Health insurance tiers: which one is right for you?
Published January 2026
Expert contributor Patricia Kennedy Smythe, Senior Operations Manager, RT Health
Words by Angela Tufvesson
Confused by the different health insurance tiers and what they cover? We break down what they are and how to choose the right one for your needs and budget.
In Australia, private hospital cover falls under one of four tiers: Gold, Silver, Bronze and Basic. Each tier has a set of minimum services that it must include, which are set by the government. Some policies include extra benefits on top of this and are called ‘Plus’ policies, such as Bronze Plus or Silver Plus.
Your health needs, lifestyle and finances naturally change over time, so it’s important to regularly review your cover and make sure you’re getting the right balance of benefits, flexibility and value.
Whether you’re planning to start a family, approaching retirement, navigating a chronic condition or focused on the cost of living, comparing your health needs to the types of things covered on the different health insurance tiers can help you decide which level of cover is right for you.
What’s covered with Gold cover?
Gold cover represents the highest level of private health insurance. Under RT Health’s Gold Optimal Hospital cover, you’re covered for all the clinical categories set out by the Australian Government – everything from assisted reproductive services, pregnancy and birth, to joint replacements and hospital psychiatric services.
“Because of the extensive cover it offers, premiums for this type of hospital cover are higher than for other tiers,” explains Patricia.
Our Gold Optimal Hospital cover must be purchased with an RT Health extras cover, and is ideal if you’re looking for extensive coverage, including maternal healthcare and specialist procedures. It often suits people with complex health needs or anyone looking for maximum flexibility and peace of mind.
If you’re planning a family, getting older or living with a chronic condition requiring regular specialist care, this level of cover might be right for you.
What’s covered with Silver cover?
With Silver cover, you’re covered for heart and vascular system, implantation of hearing devices, and plastic and reconstructive surgery. You’re not covered for things like pregnancy and birth or weight-loss surgery.
At RT Health, we have two options for Silver Cover: Silver Plus Standard Hospital cover and Silver Plus Assure Hospital cover, which comes with more inclusions. “Silver Plus Assure covers you for dialysis for chronic kidney failure and insulin pumps, while these aren’t covered under Silver Plus Standard,” explains Patricia.
However, both strike a good balance between cost and coverage. They’re often a good option if you’re generally healthy and not planning to have a baby in the near future. You might already have a young family and need cover for the usual scrapes, breaks and illnesses. Or maybe you’re someone who works with their hands and need cover for injuries or joint issues.
What about Bronze and basic cover?
Bronze and basic cover typically cover the basics. With Basic Plus Starter Hospital cover, you’ll be covered for things like tonsils, adenoids and grommets, joint reconstructions, and treatment for a hernia and appendicitis. RT Health’s Bronze Plus Essential Hospital cover will also cover you for things like diabetes management (excluding insulin pumps), and chemotherapy, radiotherapy and immunotherapy for cancer.
“While Bronze Plus and Basic Plus are lower levels of cover, if you’re just starting, they may be a good option for you,” says Patricia.
If you’re young, healthy and on a tighter budget – or your income has reached the threshold where you’ll be charged the Medicare Levy Surcharge without hospital cover – Bronze Plus Essential or Basic Plus Starter Hospital could be the right option for you.
Extras cover
For comprehensive healthcare and peace of mind, pair your hospital cover with extras. Extras cover pays benefits towards things like prescription glasses, dental-checkups, psychology and/or counselling, health and physio appointments, supporting your day-to-day health and wellbeing.
With RT Health, you can choose between three levels of extras cover – Top, Smart and Value – which you can mix and match with different levels of hospital cover.
When to review your cover
Patricia suggests reviewing your cover regularly and whenever your life is changing. If it's no longer meeting your needs, you might want to consider switching to a different level of cover.
“If you’re thinking of starting a family, it’s a good time to have a look at the options available,” she says. “At the other end of the spectrum, a lot of people as they get older no longer need cover for things like pregnancy, so they may consider changing to our Gold cover.
“Any time you feel private health cover is becoming unaffordable, or if you’re not sure you have the right level of cover, it’s best to give us a call, because there may be options we can offer you,” she adds. Keeping your cover (instead of cancelling it) can also help you avoid paying Lifetime Health Cover (LHC) loading – an extra 2% on top of your hospital premium for every year you go without cover after turning 31.
If you do update your cover, it’s important to keep in mind any waiting periods you may need to serve (12 months for pre-existing conditions and pregnancy and birth, and two months for other services).
“If you’ve already met the waiting period for a particular service, you don’t have to re-serve it,” explains Patricia. “But if you’re on a new cover that covers you for new services, then you’ll have to serve the waiting periods.”
Still have questions?
If you need some advice or want to know more, we’re here with you every step of the way to help you get more value from your cover. Our Member Care team can answer any questions you have. Give them a call on 1300 886 123 or get in touch via email to help@rthealth.com.au
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