The 2025 PHI Innovation Report once again confirmed Medibank as Australia’s most innovative health insurer, recording an Innovation Index score of 91 percent, the highest result in the sector for the second year running. What stands out is not a single program or headline announcement, but how Medibank has built a connected, system-level approach that links affordability, prevention, digital capability and new models of care.
Innovation has become part of how the organisation operates, shaping how Australians access, receive and understand their health cover. The result is a model that continues to set the pace for the entire sector.
According to former Medibank executive Marc Miller, the real turning point wasn’t technology or budget. It was where Medibank chose to focus its innovation efforts.
Making healthcare more affordable in measurable ways
Affordability remains the biggest expectation members have of their fund, and Medibank delivered the most comprehensive response of any major insurer.
The organisation returned $1.71 billion to members since 2020 through cash backs, delayed premium increases, rollovers and Live Better rewards. Its No Gap surgery program saved members more than $7 million in the past year, and diagnostic partnerships now remove around $400,000 in out-of-pocket costs every month. Live Better rewards reached $32.8 million in redemptions in 2025, helping many households offset rising living costs during a difficult economic period.
This combination of direct financial relief, structural savings and transparent fee certainty reflects a deliberate strategy to reduce costs at multiple levels, not just hold premiums steady.
Shifting care out of hospitals and into homes and communities
Medibank is the country’s largest player in virtual and home-based care. Through Amplar Health, the organisation delivered more than one million virtual consultations and more than 250,000 home visits. These services range from rehabilitation to chemotherapy and palliative support.
Care transitions through partnerships like SA Health helped older Australians return home sooner and reduced avoidable readmissions. Across the year, these models delivered the equivalent of hundreds of thousands of avoided bed days, easing pressure on private hospitals and giving members access to treatment in settings they prefer.
Where many insurers talk about reimagining care, Medibank is delivering it at national scale.
Building digital capability that improves access and trust
Digital transformation in PHI has moved well beyond convenience. Medibank strengthened its digital foundations with a formal AI governance policy, embedded automation in claims and communication workflows, and invested in the ongoing refinement of the My Medibank app.
These capabilities speed up claims processing, reduce friction for members and create clearer communication channels. Most importantly, they support safe, ethical innovation in a sensitive environment where data security and member trust are essential.
Scaling prevention and population health
If 2024 marked progress, 2025 marked acceleration. Prevention enrolments doubled to 283,000, with targeted pathways across musculoskeletal, metabolic and cardiac health. These programs help members stay well for longer, delay surgery and avoid complications linked to chronic disease.
This shift shows Medibank’s growing maturity in population health, recognising that long-term sustainability depends on influencing outcomes well before hospital admission.
A connected innovation system, not a collection of projects
Other insurers delivered strong results in 2025, but Medibank stood out for the maturity of its approach. Innovation is tied to strategy, data, service design and measurable member outcomes.
The organisation has moved from digital convenience to system innovation. From affordability levers to hospital partnerships, from national virtual care to prevention at scale, Medibank is demonstrating what the future of private health insurance can look like when innovation is embedded rather than bolted on.
The benchmark for 2025 and beyond
This year’s report shows a sector finally shifting from pilots to performance. All major funds are progressing, and each has strengths worth noting. But Medibank continues to lead because it delivers innovation with reach, depth and impact.
As Australia faces rising illness, workforce pressure, chronic disease and increasing demand for connected care, Medibank provides a clear blueprint for the next generation of private health insurance: affordable, digitally enabled, community based and prevention led.
The gap between leaders and followers is widening, and Medibank is setting the pace.
Download the 2025 PHI Innovation Report
If you’d like the full picture of how Medibank and the rest of the sector performed, you can download the 2025 PHI Innovation Report for free.
The report includes:
✅ A clear ranking of Australia’s most innovative health insurers
✅ Evidence on what is actually shifting affordability, digital capability and new care models
✅ Detailed case studies across the five major funds
✅ Early signals for what 2030 will look like for the PHI sector
✅ Practical guidance for leadership teams planning their next strategic move