Medibank private health insurance: what it costs, what the government data shows

Medibank Private Limited is the largest private health insurer in Australia. PrivateHealth.gov.au describes it as a shareholder owned company operating on a for profit basis, and it operates in all states and territories. This page sets out what it charges in 2026-27, what the government’s own published figures say about how it performs, and the one thing its tier names will not tell you.

Plain Cover does not score or rank funds. The Plain Cover methodology does not yet set scoring weights, so no rating appears here. What follows is the published record, with the source next to each number.

What Medibank cover costs in 2026-27

Medibank announced an average premium change of 5.10% effective 1 April 2026, stating the effect as $2.14 a week for a single policy and $4.46 a week for a family policy. The Department of Health, Disability and Ageing approved an industry average change of 4.41% for the same date, announced on 17 February 2026. Medibank therefore rose by more than the industry average in 2026.

A percentage is hard to weigh, so the table below converts each fund’s approved 2026 change into dollars a year on the same A$2,400 a year policy. The policy is a stated example, not a Medibank quote: your own premium depends on the tier, the excess, your state and your rebate tier.

Each percentage is the fund’s own announced figure, published between 16 and 18 February 2026, and each is linked in the sources below. Dollar figures are Plain Cover arithmetic on the stated A$2,400 example. Last verified 19 September 2026.

How Medibank performs on the government’s own figures

PrivateHealth.gov.au, the Australian Government’s comparison site, publishes four performance figures for every insurer. Medibank’s are below, each against the industry figure the same site gives.

Medibank sits above the industry figure on three of the four, and draws a smaller share of complaints than its share of the market. PrivateHealth.gov.au does not state the period these figures cover. Read 19 September 2026.

The Commonwealth Ombudsman’s State of the Health Funds Report 2023-24, published in March 2025, is dated and puts Medibank at 17.9% of all complaints on a 26.7% market share. The two sources cover different periods, which is why the numbers differ.

Why “top cover” does not mean everything is covered

This is the mistake that costs Medibank members the most, and it is not specific to Medibank. A policy’s marketing name is not a regulated term. What is regulated is the tier: Basic, Bronze, Silver or Gold, and the Plus variants. Each tier is defined by the clinical categories it must cover, set by the Australian Government, and a fund cannot sell a Silver policy that leaves out a Silver category.

What a fund can do is give a Silver policy a confident name. A member on a policy called “top” hospital cover can still find a procedure sits in a Gold-only clinical category, and the shortfall is discovered at the point of admission rather than at the point of purchase.

The check that works is to read the Private Health Information Statement for the exact policy and look at the clinical category list, not the policy’s name. Every fund must give you one. The tier, not the name, is what determines what must be paid. Gold, Silver, Bronze and Basic compared sets out what each tier has to cover.

The privacy proceeding, and where it stands

On 5 June 2024 the Office of the Australian Information Commissioner began civil penalty proceedings in the Federal Court against Medibank Private Limited. The Commissioner alleges Medibank seriously interfered with the privacy of 9.7 million Australians by failing to take reasonable steps to protect their personal information, in breach of Australian Privacy Principle 11.1 under the Privacy Act 1988. The alleged period runs from March 2021 to October 2022. The OAIC names ahm as the subsidiary also affected.

The maximum penalty is A$2,220,000 for each contravention. No finding has been made and the matter is still before the court. The OAIC’s own words are that whether a civil penalty order is made, and the amount, are matters for the court.

That is the whole of the public position as at 19 September 2026. An allegation is not a finding, and this page does not treat it as one.

What you actually pay after the rebate

The Australian Government Rebate is set by income, not by fund, so it is identical whichever of these seven you hold. From 1 April 2026 a single under 65 earning A$105,000 or less gets 24.118% back. On the A$2,400 example that is A$578.83, leaving A$1,821.17. It does not apply to any Lifetime Health Cover loading.

The Medicare Levy Surcharge works the same way: 1% above A$105,000 for a single in 2026-27, rising to 1.25% and 1.5%. In 2025-26 those thresholds were A$101,000, A$118,000 and A$158,000. The Medicare Levy Surcharge in 2026-27 has the full table, and the rebate guide has every age band.

Does Medibank cover ambulance?

Yes, and without a cap. Medibank states: “No matter which Hospital or Extras policy you choose, you’ll have the peace of mind that comes from knowing that your cover includes unlimited emergency ambulance Australia-wide.”

That is a real difference rather than a marketing line. Bupa’s own pages give the cap as one trip a year for a single and two for a couple or family, while also describing the cover as uncapped elsewhere. Medibank states no trip cap and no dollar cap, on every policy it sells.

Air ambulance is covered with pre-approval, in Medibank’s words “Transport by air ambulance where pre-approval is obtained from Medibank”, while fully subsidised air ambulance services are excluded. Non-emergency transport is excluded, described as “Where immediate professional attention is not required e.g. general patient transportation”. The waiting period is 1 day.

Queensland and Tasmania residents do not need it. Medibank states both have state schemes providing ambulance services for their residents. Read 20 September 2026.

What Members’ Choice changes about what you pay

Members’ Choice is Medibank’s own provider network, and the cost difference is published rather than implied. Medibank’s worked example on the same service is A$19 out of pocket at a Members’ Choice provider against A$44 at a non-Members’ Choice provider, a gap of A$25 on one visit.

The mechanism is two-part: “Capped prices so there are no surprises in your bill”, and a percentage back that Medibank states “could be 55%, 60%, 70%, 75%, 90% or 100% depending on your cover”. A second tier, Members’ Choice Advantage, carries 100% back on up to two dental check-ups every year, including x-rays, after a two month waiting period.

The practical consequence is the same as at every large fund: the same treatment costs a member two different amounts depending only on who performs it. Check the provider before booking.

Extras waiting periods run 2 months for general dental, remedial massage and physiotherapy, 6 months for optical, 12 months for major dental and orthodontics, 24 months for blood glucose and blood pressure monitors, and 36 months for hearing aids.

How to claim with Medibank, and the figure it does not publish

Medibank members claim through the My Medibank online account, the My Medibank app, in store, by post, or on the spot at a provider using the membership card. An Android digital membership card is available.

Medibank publishes no processing time. Its claims pages set out the methods and the receipt requirements, including that a receipt must be “dated within the last two years”, but give no figure in days for how long a claim takes to pay.

That is a gap worth naming, because two of the other funds do publish one. HCF states claims are “usually processed and paid within 7 working days”, and HBF states seven business days for extras, ten for hospital, and payment within two more. Bupa states five business days. Read 20 September 2026.

Who tends to weigh up Medibank, and against what

People in this situation typically weigh up scale against price. Medibank is the largest insurer, covers all states and territories, and returns a higher share of contributions as benefits than the industry figure. Against that, it raised premiums by more than the industry average in 2026, and it is a for profit insurer, so a surplus can go to shareholders rather than back into benefits.

The comparison people most often make is with the two large not-for-profit funds. HCF returns 87.8% of contributions as benefits against Medibank’s 85.6%, but retains fewer members, at 83.7% against 85.4%. HBF raised premiums 2.15% in 2026 against Medibank’s 5.10%, but returns 82.2% of contributions as benefits.

None of those figures makes one fund correct for a given person. They are the published record, and they are the part of the decision that can be checked rather than assumed.