| Medibank | |
|---|---|
| Registered insurer | Medibank Private Limited |
| Who can join | Open to anyone |
| Business structure | Shareholder-owned company, for-profit |
| Hospital policies (30 June 2025) | 1,532,670 (25.0% of all hospital policies), covering 3,032,305 people. Figure is for Medibank Private Limited, which includes ahm |
| Hospital tiers on sale (1 September 2026) | Gold, Silver Plus, Silver, Bronze Plus, Basic Plus, Basic |
| Excess options on open hospital policies | $250, $500, $750 |
| Age-based discount (18-29) | Offered on some of its open hospital policies |
| Ambulance | Emergency ambulance on most of its open hospital policies |
| Question | What the official data shows |
|---|---|
| Out-of-pocket costs in hospital | 81.8% of in-hospital medical services had no gap for the member (industry 87.1%), and 89.6% of hospital charges were covered (industry 89.0%), 2024-25 |
| Waiting periods and pre-existing conditions | The legal maximums apply: 12 months for a pre-existing condition (signs or symptoms in the 6 months before you joined or upgraded) and for pregnancy and birth, 2 months for other hospital treatment. Every hospital policy open to new members in the Government's data at 1 October 2026, at every fund, used the 12-month pre-existing wait |
| Switching from another fund | Waits you've already served on the same or a lower level of cover carry across to Medibank, and from it. Ask your old fund for a clearance certificate and keep the break between policies short |
| The Medicare Levy Surcharge | Excess options on its open hospital policies go up to $750, so all are within the $750 singles limit, and every policy was flagged as meeting the surcharge rules in the Government's data at 1 October 2026 |
| Adult children (dependants) | Up to age 30, studying or not, in the fund's own record (Government data, 1 October 2026). Adult dependants often need an extended family option |
| Claims experience | 23.9% of Ombudsman complaints about insurers on a 26.5% market share (ratio 0.90), and 17.3% of the complaints the Ombudsman investigated, 2024-25 |
General advice only. This information doesn't take into account your objectives, financial situation or needs. Consider whether the product is right for you and read the Product Disclosure Statement (PDS) and Target Market Determination (TMD) before you decide. We don't compare every product in the market, and we may earn a commission if you take up a product through our links.
Medibank and ahm: one insurer, two brands
Medibank and ahm are listed separately on PrivateHealth.gov.au, but ahm is owned by Medibank and reported within Medibank Private Limited. The two brands sell different products at different price points; the Ombudsman and APRA figures cover both. If you're comparing them, compare the policies, not the fund-level data. Our separate ahm review covers what ahm sells.
Medibank is an open fund with no membership restrictions and operates in every state and territory. Its PrivateHealth.gov.au record lists overseas visitors, overseas student and corporate products as well as its retail range.
Complaints: fewer than its size suggests
Medibank and ahm together accounted for 23.9% of Ombudsman complaints about insurers in 2024-25, below their 26.5% market share. Their share of investigated complaints was 17.3%, again below their market share. Member retention was 85.4%, just above the industry's 85.0%.
Benefits and costs: the lowest expense ratio of the large funds
Medibank returned 85.6% of premium income as benefits in 2024-25, above the industry's 84.5%, and its management expenses were 7.6% of contribution income, well under the industry's 10.9%. Scale helps here: running costs spread over 1.5 million hospital policies weigh less on each one.
The weaker number is gaps. 81.8% of in-hospital medical services had no gap for Medibank members, against 87.1% across the industry, and 96.2% had no gap or a known gap (industry 97.1%). In other words, Medibank members were more likely than average to face an out-of-pocket medical bill after a hospital stay. Hospital charges covered were 89.6%, slightly above the industry result.
What Medibank sells
Medibank's open hospital policies at 1 September 2026 span Gold, Silver Plus, Silver, Bronze Plus, Basic Plus and Basic, with excess options of $250, $500 and $750. Some, but not all, of its open hospital policies were listed with the age-based discount. Emergency ambulance is included on almost all of them.
Medibank also markets its Members' Choice provider network for extras; that is the fund's own description, and network rules differ by service.
Medibank against the industry: 2024-25 data
Every year the Private Health Insurance Ombudsman compares all insurers on the same measures, and PrivateHealth.gov.au republishes the results on each insurer's profile. The table below is Medibank's (reported at the level of the registered insurer), with the industry result beside each figure. Its complaints-to-market-share ratio was 0.90: a figure of 1.00 means complaints exactly in proportion to size.
| Measure | Medibank | Industry | Reading |
|---|---|---|---|
| Share of all Ombudsman complaints | 23.9% | Market share 26.5% | In proportion to its size |
| Share of investigated complaints | 17.3% | Market share 26.5% | |
| Member retention (hospital cover) | 85.4% | 85.0% | In line with industry |
| Benefits paid as % of premiums | 85.6% | 84.5% | Better than industry |
| Management expenses % of premium income | 7.6% | 10.9% | Better than industry |
| Hospital charges covered | 89.6% | 89.0% | Better than industry |
| Medical services with no gap | 81.8% | 87.1% | Weaker than industry |
| Medical services with no gap or a known gap | 96.2% | 97.1% | Weaker than industry |
| Extras (general treatment) charges covered | 51.3% | 50.7% | Better than industry |
Medibank vs Bupa: the official data side by side
Here are both insurers' 2024-25 figures on every measure the Ombudsman publishes, with the industry result beside them. In 2024-25, Medibank (incl. ahm) had the stronger figure on complaints relative to size, benefits paid as a share of premiums, management expenses and hospital charges covered; Bupa on member retention and the no-gap rate. They were level on extras charges covered. Neither set of figures is a price, and the right policy depends on what it covers.
| Measure | Medibank (incl. ahm) | Bupa | Industry |
|---|---|---|---|
| Share of all Ombudsman complaints | 23.9% | 25.2% | - |
| Market share | 26.5% | 25.5% | - |
| Complaints ÷ market share (1.00 = in proportion) | 0.90 | 0.99 | 1.00 |
| Share of investigated complaints | 17.3% | 16.4% | - |
| Member retention (hospital cover) | 85.4% | 86.1% | 85.0% |
| Benefits paid as % of premiums | 85.6% | 82.4% | 84.5% |
| Management expenses % of premium income | 7.6% | 11.3% | 10.9% |
| Hospital charges covered | 89.6% | 89.0% | 89.0% |
| In-hospital medical services with no gap | 81.8% | 90.2% | 87.1% |
| Medical services with no gap or a known gap | 96.2% | 97.8% | 97.1% |
| Extras charges covered | 51.3% | 51.3% | 50.7% |
| Private hospital agreements, all states | 252 | 273 | - |
| Day hospital agreements, all states | 225 | 273 | - |
| Hospital policies (30 June 2025) | 1,532,670 | 1,498,193 | 6,125,068 |
Read our Bupa review, or see the five largest health funds side by side.
How to read it: complaint share is the fairest single comparison of service across funds of different sizes, because it's measured against market share. Benefits as a % of premiums shows how much of the premium pool went back to members as claims; a mutual that returns more is not necessarily cheaper, and a fund can move this figure by changing prices. The gap measures show how often members avoided an out-of-pocket medical bill after a hospital stay, which is what most people mean by "good cover".
Hospital agreements
| ACT | NSW | VIC | QLD | SA | WA | TAS | NT | |
|---|---|---|---|---|---|---|---|---|
| Private hospitals | 5 | 86 | 64 | 52 | 17 | 21 | 6 | 1 |
| Most held by any insurer | 7 | 95 | 73 | 63 | 17 | 23 | 7 | 1 |
| Day hospitals | 7 | 81 | 42 | 44 | 21 | 20 | 9 | 1 |
| Most held by any insurer | 11 | 109 | 73 | 58 | 35 | 28 | 12 | 2 |
What to check before you join Medibank
- The no-gap rate (81.8%) was below the industry's 87.1% in 2024-25. Ask your surgeon and anaesthetist whether they use Medibank's gap scheme before you're admitted.
- Medibank and ahm policies are different products even though the fund-level data is shared.
- Corporate policies can differ from retail ones. If your employer offers Medibank cover, compare its clinical categories with a retail policy.
- Over 31 and joining for the first time? Work out your Lifetime Health Cover loading first, and if you earn over the threshold, check the Medicare Levy Surcharge you'd avoid.
Common questions about Medibank
Is Medibank the biggest health insurer in Australia?
By hospital policies, yes. APRA's figures show Medibank Private Limited (including ahm) held 1,532,670 hospital policies at 30 June 2025, slightly more than Bupa's 1,498,193. Bupa covered slightly more people.
Is Medibank for-profit?
Yes. PrivateHealth.gov.au describes Medibank Private Limited as a shareholder-owned company that operates on a for-profit basis.
Are Medibank and ahm the same company?
ahm is owned by Medibank and reported as part of Medibank Private Limited, so they share one set of Ombudsman and APRA figures. They sell different policies.
What are the three largest health insurers?
By market share in 2024-25: Medibank (including ahm) with 26.5%, Bupa with 25.5% and HCF (including RT Health) with 12.8%, the figures the Ombudsman uses and PrivateHealth.gov.au publishes. By hospital policies at 30 June 2025 the order is the same: Medibank 1,532,670, Bupa 1,498,193 and HCF 842,024 (APRA). Size isn't a measure of value; our five largest health funds table sets them side by side.
What is the cheapest way to get private health insurance?
Buy only the cover you need: the lowest hospital tier that covers the treatments you care about, a higher excess if you could pay it, and extras only if you'd claim more than they cost. Then use what the rules allow: the under-30 age-based discount where a policy offers it, and paying in advance before the 1 April premium change where your fund lets you. Our guide to paying less for health insurance goes through each one. We don't quote premiums, which change every 1 April.
What are the downsides of private health insurance?
Premiums rise most years from 1 April, waiting periods apply before you can claim, an excess and doctors' fees above the Medicare schedule can leave out-of-pocket costs, and extras limits cap what you get back. Gaps vary by fund: in 2024-25, 81.8% of in-hospital medical services for Medibank members had no gap, against 87.1% across the industry. Ask your specialist about gap arrangements before a planned admission.
Other fund reviews
See every registered health insurer compared on complaints and benefits, or read how the private health insurance rebate and hospital cover tiers work.
General advice only. It doesn't consider your circumstances. Read the PDS and TMD before you decide.
This review is general information based on published government and regulator data. We don't rate or rank funds, and it doesn't consider your circumstances. Check a policy's Private Health Information Statement before you buy.