Private vs medicare

How Medicare works, and what private health insurance can do for you.    
 

• Private health cover is divided into three areas: hospital, extras and ambulance
• Hospital cover enables you to choose your doctor and hospital
• Extras cover can help with the cost of services not covered by Medicare

Medicare is available to Australian citizens and most permanent residents. It covers part of the cost of seeing a GP or specialist (or the full cost if they bulk bill), and most prescription medicines. It also provides free treatment and accommodation in public hospitals.

As a public patient in a public hospital you’ll be treated by hospital-appointed doctors and subject to waitlists for non-emergency treatment.

Medicare doesn’t cover the cost of ambulances, glasses/contact lenses or hearing aids. It also excludes therapies such as speech pathology, osteopathy and remedial massage.

Private health insurance can fill the gaps in Medicare’s coverage and give you more choice about your treatment.

Hospital

Hospital cover enables you to be treated as a private patient in a public or private hospital. As a private patient you have a greater chance of being able to choose your doctor.

At a public hospital it’s likely you’ll have to wait for non-emergency treatment; private hospitals can provide faster access.  

Your entitlements (which treatments and procedures you can claim for) will depend on your level of cover.

It’s wise to find out upfront if your insurance will cover the full cost of your treatment so you’re not left with unexpected out-of-pocket expenses, known as ‘the gap’.

Extras

Extras cover allows you to claim for a range of day-to-day services, such as dental treatment, glasses and contact lenses, and a range of therapies not covered by Medicare.

The treatments you can claim for, and how much you can claim (your limits), are determined by your level of cover.

Government incentives

Depending on your income, hospital cover could help you avoid the Medicare Levy Surcharge (extra tax). If you get cover before the age of 31 you’ll avoid Lifetime Health Cover loading, lowering the cost of your premium. The Australian Government Rebate is also designed to make private health insurance more affordable.