Are you getting the most out of your cover? Questions to ask

Two people moving house


Published: July 2026
Words by: Angela Tufvesson

Regularly reviewing your private health cover can help you make sure it’s meeting your needs and giving you value for money.

Private health cover is one of those things many people sign up for and then forget about. But as your life changes, so do your needs – and your cover should keep up.

In Australia, there are four private health insurance tiers: Gold, Silver, Bronze and Basic. It's a good idea to review your health cover every now and then to make sure it still suits your needs, especially if your family, work or health situation has changed. Reviewing (and, if necessary) changing health insurance tiers at the right time can help you get more value.

Here are some questions to ask to help you work out whether your current policy is still the right fit for you.

Has your household situation changed?

Perhaps you’re newly single, moving in with a partner or you’ve recently separated and are co-parenting. Your young adult children might have moved back home or maybe you’ve become part of a blended family. Whatever the change in your household, it’s a good time to take a look at your health cover.

If you and your partner are on separate policies, you may want to consider taking out couples cover. The benefits of this include less admin (as there’s one less policy to manage) and a simpler tax return process. If either of you has Lifetime Health Cover loading (LHC), it gets averaged between you both. However, if the two of you have different healthcare needs, sticking to two singles policies could be a better option.

If you or your partner has kids, family cover might be a good choice. With RT Health, adult dependants who are studying full-time up to the age of 30 and are dependent on you for maintenance and support can stay covered under their parents’ policy for free. Working kids up to the age of 30, who are not married or in a de facto relationship and are dependent on you for maintenance and support can remain covered for an additional premium (less than the amount they’d pay for an equivalent single person cover), until the age of 31.

Are you approaching a major life milestone?

Starting a family is an exciting time and it’s helpful to plan ahead to avoid any unnecessary out-of-pocket expenses. To be covered for pregnancy and birth, you’ll generally need to have Gold cover. And because there’s a 12-month waiting period, you’ll  need to have it for at least three months before you become pregnant.

If you’ve recently changed jobs or been promoted, your salary may have increased, and you may need to pay the Medicare Levy Surcharge (an extra fee at tax time) if you don’t have an appropriate level of private hospital cover. It’s usually cheaper to take out basic hospital cover than to pay the Medicare Levy Surcharge, which, if applicable to you, is based on the percentage of days in the financial year you do not hold eligible hospital cover.

When did you last use your cover – and what for?

It’s worth taking a moment to think about the last time you used your private health cover. Was it for a dental check-up, new glasses, a physio appointment or a hospital stay?

Looking back at your claims history can help you work out whether your current policy still matches your needs. You might realise you’re not taking advantage of benefits you’re paying for or that your current policy no longer reflects the services you need the most. Reviewing how often you claim and which services you actually use can help you decide whether it’s time to make changes to your private health insurance.

Has your health status changed?

If you (or someone included in your policy) has a health condition,  cover that meets your needs can help with out-of-pocket costs, give you more choice of hospitals and doctors, and get you treated sooner. But a policy that worked for you in the past might not suit your needs now. If your health needs have changed, it might be time to upgrade – just keep in mind that some treatments carry a 12-month waiting period.

You also don’t need to wait until you’re sick to use your health cover. Some of our programs may be able to help you prevent or manage any health concerns before they start to impact your everyday life. For example, if type 2 diabetes is a concern, exercise and weight management programs can be a great way to stay on top of your health. Eligible RT Health members have access to 12 weeks of free access to the CSIRO Total Wellbeing Diet*, exercise physios via their extras cover and they may even be able to claim a benefit for their gym membership.

Reviewing your cover

Your health needs, finances and lifestyle can change over time, so it’s a good idea to review your health insurance regularly to make sure you’re getting good value – ideally once a year or after a major life event. The first step is to check out your Cover Guide or visit online member services. 

Before deciding on any cover, make sure to review the full terms and speak with us to discuss your specific needs.

Still have questions?

For help and more advice on reviewing your private health insurance, our Member Care team are here to help you get more value from your cover. Give them a call on 1300 886 123 or get in touch via email at help@rthealth.com.au



* This offer is available to RT Health members with hospital cover, who also:

  • are aged 18 or over
  • have a Body Mass Index of 28 or above
  • have multiple lifestyle risk factors like smoking, physical inactivity and poor nutrition.

As you get older and consider semi- or full retirement, services like dental, optical and hearing become more important. These services are not always fully covered by Medicare and can come with out-of-pocket costs. Having extras cover can save you money on your check-ups and give you peace of mind in case you need additional treatments.



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