Insurance brokers and advisers are coming under increased focus in the private health insurance market, as new figures show Australians who stay with the same insurer for a decade or more are paying significantly more than those who have switched policies in recent years.
Survey data from comparison site Compare the Market indicates a clear cost gap between long‑tenure and newer policyholders, raising questions about how often long‑standing customers are prompted to review their cover. Australians who have held private health cover with the same insurer for at least 10 years are paying an average premium of $306.88 per month, according to the research. Those who took out a new policy about a year ago are paying an average of $237.84 per month.
The difference of $69.04 a month equates to an additional $828.48 per year for long‑tenure customers compared with recent switchers. On a percentage basis, the analysis suggests long‑standing policyholders are paying about 29% more than newer customers for their private health insurance. Across all policyholders, average spending on private health insurance comes to $255.67 per month, or about $3,068 annually. For brokers and advisers, the figures point to the impact of infrequent policy reviews and the way older products and benefit structures can drift away from current market pricing and customer needs.
David Koch, economic director at Compare the Market, said the research suggests many policyholders assume that remaining with a single insurer will deliver better results over time. “Australians who stick with the same insurer may think they’re being rewarded, but when premiums increase year-on-year, that’s often not the case. Your insurer isn’t going to tell you if you’re shelling out more than you need to. It’s up to you to take control and look for better value,” Koch said, as reported by 9News.
Koch also highlighted the persistence of outdated benefits on some long‑term policies. “The number of people I speak to who have cover for pregnancy when they’re well into their 50s and 60s is outrageous – I was one of them until my wife pointed it out,” he said. For intermediaries managing long‑standing portfolios, such examples are prompting closer attention to whether inclusions still match a customer’s life stage and claims profile, and whether alternative products or providers would deliver similar coverage at lower cost. The findings also reinforce the role of annual or periodic check‑ins with clients, particularly those on legacy or closed products that may not align with current pricing structures.
The pricing gap between loyal and recent customers is emerging ahead of premium increases scheduled from April 1, with 2026 expected to bring the largest average adjustment in close to a decade. Compare the Market’s analysis of policies sold via its platform between January and November 2025 suggests premium rises in the range of about 4% to 5% would affect major product categories across the market. For a hospital‑only policy with an average annual premium of $2,641, a 4% to 5% increase would add approximately $105.60 to $132 per year. For combined hospital and extras cover with an average annual premium of $3,560, the same range of increases would translate into an additional $142 to $178 a year.
Extras‑only cover, with an average annual premium of $830, would rise by around $33.20 to $41.50 under similar percentage changes. These projections factor in government rebates, age‑based discounts, and lifetime health cover loadings. Separate estimates for combined hospital and extras policies indicate that singles could pay roughly $127 to $144 more per year under a 3.9% to 4.4% rise, while families would see annual costs lift by about $191 to $216. For the intermediary market, the combination of a documented loyalty gap and broad‑based premium increases is expected to bring more enquiries from clients seeking to control out‑of‑pocket costs while maintaining access to preferred hospitals, specialists, and ancillary services.
At the same time, the federal government is progressing reforms aimed at increasing price transparency around specialist medical fees and tightening oversight of private health insurance product changes. The Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026, introduced by the Albanese government, is intended to revise the Medical Costs Finder website and address concerns about the practice known as “product phoenixing.”
The Medical Costs Finder, developed under the Morrison government at a cost of $24 million, was designed to use Medicare data to show indicative costs for common services and to display fees supplied voluntarily by individual specialists. Specialist participation has remained low. By the end of 2022, only six of about 6,300 eligible specialists across 11 specialties had chosen to publish their fees. Three years later, that figure had increased to around 88 doctors.
Under the proposed amendments, the government would be able to use Medicare, hospital, and insurer billing data it already holds to publish information about what individual specialists charge for particular services on the Medical Costs Finder. Patients would be able to compare typical charges and likely out‑of‑pocket costs across practitioners, which may influence decisions on whether to proceed with referrals under private cover or seek alternatives.
Health Minister Mark Butler said the legislation responds to cost concerns that are affecting patient behaviour. “Specialists and private health funds have been given the opportunity to be upfront about patient costs and out of pocket expenses but frankly, have failed to do so. We know an increasing number of Australians are not taking up referrals from their GP to see a specialist due to concern about cost, but this legislation will give hard working Australians the clarity they deserve about costs and more choice in their health care,” Butler said.
The bill would also increase regulatory oversight of product changes in the private health sector. It would prohibit “product phoenixing,” in which an insurer closes an existing policy and introduces an identical or near‑identical product at a higher premium or with reduced benefits. Under the reforms, insurers would need ministerial approval for premiums on new products and for certain changes that reduce the cover or value of existing policies. Butler said the bill “legislates wider scrutiny of premiums so consumers can be more confident in the value of private health insurance.”
For insurers, the proposed framework would place additional approval steps into product development and repricing processes. For brokers and advisers, the changes are expected to add further context to discussions with clients about why policies change over time and how new products compare with existing cover. Combined with evidence of higher costs for long‑term policyholders, the reforms are likely to reinforce the focus on documenting advice, comparing alternatives at renewal, and monitoring legacy products that may contribute to the premium differentials now being observed in the Australian private health insurance market.
