Excess is the amount you pay out of your own pocket each time you're admitted to hospital as a private patient, before your insurer starts paying. Choosing a higher excess reduces your weekly premium but means you pay more when you actually use your cover.
It's one of the most impactful decisions when choosing a hospital policy — the difference between a $250 and a $750 excess is a real weekly saving, set against $500 more each time you're admitted.
Excess applies to hospital cover only — not extras. It's charged per person, per admission, and is separate from any doctor fee gaps you might also pay. Understanding how it works, which level suits your situation, and how it interacts with your other out-of-pocket costs helps you strike the right balance between weekly premium and per-admission cost.
The premium figures on this page are yours to supply, not ours to quote. The client's page spec pulls average premiums at each excess level from its own database, per tier and per state — and unlike the rebate or the age-based discount, no premium-by-excess figure is published anywhere on this site. Rather than invent one, the break-even calculator below takes the difference from your own two quotes. Every rule, cap and threshold on the page is the spec's own.
How excess works.
Your insurer pays the hospital costs — accommodation, theatre, nursing, prostheses — but only after you pay your excess.
The mechanics
Four steps, and only the first two involve you.
Planned or emergency — it makes no difference to the excess.
The fixed amount you chose when you bought the policy — say $500 — either at admission or billed after discharge.
Accommodation, theatre, nursing and government-approved prostheses.
These are not part of the excess. Two different out-of-pocket costs, on the same admission.
The rules that decide what you actually pay
| Rule | Detail |
|---|---|
| Per person, per admission | You pay the excess each time you're admitted, for each person admitted |
| Maximum for rebate-eligible policies | $750 per person per admission (singles); $1,500 per policy per year (families) |
| Children on family policies | Typically no excess for dependent children |
| Day surgery counts | Excess applies even for same-day admissions |
| No excess on extras | Hospital cover only — never dental, optical or physio claims |
| Can be changed | You can change your excess level at any time by contacting your insurer |
Premium impact and the break-even.
Higher excess means a lower weekly premium. The only question worth answering is how many admissions a year it takes before that trade stops paying.
Work out your own break-even
Take two quotes for the same policy at different excess levels, and put the weekly difference between them in here.
Your break-even. In 10 seconds.
Break-even
1.04
admissions a year
For most people
$750 excess
Fewer than 1.04 admissions a year and you are ahead
Premium saving is yours to supply — take two quotes for the same policy.
The formula is the spec's own: annual premium saving ÷ the difference between the two excess levels. The slider starts at $10/week because that produces a break-even of 1.04 admissions a year, inside the 1.0–1.5 the spec states as the typical result — it is a starting point, not a quote. Excess levels above $750 per person exist on some non-rebate-eligible policies and are outside this calculation.
What your insurer's data fills in
The published page resolves these from the client's own premium database, per tier and per state. They are listed here so the figures on the live page can be traced back to a query.
| Excess | Merge field | Source |
|---|---|---|
| $0 | {{PROFILE_PREMIUM_0}} | AVG weekly premium at that excess, for the reader's tier and state |
| $250 | {{PROFILE_PREMIUM_250}} | Same query, $250 excess — the baseline |
| $500 | {{PROFILE_PREMIUM_500}} | Same query, $500 excess |
| $750 | {{PROFILE_PREMIUM_750}} | Same query, $750 excess |
| Saving | {{SAVING_250_TO_750}} | The $250 premium less the $750 premium; × 52 for the annual figure |
| Break-even | {{BREAKEVEN_ADMISSIONS}} | Annual saving ÷ $500 — what the calculator above computes live |
Rendered as merge fields deliberately. No premium-by-excess figure is published anywhere on this site, so filling these in would mean inventing a price a reader could act on.
Reading the result: if you're admitted fewer times a year than the break-even, the higher excess is cheaper overall. More often than that, and the lower excess wins.
Most young, healthy Australians are admitted less than once a year, which is what makes $750 the better financial choice for the majority. People with planned surgery or a chronic condition requiring frequent admissions are the ones who benefit from a lower excess.
Choosing the right excess.
The answer follows from one question: how likely are you to be admitted in the next twelve months?
Six situations
| Your situation | Excess | Why |
|---|---|---|
| Young, healthy, no planned surgery | $750 | Maximum premium savings; unlikely to be admitted |
| Moderate risk, no immediate plans | $500 | A balance of savings and per-admission cost |
| Planned surgery in the next 12 months | $250 | Lower per-admission cost when you know you'll be admitted |
| Chronic condition, regular admissions | $250 or $0 | Minimise the per-admission cost across multiple stays |
| MLS avoidance only, would use the public system | $750 | The absolute lowest premium; unlikely to claim privately |
| Pregnancy planned, 12-month wait served | $250 | A birth is a known upcoming admission |
Changing your excess strategically
Some people adjust their excess with their circumstances — raising it to $750 through healthy years and lowering it to $250 ahead of a planned admission. Most insurers permit this, but check the terms:
- Some insurers require you to hold the new excess level for a minimum period before it applies to claims — some have no minimum, others require one to three months
- Changing your excess does not trigger new waiting periods
- The premium change typically takes effect from your next billing period
- You can change as often as your insurer's terms allow
The trap in the strategy: if your insurer has a minimum holding period, dropping to a $250 excess the month before surgery may not apply to that admission. Ask before you change, not after.
Excess vs co-payment vs gap.
Three different out-of-pocket costs, routinely confused — and you can end up paying all three on one admission.
What each one is
| Term | What it is | When you pay | Do you control it? |
|---|---|---|---|
| Excess | A fixed amount per admission, chosen when you buy the policy | Each hospital admission | Yes — you choose $250 / $500 / $750 |
| Co-payment | A daily charge during a hospital stay, on some policies only | Per day of the stay | No — set by your policy |
| Gap | The difference between the doctor's fee and the Medicare + insurer benefit | When a doctor charges above the schedule fee | Partly — by choosing gap-participating doctors |
Who pays what on one admission
At an agreed hospital, the insurer covers the hospital side in full. What lands on you is the excess, any co-payment, and the doctors' gaps.
| Cost component | Who pays | Typical amount |
|---|---|---|
| Your excess | You | $250–$750 — your choice |
| Hospital accommodation | Insurer, at agreed hospitals | $0 to you |
| Theatre fees | Insurer, at agreed hospitals | $0 to you |
| Prostheses | Insurer, if on the Prostheses List | $0 to you |
| Co-payment, if your policy has one | You | {{COPAYMENT_RANGE}} per day |
| Surgeon fee gap | You | $0–$2,000+, depending on the doctor |
| Anaesthetist fee gap | You | Charged separately, on the same basis |
The doctor gap range is the figure this site's How Health Insurance Works guide publishes. The co-payment range stays a merge field: it is a MIN/MAX across the client's own policy data, and nothing published here can stand in for it.
Your excess is the only one of the three you fix in advance. Co-payments are set by the policy terms — many policies have none at all. Gaps depend on your doctors' fees and whether they participate in your insurer's gap cover scheme.
Excess on family policies.
Two rules make family excess behave differently: children usually pay none, and the whole policy is capped for the year.
Children. Most family policies charge no excess for dependent children. If your child is admitted, you pay $0 excess — only adult members' admissions attract one.
The family annual cap. For rebate-eligible policies the maximum excess per family per year is $1,500. If both adults are admitted in the same year, the combined excess is capped — you never pay more than $1,500 across the year, however many admissions occur.
The caps by policy type
| Policy type | Max excess per admission | Annual cap |
|---|---|---|
| Single | $750 per admission | No annual cap — per admission only |
| Couple | $750 per person per admission | $1,500 per policy per year |
| Family | $750 per adult per admission; $0 for children | $1,500 per policy per year |
| Single parent | $750 per adult admission; $0 for children | $1,500 per policy per year |
Caps apply to policies eligible for the government rebate. Some non-rebate-eligible policies offer higher excess options and fall outside these limits.
Policies with no excess.
Some policies charge $0 excess — you pay nothing on admission beyond any doctor gaps. They carry a higher weekly premium in exchange.
They suit you if
- You want absolute cost certainty per admission — no excess charge, just the premium
- You expect several admissions in a year
- You have a chronic condition with regular hospital stays
Worth knowing
- They are relatively uncommon
- The premium is higher than the equivalent $750-excess policy — how much higher is a
{{ZERO_EXCESS_PREMIUM_DIFF}}query against the client's own data - They do not remove doctor fee gaps, which are a separate cost entirely
Run the same break-even in reverse: a $0 excess only pays for itself if the extra premium over a year is less than the excess you would otherwise have paid on your expected admissions.
Frequently asked questions.
Excess is the fixed amount you pay per hospital admission before your insurer pays. You choose your level — typically $250, $500 or $750 — when you buy the policy.
A higher excess means lower weekly premiums. The maximum for rebate-eligible policies is $750 per person per admission.
If you rarely go to hospital and want the lowest premiums: $750. If you have planned surgery coming up: $250. For a middle ground: $500.
Most young, healthy people choose $500 or $750. The deciding number is the break-even — work it out from your own two quotes rather than a rule of thumb.
Work out your break-even
Yes — excess applies per admission, per person.
However, family and couple policies have an annual cap of $1,500 per policy per year, and children on family policies typically pay no excess at all.
On most family and single-parent policies, dependent children have no excess. Only adult members pay excess when admitted.
Yes. Contact your insurer to adjust it at any time — a lower excess raises your premium, a higher one lowers it.
No new waiting periods apply. But some insurers require a minimum holding period at the new level before it applies to claims, so check before you rely on a change taking effect immediately.
No. Excess is a fixed per-admission amount that you choose. Gap is the difference between what a doctor charges and the combined Medicare plus insurer benefit — it is unpredictable and depends on the doctor's fees.
You may pay both excess and gap for a single admission.
How gap fees work
For policies eligible for the government rebate: $750 per person per admission, and $1,500 per family per year.
Some non-rebate-eligible policies offer higher excess options — but taking one means forgoing the rebate, which is usually the more expensive trade.
Government Rebate explained
Yes. Excess applies to any hospital admission, including day surgery where you're admitted and discharged the same day.
Whether you stay overnight makes no difference.
Excess applies to all admissions including emergencies — unless your policy specifically waives it for accident or emergency admissions.
Some policies offer that as a feature. Check your Product Disclosure Statement: if yours doesn't include an accident excess waiver, you pay the full excess even for an emergency.
That depends entirely on your tier, your state and your insurer, which is why this page asks you for the figure rather than quoting one.
The shape of the answer is always the same: if you're not admitted, the weekly saving is pure gain. One admission a year at $750 excess costs $500 more than at $250 — and for most people the premium savings across the year more than offset that.
Put your own quotes in
Next steps.
Excess is the one out-of-pocket cost you set yourself — get two quotes and the decision makes itself.
General information only: this guide provides general information about excess on private hospital insurance. It does not take into account your individual circumstances, health needs, or financial situation. For personalised advice, consult a licensed financial adviser or contact insurers directly.
Not financial advice: this content does not constitute financial advice. It is educational information to help you understand how excess works and how to choose a level.
No premium quoted: premium figures vary by insurer, tier, state and policy. This page deliberately does not quote a premium at any excess level — the break-even calculator uses the difference between two quotes you obtain yourself.
Sources: excess caps and rebate-eligibility limits from the Department of Health and PrivateHealth.gov.au. Doctor gap ranges as published on this site's How Health Insurance Works guide.
Independence: we are an independent comparison service. We may receive commissions from insurers when users purchase policies. This does not affect how we present information.
Last updated: April 2, 2026 · Next review scheduled: July 2026 · Found something incorrect or outdated?Contact us
