	Not covered	Included	Included	Included
Pain management	Not covered	Included	Included	Included
Pain management with device	Not covered	Not covered	Not covered	Included
Sleep studies	Not covered	Not covered	Not covered	Included
Kidney, bladder and men's health
Kidney and bladder	Not covered	Included	Included	Included
Male reproductive system	Not covered	Included	Included	Included
Dialysis for chronic kidney failure	Not covered	Not covered	Not covered	Included
Women's health, pregnancy and fertility
Gynaecology	Not covered	Included	Included	Included
Miscarriage and termination of pregnancy	Not covered	Included	Included	Included
Breast surgery (medically necessary)	Not covered	Included	Included	Included
Pregnancy and birth	Not covered	Not covered	Not covered	Included
Assisted reproductive services	Not covered	Not covered	Not covered	Included
Cancer, skin, dental and reconstructive
Chemotherapy, radiotherapy and immunotherapy for cancer	Not covered	Included	Included	Included
Skin	Not covered	Included	Included	Included
Dental surgery	Not covered	Not covered	Included	Included
Plastic and reconstructive surgery (medically necessary)	Not covered	Not covered	Included	Included
Diabetes and metabolic
Diabetes management (excluding insulin pumps)	Not covered	Included	Included	Included
Insulin pumps	Not covered	Not covered	Not covered	Included

Plus tiers: the option most people are never shown

Alongside the four standard tiers, funds can sell Basic Plus, Bronze Plus and Silver Plus policies. A Plus policy meets its tier's minimum requirements and then adds categories from the tier above — while still being classified, and usually priced, within the lower tier.

Silver Plus policies that include joint replacements and cataracts are frequently the best-value option for people over 60, because they skip the pregnancy and fertility categories that make Gold expensive.
Bronze Plus often adds back, neck and spine, or dental surgery — useful if a specific procedure is on your radar.
Two policies with the same Plus label can cover different things. The category list is the only thing that matters.

Where this matters most

If you're over 60 and Gold has been quoted to you without a Silver Plus alternative beside it, you haven't seen the full picture yet.

Over 60s: Gold vs Silver Plus

Excess: the biggest lever on your premium

Your excess is what you agree to pay towards a hospital admission before the fund starts paying. Choosing a higher one lowers your premium every month of the year — and you only ever pay it if you're actually admitted.

A worked example

Two identical Silver policies, one with a $250 excess and one with $750. The higher-excess policy costs less every month. If you're not admitted at all this year, you keep the whole difference. If you are admitted once, you pay $500 more on the day — and whether that's a good trade depends entirely on how much the monthly saving added up to over twelve months. It's arithmetic, not a gamble.

Excess is only payable on admission — not on GP visits, tests or extras claims.
Most funds charge the excess once per person per membership year, and many cap it per family.
Many funds waive the excess entirely for dependent children.
Keep the excess at or below the government limit to stay exempt from the Medicare Levy Surcharge.
Some policies also carry a per-day co-payment — check for it, because it's easy to miss.

Medicare Levy Surcharge explained

Public patient or private patient: what changes

Hospital cover doesn't buy you better medicine. It buys you control over who treats you and when. Here's the practical difference.

Public patient compared with private patient in an Australian hospital
	Public patient	Private patient
Choice of doctor	Assigned to you by the hospital.	You choose your specialist, and can keep the one who diagnosed you.
Timing of surgery	Public waiting list, prioritised by clinical urgency.	Booked with your specialist, usually far sooner for non-urgent surgery.
Room	Shared ward.	Private room where one is available.
What you pay	Nothing, in almost all cases.	Your excess, plus any specialist gap above the Medicare schedule fee.
Where you're treated	Public hospital only.	Private hospital, or as a private patient in a public one.

Read the tier that fits your next few years

Each tier page sets out the full category list in plain English, names what sits in the tier above, and says candidly who it suits.

All cover explained Extras cover Switching funds

Hospital cover tiers: common questions

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