Australia's private hospital insurance membership reached 12,688,193 people, or 45.6% of the population, by 31 December 2025, according to Australian Prudential Regulation Authority data showing a slight increase compared with September 2025. The figure caps seven consecutive years of net growth since a marginal dip in December 2019, when coverage stood at 11.23 million, or 44.0% of the population.
National growth accelerated through the period, from 0.9% in 2020 to a peak of 2.5% in 2024, before easing slightly to 2.3% in 2025. Western Australia and the Australian Capital Territory recorded the highest hospital cover participation rates, at 54.6% and 54.3% respectively, while the Northern Territory remained the lowest at 39.0%. Victoria recorded the largest increase in the number of people covered during 2025, adding 77,000 to reach 3.07 million, narrowly ahead of New South Wales, which added 76,000 people to reach 4.07 million.
The December quarter added 54,262 insured people nationally, with family policies increasing by 7,028 and single policies by 12,253. After accounting for people moving between age groups, children aged 0 to 4 recorded the largest net increase in coverage, rising by 25,668. By year-end, 1,165,332 people were subject to a Lifetime Health Cover loading because they first took out hospital cover after age 30, up 78,833 from a year earlier.
That steady, multi-year climb in membership is about to face its sharpest cost test in years.
The Department of Health approved an average premium increase of 4.41% from 1 April 2026, moderately higher than last year's 3.73% rise, reflecting medical and hospital costs that rose 5% over the past financial year. Consumer group CHOICE called it the largest average hike since 2017, with individual fund increases ranging from 1.98% to 5.98% - a spread wide enough that some members will feel considerably more pressure than the national average suggests.
Private Healthcare Australia, whose members include Medibank, Bupa and NIB, said the rise reflects rising treatment costs. "More people are using their health insurance for high-cost hospital care such as joint replacements and cancer treatment, and the cost of delivering care continues to rise. This premium increase reflects those realities," said Dr Rachel David, chief executive, Private Healthcare Australia.
Not-for-profit insurer body Members Health Fund Alliance said its members' funds set a lower average increase. Its chief executive, Matthew Koce, said: "Members Health funds remain firmly committed to keeping premiums as affordable as possible for the more than 5.4 million Australians who are members of a not-for-profit fund."
Members Health Fund Alliance said its member funds' average premium increase for 2026 was 3.62%, compared with 5.12% for the three largest for-profit insurers, and that its funds operated on net margins of 2.6% versus around 7% for the major for-profit insurers.
Whether Australia's eighth consecutive year of membership growth continues will likely depend on how the roughly two-point gap between fund types, and the widening 1.98%-to-5.98% spread across individual insurers, plays out at renewal - the first real affordability test the market has faced since growth began accelerating in 2022.
