About

Tiers and Gaps is an independent information site about private health insurance in Australia and how it works alongside Medicare. It is for people deciding whether to take out hospital or extras cover, comparing policies, wondering about the Medicare Levy Surcharge or Lifetime Health Cover loading, or trying to understand a gap fee.

The guides explain the rules set by the Australian Government under the Private Health Insurance Act 2007 and the tax rules administered by the ATO, using worked examples with the arithmetic shown. Income thresholds and rebate percentages come from privatehealth.gov.au; premiums, excesses and fees in examples are illustrative figures, not quotes from any insurer.

We do not sell insurance, rank insurers or receive commissions on policies, and nothing here is personal financial, tax or medical advice. For decisions about your own cover, read the Private Health Information Statement, ask the insurer to confirm in writing and consider speaking to a registered tax agent or financial adviser. For any health concern, see your GP or call healthdirect on 1800 022 222; in an emergency call 000.

Rules change, particularly on 1 April and 1 July each year. If you spot something out of date, please tell us through the contact page.

How this site is made

Tiers and Gaps is an independent information project. Guides are drafted with the help of AI writing tools and checked against official and primary sources before publication; see our Editorial Policy. We are not affiliated with any provider mentioned on the site and do not sell products or services.