Millions of Australians are heading into the April 1 premium round facing much steeper private health insurance increases than the headline government figure suggests, with CHOICE analysis showing some policies will jump by as much as 25%.
According to an ABC News report on new CHOICE research, the sharpest increases are hitting gold-tier hospital cover, with HCF’s Hospital Optimal Gold policy facing a 25% rise. Across the big five funds analysed by CHOICE, gold-level policies were found to be rising by an average 13.3%, well above the broader industry benchmark.
Last month, the Albanese government approved the 2026 private health insurance premium round, signing off on an industry-weighted average increase of 4.41%. The increase is an average across insurers and product groups, not a cap on every policy, which is why some individual policies look set to rise by much more.
CHOICE’s analysis covered five major funds — Bupa, HCF, HBF, Medibank and NIB — and found a stark divergence between top-end and lower-tier products. Gold policyholders were the clear losers, with CHOICE reporting average increases of 25% for HCF, 12% for Bupa, 11.65% for NIB’s Qantas cover, 9.93% for Medibank and 7.89% for HBF.
By contrast, customers on basic, bronze or silver cover were found to be facing much smaller average rises, ranging from 2.6% to 3.3%, while some basic policies may not move at all.
ABC reported CHOICE found the cost of gold cover has climbed more than 70% over the past five years, while the number of Australians holding gold-tier hospital cover has fallen by more than 20% in just under six years.
The industry’s defence is that gold products are carrying the heaviest claims burden. Private Healthcare Australia, which represents the major funds, told ABC that gold cover now functions as a catch-all for many of the most expensive and complex treatments, often used by a relatively small group of members who are more likely to claim.
PHA chief executive Rachel David said the higher increases reflected rising health inflation, an ageing population and the growing cost of delivering care. In the industry’s view, entry-level policies remain essential to maintaining participation, while gold products are becoming less sustainable in their current form.
That puts pressure on the policy architecture as much as on premium settings. PHA has called for a review of the gold, silver and bronze tier system, arguing insurers need more flexibility to design products better matched to different health needs.
