Private Health Insurance vs Medicare: Who pays for what?
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 cover enables you to be treated as a private patient in a public or private hospital. As a private patient you can choose your own doctor.
At a public hospital it’s likely you’ll have to wait for non-emergency treatment; private hospitals usually 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 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.
Ambulance cover covers the cost of emergency ambulance services (which aren’t covered by Medicare). It’s included on all levels of HCF hospital and extras cover. If you want ambulance-only cover, we do that too.
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.
Community rating and health insurance
Private health insurance in Australia is community-rated. This means you pay the same premium for the same level of cover as everyone else in your state, regardless of your age or health status, or the number of claims you make. This helps make private health insurance more accessible for everyone.
Charges and paying the gap
How to avoid out-of-pocket costs for hospital treatment.
Why health insurance premiums go up
And what we're doing to make health care as affordable as possible for our members.
How the govt rebate works
Why your income affects your health insurance premium.
Choosing an excess
How it works, and how to decide what’s right for you.