“Private Health Coverage for GP Care: A Future Without Plans”

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Appeals for the Federal Government to abolish a prohibition on private health insurers subsidizing GP consultations have been quashed by the Health and Aged Care Minister.

 

The appeals were prompted by the release of the 2025 Cleanbill survey on Monday, revealing that patients are encountering rising out-of-pocket expenses and diminishing bulk-billing rates when visiting their GP.

 

At present, under Australian legislation, private health insurance is not permitted to provide coverage for out-of-hospital medical services, including GP visits, as these can be covered by Medicare.

 

This development occurs at a moment when the number of Australians enrolling in private health insurance continues to increase.

 

As of September 30, 2024, 54.7% of the population had some form of general treatment insurance, marking a 2.3% rise in just one year.

 

Matthew Koce, Chief Executive of Members Health, the organization representing not-for-profit health funds, stated that an immediate termination of the ban is essential to assist with GP expenses, describing it as ‘long overdue’.

 

‘GPs are the foundation of the healthcare system. They are essential to maintaining good population health. Delaying a visit to the GP due to costly out-of-pocket fees can lead to very serious repercussions,’ he remarked.

 

‘It is illogical that health insurance schemes can assist with the costs of dental, optical, and physiotherapy appointments, but not for something as critical as a GP visit.

 

‘Allowing this would make GP visits more accessible for a larger number of Australians, improve health outcomes, and help alleviate escalating cost-of-living pressures.’

 

However, Federal Health and Aged Care Minister Mark Butler stated, ‘we currently have no intentions’ to lift the restriction on insurers covering GP appointments.

‘Australia has maintained a long-standing policy against creating the potential for a dual-tier system in fundamental general practice and access to essential primary care,’ he explained.

 

‘This has been a crucial component of the Medicare principles that have provided a high-quality healthcare system ranked among the best globally.

 

‘Such a change would represent a significant shift in how Medicare functions.’

 

Last year, Bupa, a private health insurer, commenced offering over two million of its customers complimentary telehealth consultations annually through its digital health platform, Blua, branding it a ‘cost-of-living health initiative’.

 

However, this was only achievable because while Medicare benefits apply to video and phone telehealth services provided by GPs, telehealth services can solely be utilized for patients with whom they have an existing relationship, or who have attended the practice for a face-to-face service within the last year.

 

‘I also recognize that some of our major private health insurers are undertaking innovative efforts to enhance access to not only primary healthcare but also preventive care for their members,’ Minister Butler stated.

 

‘I encourage them to persist in these efforts.’

 

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