Last updated on September 19th, 2023 at 07:33 pm
One of the most important things to learn about when relocating to Australia is how the healthcare system works. At first glance, it may seem like there’s a daunting amount of information to digest, but don’t worry. To make things easier, we’ve broken down the essential details in this quick guide, so you’ll be all set to make the right decision for your circumstances in order to get health insurance in Australia.
How healthcare works in Australia
Australia has a public healthcare system called Medicare. This is funded by taxpayers and provides medical services to citizens and some immigrants, either at no extra cost or at subsidised prices. However, it’s important to note that more than half the population of Australia also has health insurance in place. This provides paid-for access to healthcare services and treatments that aren’t covered by Medicare.
Who can access Medicare?
Medicare, the public healthcare system, is available to:
- Australian citizens
- New Zealand citizens
- Immigrants who have become permanent Australian residents, for example by obtaining permanent work visas
- Immigrants applying for permanent residency
- Visitors from countries with Reciprocal Health Care Agreements with Australia, namely Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the Republic of Ireland, Slovenia, Sweden, and the United Kingdom.
What does Medicare cover?
Medicare covers some or all of the costs for a huge range of healthcare services as listed in Australia’s Medical Benefits Schedule, including:
- GP (general practitioner) and specialist consultations
- Hospital care
- Diagnostic tests and scans
- Most surgery procedures
- Eye tests by optometrists
- Some dental treatments
Those enrolled with Medicare can also obtain prescription medicines at discounted prices through the Pharmaceutical Benefits Scheme. You just have to show your Medicare card at the pharmacy to get the discounted rate.
What Medicare doesn’t cover
Although Medicare is a comprehensive system, there are some important costs which it doesn’t cover. These include:
- Ambulance services (except in Queensland and Tasmania, where ambulance costs are covered by the state government)
- Most dental examinations and treatments
- Glasses and contact lenses
- Most physiotherapy, speech therapy, and psychology services
- Treatment that isn’t clinically essential
How to access Medicare
If you’re eligible for Medicare, you can enrol by downloading and completing the form found here. As part of your application, you’ll also have to provide certain documents that vary depending on your circumstances.
For example, if you’re an immigrant with a permanent residency visa, you’ll need to provide your current password and proof of residency status from the Department of Home Affairs. If you’re currently in the process of applying for permanent residency, you’ll need to provide your current passport, your visa, and proof that an application for permanent residency has been lodged with the Department of Home Affairs.
Once your application has been processed, you’ll be sent your Medicare card. When you receive healthcare, for example at your doctor’s office, you may have to pay the fee and then make a claim to get the money back from Medicare. This can be done right there at the doctor’s office, through your Medicare online account, through the Medicare Express Plus mobile app, and by mail using the Medicare claim form. The good news is that many healthcare providers in Australia choose to ‘bulk bill’, which means they get paid by the government for the work they do, and you won’t have to go through the process of paying fees and reclaiming from Medicare.
You can search for doctors and other healthcare providers near you that bulk bill using this directory.
Do you need private health insurance in Australia?
As mentioned earlier in this guide, many Australians and immigrants with permanent residency choose to pay for private healthcare on top of what’s provided by Medicare. After all, it comes with considerable benefits, such as shorter waiting times for surgery, and coverage for treatments that don’t fall under Medicare’s jurisdiction (for example, most dental and physiotherapy services).
Keen to relieve some of the pressure on public healthcare, the Australian government also provides incentives for people to take out private health insurance. For one thing, the government pays a private healthcare insurance rebate which contributes to the cost of insurance premiums for those within eligible income brackets. There’s also an initiative known as Lifetime Health Cover (LHC), which means that anyone who takes out private insurance (specifically, for hospital care) before their ‘LHC Base Day’ will avoid paying an annually increasing surcharge on their premiums. For immigrants, the LHC Base Day is either July 1st following your 31st birthday, or the first anniversary of your Medicare registration (whichever comes later). There’s a third incentive called the Medicare levy surcharge, which means that higher earners have to pay more towards Medicare if they don’t take out private hospital cover.
If you’re not eligible for Medicare – say, you have a temporary work visa entitling you to live in Australia for up to four years – then you’ll very probably want to take out private health insurance or run the risk of paying higher fees whenever you need medical treatment. Indeed, depending on your visa, you may be required to get health insurance in Australia as part of the application process. For example, most international students will need to take out Overseas Student Health Cover which must cover hospital treatments and ambulance services.
How private healthcare works for Medicare users
If you’re eligible for Medicare, there are two main types of private health cover in Australia. You can take out one or both of the following.
Hospital cover
This will allow you to be treated at private hospitals, which tend to provide more comfortable surroundings (and often your own room), nicer food, and other perks. You’ll be able to choose your own doctor, and you can look forward to having surgery and other treatments more quickly. You’re also able to be treated as a private patient at a public hospital if that’s more convenient for you.
Hospital cover is divided up into four tiers: basic, bronze, silver, and gold. These tiers reflect the scale of the cover provided by the policy. For example, gold policies will cover joint replacements and childbirth, neither of which are included in the lower tiers.
General or ‘extras’ cover
This kind of policy covers things like dental services, physiotherapy, and the cost of glasses and contact lenses. Bear in mind that you’ll typically only get partial coverage – for example, 60% of the price of root canal treatment. You can also take out ambulance cover to cover transportation to the hospital, though some states and territories let you pay an ongoing subscription fee for ambulance services in that region.
How private healthcare works if you can’t access Medicare
If your visa doesn’t make you eligible for Medicare, you won’t need to look at the tiered policies listed above. Instead, you’ll be able to take out Overseas Visitors Health Cover (or Overseas Student Health Cover if you’re coming to Australia to study). What’s included in your Overseas Visitors Health Cover package will differ between insurance companies – some will include GP consultations and prescription medicines, while others are limited to hospital treatments.
Health insurance costs
Most Australian residents eligible for Medicare must contribute to this public healthcare scheme by paying a 2% levy on their taxable income. With regards to private health insurance, it’s been estimated that the average cost of hospital-only cover in Australia is around $166 per month. Of course, the price of private health insurance varies widely, depending on the exact policy you take out. For example, a gold-tier hospital and extras combined policy will cost significantly more than simply taking out an extras policy. This is why it’s important to carefully assess your needs. If, say, you’re a younger person with no pre-existing health conditions, you might decide to take out a lower level of cover.
It’s a good idea to use comparison tools to weigh up the various healthcare packages on offer. Here are some sites that can come in handy:
- PrivateHealth.gov.au, the official private health insurance ombudsman site which lists all registered insurance companies and lets you compare policies for Medicare-eligible residents
- iSelect, a popular Australian price comparison site with a comprehensive health insurance section
- Finder, another top price comparison site that lets you specify exactly what kind of policy you’re after