The health care system in Australia is a mix of public and private services. A national health insurance scheme called Medicare provides basic care for all Australian citizens and eligible residents, and private health insurance covers everything else. Medicare gives free or subsidised access to many healthcare services - including visits to the doctor, prescribed medications, and the emergency departments of public and private hospitals. Private health insurance offers faster, more personalised care, and insures you for a number of services not covered by Medicare.
Overview of Australia's Health Care System
If you’re wondering what type of healthcare system is in place in Australia, think of a two tier system. Private health insurance lets you select the hospital and the doctor or specialist who will treat you, Medicare doesn’t. Medicare will cover a portion of your doctors' fees, but private health insurance covers a range of additional treatments and services that you might not be aware of.
Medicare
If you are eligible, Medicare will pay the entire cost of your treatment at an Australian public hospital. But you do not have the option to select your hospital or the doctor or specialist who will treat you. There may also be much longer waiting times for non-essential surgery under Medicare.
To be eligible for Medicare you must be an Australian citizen or permanent resident, or a visitor from a country with a Reciprocal Health Care Agreement (RHCA) with Australia. Each country has different agreements and this will affect the sort of health services you are covered for.
Private Healthcare
Private health insurance pays most of your hospital fees, including overnight stays and care, along with theatre costs. With private insurance, you can be treated in a private or public hospital by your choice of doctor, surgeon or other health professional. You can also purchase extras cover, which insures you for additional treatments not covered by Medicare (e.g., physiotherapy and dental work). ‘Comprehensive’ insurance offers both essential and extras cover and usually lets you tailor the extras you require.
Note: There may be gap payments to pay with private insurance, such as excess costs, so be aware of the terms of your cover before you buy.
How Does Australia's Medicare System Work?
Medicare is funded by the Australian government through general taxation, and provides a range of services for residents, including hospital care, doctor visits, and certain medical tests.
Medicare and Public Hospitals
Patients can access public hospitals where treatment is free, and be subsidised for visits to many private practitioners. That means that, even if you have to pay for some services, you will be able to claim some sort of refund for your expenses later. And, if your healthcare provider ‘bulk bills’ the Australian government for their services, you will not pay any out-of-pocket expenses at all.
Medicare also subsidises many medications through the Pharmaceutical Benefits Scheme (PBS), ensuring affordability for necessary prescriptions and better public health overall.
Services Not Covered by Medicare
Whilst Medicare guarantees necessary medical treatment for all residents, it will not cover you for many ancillary healthcare services like dental care, optical treatments, and physiotherapy. Nor does it cover treatments in private hospitals or ambulance services, which are very expensive.
Is Private Health Cover Necessary?
Whilst all permanent residents and some visitors to the country are covered for essential medical treatment, the health care system in Australia strongly encourages everyone to take out their own private cover if they can afford it. That’s because private insurance provides significantly reduced waiting times and better access to your choice of healthcare provider - and the much larger range of services available in the private sector.
Regardless of your residency status, you may be able to claim a rebate on your private insurance premium via your insurer or through the Australian taxation system. To request the rebate you will have to be eligible for Medicare, have a complying health insurance policy, and an income that is less than the required threshold.
Healthcare For International Visitors
For overseas visitors to Australia, it’s crucial to have the right healthcare coverage while you are here. Here are some important things to think about before you leave.
Overseas Visitor Health Cover (OVHC)
Consider purchasing OVHC insurance, which is specifically designed for overseas visitor health cover. This helps pay for medical treatments, hospital stays, and other healthcare services not covered by Medicare.
Note: If you’re an international visitor to Australia, you generally won’t have access to Medicare. Owning private health insurance for the duration of your visit is a condition of your visa.
Potential Healthcare Needs
What are your possible health needs based on the length of your stay and activities in Australia? Do you have any pre-existing conditions, or could you need specialist services, like dental work, while you’re here? Check that your private policy covers them - just in case - as many insurers have exclusions.
Reciprocal Health Care Agreements
If you’re from a country with a reciprocal health care agreement (RHCA) with Australia (e.g., the UK, New Zealand), you may be eligible for some Medicare services. However, coverage can be limited, so private cover is still strongly advised.
Emergency Services
Under Australia's health care system, Ambulance coverage varies across states and between different insurance providers. So, if you should require an ambulance while you’re here, make sure you’re covered by insurance, Medicare or an ambulance subscription to avoid any unexpected costs. Also, make a note of emergency numbers and local health care facilities to get urgent help in case you need it.
