AMA releases the Private Health Insurance Report Card 2025, showing Australians are paying more for private cover while getting less value, and calling for reform including an independent Private Health Authority.

AMA earner Dr. McMullen argues insurers have the capacity to lift benefits to reflect rising costs and profits.,

McMullen highlights concerns about 'shady tactics' like product phoenixing and complex tiered policies, urging independent oversight to protect consumers.

Since 2008, private health insurance premiums have risen by over 100%, outpacing inflation and MBS indexation which grew less than 20%.

The AMA highlights systemic issues—rising premiums, low-value offerings, and tactics like product phoenixing—and argues for a single independent regulatory authority to drive reform.

AMA President Dr Danielle McMullen calls for a single independent Private Health System Authority to oversee reform and unify regulation across the sector.

The Australian Medical Association warns that private health insurance in Australia is becoming less affordable, with higher premiums and shrinking coverage driving pressure on both public hospitals and private providers.

Between six years to mid-2025, in-hospital benefits rose about 18.1% while sector profits nearly doubled, suggesting profits are increasing faster than benefit payouts.

The AMA says reform is needed even as insurers remain profitable, and that they have capacity to increase patient benefits while addressing price-gouging and phoenixing tactics.

In 2024-25, insurers returned about 84.2% of premiums as benefits, below 2019’s 88%, prompting calls for a mandatory 90% return to consumers.

Gold-tier policies have declined by about 360,000 since March 2020, even as overall policy numbers rose, reflecting affordability pressures.

AMA urges government action to mandate at least a 90% return of premiums as benefits and to establish independent oversight via a Private Health System Authority.