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How Does Medicare Work?

Australia's healthcare system has 2 parts: the public health system (known as Medicare) and the private health system.

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Things to know
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What is Medicare?
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Do I need Medicare?
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How do I apply for Medicare?
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Do I also need health cover?
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Frequently asked questions

Things to know

Medicare

Medicare funds Australia’s public healthcare system. It provides Australian residents with access to free public hospital treatment and lowers the cost of medical treatment outside of hospitals.

Reciprocal Health Care Agreements

If you’re visiting from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia, you may be able to access some Medicare services, like emergency hospital care.

Private health insurance

Private health insurance provides access to healthcare services not covered by Medicare. For many visitors, health insurance is also a visa requirement (even if you have access to an RHCA) because medical treatment in Australia can be very expensive.

What is medicare?

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Medicare

Medicare is Australia’s public healthcare system. It’s available to Australian citizens and most permanent residents. It covers part of the cost of seeing a doctor or specialist (or the full cost in some cases) and most prescription medicines. It also provides free treatment and accommodation in public hospitals.

As a public patient in a public hospital, you won’t be able to choose your doctor and you may have to wait longer for non-emergency treatment.

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

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The private health system

The private health system is made up of health insurers like HCF, private hospitals and health providers like dentists and physiotherapists.

Health insurance, including OVHC, can help you pay less and give you more choice if you get sick or injured and need medical treatment.

It provides cover for emergency ambulance transport, private hospital treatment and extras like dental, glasses, physiotherapy and acupuncture (depending on your level of cover).

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Covered under Medicare (out-of-pocket costs may apply)
  • Treatment as a public patient in a public hospital
  • Visiting a doctor (GP) or specialist
  • Tests and scans, like X-rays
  • Eye tests by optometrists
  • Some pharmaceutical costs
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May be covered under OVHC (out-of-pocket costs may apply)
  • Visiting a doctor (GP) or specialist
  • PBS medicines
  • Hospital treatment
  • Emergency ambulance*
  • Tests and scans, like blood tests and X-rays^
  • Dental treatment
  • Glasses and contact lenses
  • Extras like acupuncture, physio, remedial massage and more

Do I need medicare?

Medicare is available to eligible visitors from countries that have a Reciprocal Health Care Agreement (RHCA) with Australia. Learn more about RHCAs.

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If you’re covered by an RHCA

If you’re covered by an RHCA, you’ll have access to some Medicare services when you’re in Australia, however, you may still need to maintain health insurance to meet your visa requirements. Find out how to apply for Medicare.

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If you’re not covered by an RHCA

If you come from a country that doesn’t have an RHCA with Australia, it’s a good idea to take out health insurance in case you need medical or hospital treatment while you’re here, which can be very expensive. It could also be a visa requirement (visa condition 8501).

HOW DO I APPLY FOR MEDICARE?

Medicare is only available to eligible visitors from countries that have an RHCA with Australia.

 

  1. Find out if your country is covered by an RHCA by visiting Services Australia.
  2. Download and complete the Medicare enrolment form.
  3. Submit your form and supporting documents to Services Australia by email or post.

Do I Also Need Health Cover If I Have Medicare?

Even if you have access to Medicare, having OVHC means you’re covered for more healthcare services while you’re in Australia.

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Emergency ambulance

Get cover for emergency treatment and transport to the nearest hospital across Australia*.

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Private hospital treatment

Our large national network of private hospitals helps you pay less if you, or your family, need treatment in a private hospital.

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National doctor network

See a doctor (GP) in person from our network or get a 10-minute online consultation, and you could get 100% back on the appointment+.

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Extras services

Our extras cover pays benefits towards services like dental, physiotherapy, glasses, acupuncture, remedial massage and more.

Frequently Asked Questions About Medicare

We answer some of your most common questions about Medicare.

Medicare is Australia’s healthcare system that provides residents with access to hospital treatment and lowers the cost of some medical treatment outside of hospitals. Medicare generally doesn’t cover treatment in private hospitals, ambulances and services like private dental treatment and physiotherapy. That’s where private health insurance comes in.

Medicare is available to eligible visitors from countries that have a Reciprocal Health Care Agreement (RHCA) with Australia. If you come from a country that doesn’t have an RHCA with Australia, it’s a good idea to take out private health insurance in case you need any medical or hospital treatment while you’re here, which would otherwise be very expensive. It could also be a visa requirement (visa condition 8501).

A Reciprocal Health Care Agreement (RHCA) enables visitors from certain countries to get essential medical treatment while they’re in Australia. The Australian Government has RHCAs with 11 countries. They allow eligible people visiting from those countries to access some free or reduced cost healthcare services through Medicare.

Learn more about RHCAs

Medicare doesn’t cover all health services (such as treatment in a private hospital, ambulance or extras services like dental treatment or glasses).

Private health insurance may also be a requirement for your visa, even if you have access to an RHCA, so it’s important to check this before you apply for your visa.

The Australian Government’s Medicare Benefits Schedule (MBS) sets out the fee Medicare pays for each treatment or procedure. For in-hospital treatment as a private patient, Medicare pays 75% of the MBS fee for doctors' services; your private health insurer pays the other 25% (if your private health insurance covers you for this service).

As many doctors and hospitals charge more than the MBS fee, there may be a gap, or extra cost, to pay. At HCF you can avoid having to pay a gap by going to a participating hospital, or participating doctor in the HCF network.

The Medicare Levy Surcharge (MLS) is an additional Australian taxation levy that helps fund Medicare. If you’re eligible for any Medicare services under an RHCA and earn above a certain income, you may be subject to the MLS.

Overseas Visitors Health Cover will not exempt you from the MLS, however, you may like to combine your cover with another product that will. Call us on 13 68 42 to find out more.

Learn more about the MLS

Medicare is Australia’s healthcare system that provides residents with access to hospital treatment and lowers the cost of some medical treatment outside of hospitals. Medicare generally doesn’t cover treatment in private hospitals, ambulances and services like private dental treatment and physiotherapy. That’s where private health insurance comes in.

Medicare is available to eligible visitors from countries that have a Reciprocal Health Care Agreement (RHCA) with Australia. If you come from a country that doesn’t have an RHCA with Australia, it’s a good idea to take out private health insurance in case you need any medical or hospital treatment while you’re here, which would otherwise be very expensive. It could also be a visa requirement (visa condition 8501).

A Reciprocal Health Care Agreement (RHCA) enables visitors from certain countries to get essential medical treatment while they’re in Australia. The Australian Government has RHCAs with 11 countries. They allow eligible people visiting from those countries to access some free or reduced cost healthcare services through Medicare.

Learn more about RHCAs

Medicare doesn’t cover all health services (such as treatment in a private hospital, ambulance or extras services like dental treatment or glasses).

Private health insurance may also be a requirement for your visa, even if you have access to an RHCA, so it’s important to check this before you apply for your visa.

The Australian Government’s Medicare Benefits Schedule (MBS) sets out the fee Medicare pays for each treatment or procedure. For in-hospital treatment as a private patient, Medicare pays 75% of the MBS fee for doctors' services; your private health insurer pays the other 25% (if your private health insurance covers you for this service).

As many doctors and hospitals charge more than the MBS fee, there may be a gap, or extra cost, to pay. At HCF you can avoid having to pay a gap by going to a participating hospital, or participating doctor in the HCF network.

The Medicare Levy Surcharge (MLS) is an additional Australian taxation levy that helps fund Medicare. If you’re eligible for any Medicare services under an RHCA and earn above a certain income, you may be subject to the MLS.

Overseas Visitors Health Cover will not exempt you from the MLS, however, you may like to combine your cover with another product that will. Call us on 13 68 42 to find out more.

Learn more about the MLS

Need help?

Can’t find what you’re looking for?

We’re here to help. Our friendly team speaks many different languages.

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Membership enquiries

If you have questions about your cover, you can call our team Monday to Friday, 8.30am to 5pm (AEST/AEDT).

13 68 42 (within Australia) 

+61 2 7230 5100 (outside Australia) 

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24/7 helpline

If you need help finding a doctor or hospital, or have questions about your health, call our 24/7 helpline.

13 68 42 – option 2 (within Australia)

+61 2 7230 5100 – option 2 (outside Australia)

In an emergency, call Triple Zero (000).

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Visit us

Speak to our friendly health cover experts at your nearest HCF branch.

Find a location

Important Information

* Covers emergency ambulance transport to the nearest hospital from any location except from a medical facility or a hospital. Under visa-compliant cover, emergency ambulance transfer between hospitals will only be covered if it is necessary because the original admitting hospital does not have the required clinical facilities.

^ Doesn’t include costs for medical examinations, X-rays, vaccinations or any treatment required for obtaining a visa to enter Australia, change in visa, or application for permanent residency or examination for pre-employment purpose.

+ Available on all HCF Overseas Visitors Health Covers, except Overseas Visitors Basic Cover. Eligible members under 16 years may need to have a parent or guardian present.

HCF acknowledges the traditional custodians of the lands and water upon which we work and live. We acknowledge Aboriginal and Torres Strait Islander peoples’ rich history as traditional healers and scientists, who have taken care of the health of the land and its people for thousands of years. We give thanks to elders past and present, who we have much to learn from on our reconciliation journey. View our Reconciliation Action Plan