When relocating to Australia, one of the most crucial things to learn is how the healthcare system works. At first sight, it may appear like there is an overwhelming quantity of information to process, so don’t panic. To make things easier, we’ve broken down the main elements in this brief guide, so you’ll be ready to make the best selection for your situation when it comes to getting health insurance in Australia.
How Australian healthcare works
Medicare is Australia’s public healthcare system. This is sponsored by taxpayers and provides medical care to citizens and some immigrants for free or at a reduced cost. It is important to note, however, that more than half of Australia’s population has health insurance. This allows for paid access to healthcare services and treatments that Medicare does not cover.
Who is eligible for Medicare?
Medicare, the government-run healthcare system, is offered to:
- Australian residents
- Citizens of New Zealand
- Foreigners who have become permanent residents of Australia, for example, through the acquisition of permanent work visas
- Immigrants seeking permanent residency
- Visitors from countries that have reciprocal health-care agreements with Australia, including Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the Republic of Ireland, Slovenia, Sweden, and the United Kingdom.
What exactly does Medicare cover?
Medicare pays for a wide range of healthcare treatments, as outlined in Australia’s Medical Benefits Schedule, including:
- Consultations with a GP (general practitioner) and specialists
- Medical attention
- Scanners and diagnostic tests
- The majority of surgical procedures
- Optometrists do eye exams.
- Certain dental procedures
Those who have Medicare can also obtain prescription medications at a reduced cost through the Pharmaceutical Benefits Scheme. To enjoy the discounted rate, simply show your Medicare card at the drugstore.
What Medicare does not pay for
Although Medicare is a comprehensive system, it does not cover some significant costs. These are some examples:
- Emergency medical services (except in Queensland and Tasmania, where ambulance costs are covered by the state government)
- The majority of dental checkups and treatments
- Contact lenses and glasses
- The vast majority of physiotherapy, speech therapy, and psychotherapy services
- Therapy that is not clinically necessary
How to Get Medicare
If you are eligible for Medicare, you can enroll by downloading and filling out this form. You will also be required to submit specific documents as part of your application, which will vary depending on your circumstances.
If you are an immigrant with a permanent residency visa, for example, you must provide your current password as well as proof of residency status from the Department of Home Affairs. If you’re currently applying for permanent residency, you’ll need to bring your current passport, your visa, and proof that you’ve filed an application for permanent residency with the Department of Home Affairs.
Your Medicare card will be mailed to you once your application has been processed. When you obtain healthcare, such as at your doctor’s office, you may be required to pay a charge and then file a claim with Medicare to receive reimbursement. This can be done in the doctor’s office, online through your Medicare account, via the Medicare Express Plus mobile app, or by mail using the Medicare claim form. The good news is that many Australian healthcare providers prefer to ‘bulk bill,’ which means they are reimbursed by the government for the work they do, and you won’t have to go through the process of paying fees and retrieving from Medicare.
Using this list, you can look for doctors and other healthcare providers in your area who accept bulk billing.
As indicated before in this article, many Australians and permanent residents choose to pay for private healthcare in addition to what Medicare provides. After all, it comes with numerous advantages, such as lower surgical wait times and reimbursement for therapies not covered by Medicare (for example, most dental and physiotherapy services).
In order to relieve some of the strain on public healthcare, the Australian government offers incentives for citizens to purchase private health insurance. For one example, the government provides a private healthcare insurance rebate, which helps to cover the cost of insurance premiums for people who fall into certain income levels.
There’s also a program called Lifetime Health Cover (LHC), which means that anyone who purchases private insurance (particularly, for hospital care) before their ‘LHC Basis Day’ would avoid paying an annual fee on their premiums. The LHC Base Day for immigrants is either July 1st following your 31st birthday or the first anniversary of your Medicare registration (whichever comes later).
If you are not qualified for Medicare, for example, because you have a temporary work visa that allows you to stay in Australia for up to four years, you will almost certainly want to get private health insurance or risk paying greater rates everytime you require medical treatment. Actually, depending on your visa, you may be forced to obtain Australian health insurance as part of the application process. Most overseas students, for example, will be required to obtain Overseas Student Health Coverage, which must cover hospitalization and ambulance services.
How Medicare beneficiaries use private healthcare
If you are eligible for Medicare, you have two options for private health insurance in Australia. You may remove any one or both of the following.
This will allow you to be treated at private hospitals, which usually offer more comfortable surroundings (and often your own room), better meals, and other benefits. You’ll be able to choose your own doctor, and you’ll be able to have surgery and other treatments sooner. If it is more convenient for you, you can alternatively be treated as a private patient in a public hospital.
There are four levels of hospital coverage: basic, bronze, silver, and gold. These tiers indicate the scope of the policy’s coverage. Gold policies, for example, will cover joint replacements and childbirth, which are not covered in the lower tiers.
Coverage for general or ‘extras’
Dental services, physiotherapy, and the cost of glasses and contact lenses are all covered under this type of policy. Keep in mind that you will often only receive partial coverage, such as 60% of the cost of root canal treatment. You can also get ambulance insurance to cover transportation to and from the hospital, albeit certain states and territories need an ongoing membership cost for ambulance services in that location.
What happens if you don’t have access to Medicare?
You won’t need to look at the tiered policies stated above if your visa does not make you eligible for Medicare. Instead, you can get Overseas Visitors Health Insurance (or Overseas Student Health Cover if you’re studying in Australia). What is covered in your Overseas Visitors Health Insurance plan will vary depending on the insurance company; some will include Physician consultations and prescription drugs, while others will only cover hospitalization.
The cost of health insurance
Most Australians who are eligible for Medicare must pay a 2% levy on their taxable income to contribute to this public healthcare scheme. In terms of private health insurance, it is estimated that the average monthly cost of hospital-only coverage in Australia is roughly $166. Of course, the cost of private health insurance varies greatly based on the specific coverage purchased. A gold-tier hospital and extras combo policy, for example, will cost substantially more than merely purchasing an extras policy. This is why it is critical to carefully examine your requirements. If you’re younger and have no pre-existing medical conditions, you might choose a lower level of coverage.
It’s a good idea to use comparison tools to compare the many healthcare packages on the market. Here are some websites that may be useful:
- PrivateHealth.gov.au, the official private health insurance ombudsman website, includes all registered insurance providers and allows Medicare-eligible residents to compare coverage.
- iSelect, a well-known Australian price comparison website that has a complete health insurance section
- Finder is another top price comparison service that allows you to pick the type of coverage you want.
Costs of health insurance
The majority of Australian citizens who qualify for Medicare are required to pay a 2% levy on their taxable income as a contribution to the public healthcare system. According to estimates, the average monthly cost of hospital-only coverage under private health insurance in Australia is about $166. Nevertheless, the cost of private health insurance differs greatly based on the specific coverage you purchase. A gold-tier hospital and extras combo policy, for instance, will be much more expensive than just purchasing an extras policy. Because of this, it’s crucial to properly evaluate your requirements. For example, if you’re younger and in good health, you can choose to get a lower amount of insurance.