Hospital cover in New South Wales and the ACT: what a family pays either way
One price list serves Sydney and Canberra. Enter a household and see the surcharge without cover against the cheapest family policy.
The cheapest exempt cover costs less than the surcharge by
$384
Surcharge $2,450 against $2,066 of cover: ahm health insurance, ambulance hospital (basic) (Basic, $750 excess), $205.20 a month before rebate.
| Income tested: $245,000 | Tier 1, 1.00 % |
| Surcharge without cover, you | $1,500 |
| Surcharge without cover, partner | $950 |
| Cheapest exempt policy, full premium | $2,462 |
| Rebate (16.079 %) | -$396 |
| Net cost of the policy | $2,066 |
| Income from which cover is cheaper | $117,000 |
Premiums: PrivateHealth.gov.au file of 2026-10-01, 821 open policies that avoid the surcharge for this cover type in NSW and ACT. Premiums change on 1 April 2027.
Prepared by Radif Partners · How the figures are built · thresholds read on ato.gov.au, premiums from privatehealth.gov.au data · not tax advice
Residents of New South Wales and the Australian Capital Territory choose from the same hospital policies: the PrivateHealth.gov.au file of 1 October 2026 lists no separate ACT prices, so the NSW premiums apply to both. The cheapest open policy that avoids the Medicare levy surcharge costs $102.60 a month for one person and $205.20 for a family, before the rebate, from ahm health insurance. A family with two dependent children is tested on the combined income of both parents against $211,500 in 2026-27, the $210,000 family threshold plus $1,500 for the second child. Over that line each parent pays the surcharge on their own income. On a combined $245,000, split $150,000 and $95,000, the household pays $2,450 without cover against $2,066 for the cheapest family policy after the rebate.
Four households, same state
Each row is a couple with two dependent children, the older parent aged 42 and no Lifetime Health Cover loading. The surcharge is the sum of what both parents would pay without cover; the policy figures are net of the rebate.
| Parent 1 | Parent 2 | Combined | Surcharge, household | Cheapest family policy | Median family policy |
|---|---|---|---|---|---|
| $130,000 | $85,000 | $215,000 | $2,150 | $2,066 | $4,349 |
| $150,000 | $95,000 | $245,000 | $2,450 | $2,066 | $4,349 |
| $170,000 | $110,000 | $280,000 | $3,500 | $2,264 | $4,766 |
| $220,000 | $120,000 | $340,000 | $5,100 | $2,462 | $5,182 |
The first household is just over the line and in tier 1, where the surcharge is 1 % of each income and the rebate is still 16.079 %. Even there, the cheapest family policy costs less than the tax. A policy at the median family price is another matter: it costs more than the surcharge on every row, although the gap shrinks as the tiers rise, to $82 at the last one. At that row, in tier 3, the rebate is gone and the full family premium is paid.
That gap is the real choice for a Sydney or Canberra family. The cheapest policy is the cheapest way to settle the tax question. A fuller policy is a decision about health care, and the surcharge you avoid pays for part of it: on the second row, $2,450 of the $4,349 a median policy costs. The worth it page sets out that reasoning, and the cover calculator above takes your own premium in its folded options.
The household surcharge for your two incomes
Medicare levy surcharge, 2026-27
$3,125
| Income tested for the tier | $250,000 |
| Thresholds (base / tier 1 / tier 2) | $211,500 / $247,500 / $329,500 |
| You | $2,000 on $160,000 |
| Partner | $1,125 on $90,000 |
When one parent earns little
The combined test can catch a family where one parent stays at home. If the other earns $240,000 alone, the household is in tier 1 and that parent pays $2,400 without cover. The partner with an income for MLS purposes of $28,011 or less owes nothing (the 2025-26 figure; the 2026-27 one is not published yet). Cover still has to include the whole family to stop the surcharge: a single policy for the earner leaves the household liable. The families page goes through the dependants rules.
Children change the threshold, not the rate. A third child lifts the family line to $213,000, a fourth to $214,500. A child is an MLS dependant while under 21, or from 21 to 24 while studying full time, which is why families with older children should check who still counts before they read the table.
The family price list in NSW
| Tier | Cheapest from | Cheapest per month | Median per month | Policies |
|---|---|---|---|---|
| Basic | ahm health insurance | $205.20 | $239.65 | 33 |
| Basic Plus | GMHBA Limited | $223.20 | $289.86 | 93 |
| Bronze | Phoenix Health Fund Limited | $247.82 | $315.09 | 44 |
| Bronze Plus | see-u by HBF | $243.58 | $344.70 | 166 |
| Silver | GMHBA Limited | $335.90 | $437.76 | 31 |
| Silver Plus | ahm health insurance | $314.60 | $543.10 | 378 |
| Gold | Medibank Private Limited | $486.80 | $844.14 | 76 |
The cheapest family policies cost twice the single ones, $102.60 against $205.20, and the three cheapest are within a few dollars: ahm health insurance, see-u by HBF at $206.78 and GMHBA Limited at $208.10. A single parent policy, for one adult and children, starts at $156.05. Each of these is Basic tier: it avoids the surcharge, and its Private Health Information Statement says what else it pays for. Naming the cheapest policy reports a price, it is not a recommendation.
Sources: PrivateHealth.gov.au file of 1 October 2026 on data.gov.au, ATO rules on family and dependants, thresholds and rates. How the figures are built.