Medical Coverage and Insurance in Australia

As a migrant, understanding the healthcare system can be overwhelming, but it’s essential for your well-being. Here’s a simplified guide to medical coverage, insurance, hospitals, medical claims, and general practitioners (GPs) in Australia:

1. Medical Coverage and Insurance

a. Medicare

What is Medicare? Medicare is Australia’s public healthcare system, which provides essential medical services to eligible residents and migrants. It covers doctor visits, hospital stays, and some medical procedures.
Eligibility: You are eligible for Medicare if you are an Australian citizen, permanent resident, or have a certain type of visa. Check your visa status to confirm eligibility.
Services covered: Medicare covers visits to doctors (GPs and specialists), hospital care, and some medical tests. However, it does not cover everything, like dental care or optical services.
Medicare claims: For services covered by Medicare, you typically don’t need to pay upfront. The doctor or hospital will bill Medicare directly.

b. Private health insurance

Why get private insurance? Many people choose private health insurance to access additional services not covered by Medicare, such as dental care, optical services, and private hospital stays.
Types of private insurance: There are several private health insurance providers in Australia, such as HCF, Bupa, Medibank, and NIB. Each offers different plans and benefits.
Benefits: Private insurance can provide faster access to medical services, more control over your healthcare, and coverage for services not included in Medicare.
Private insurance claims: If you have private insurance, you may need to submit claims to your insurer. This can be done online or by mail. You’ll need an itemised invoice from your healthcare provider.

2. Benefits of private health insurance

a. Flexibility and choice

Doctor and hospital choice: With private insurance, you can choose your doctor, surgeon, and hospital, which may not be possible under the public system.
Reduced waiting times: Private insurance often allows for faster access to medical services, particularly for elective surgeries, compared to public hospitals.

b. Comprehensive coverage

Additional services: Private insurance covers services not included in Medicare, such as dental care, optical services, and physiotherapy.
Ambulance services: Some private insurers, like Bupa, cover ambulance costs, which can vary by state and are not always free.

c. Visa requirements

Mandatory for some visas: Certain temporary visas require migrants to have private health insurance, ensuring they are covered for medical expenses during their stay.
Avoid financial risks: Private insurance helps protect against unexpected medical costs, which can be high without coverage.

d. Lifetime Health Cover (LHC) benefits:

Avoid LHC loading: New migrants can avoid LHC loading by purchasing private hospital cover within a year of registering for Medicare, saving on premiums4 5.
Financial Incentives: Taking out private insurance early can also provide age-based discounts for those under 31.

e. Convenience and support:

User-friendly services: Many insurers offer user-friendly apps and customer support, making it easier to manage your insurance and claims.

3. Costs of private health insurance

Premiums: The cost of private health insurance varies based on the type of cover (hospital, extras, or combined), the level of coverage (Basic, Bronze, Silver, Gold), and the insurer. For example, the average monthly premium for a single person with Gold hospital coverage is around $272.45. In 2025, premiums are expected to rise by an average of 3.73% across the industry.
Premium increases: Insurers like Bupa are increasing premiums by 5.10% in 2025, reflecting rising healthcare costs and inflation. Other insurers, such as Medibank, are raising premiums by 3.99%.
Out-of-pocket expenses: Even with private insurance, you may face out-of-pocket costs for services not fully covered by your policy.

a. Comparison

Cost vs. benefits: While private health insurance costs can be significant, the benefits include more control over healthcare, access to additional services, and potential tax savings. For those who value these benefits and can afford the premiums, private insurance may be worthwhile.
Financial considerations: The decision to purchase private health insurance depends on your financial situation and healthcare needs. If you frequently use services not covered by Medicare or prefer the flexibility and choice private insurance offers, it might be a good investment.

4. Differences between Medicare and private health insurance

a. Coverage and services

Medicare: Covers essential medical services, including visits to GPs, specialists, public hospital stays, and some diagnostic tests. It does not cover services like dental care, optical services, or ambulance costs in most states.
Private health insurance: Offers additional services not covered by Medicare, such as dental, physiotherapy, optical services, and ambulance cover. It also provides hospital cover, allowing you to choose your doctor and hospital.

b. Cost and payment structure

Medicare: Funded through taxes, with no premiums required. Services are often provided at no upfront cost or with reduced costs for bulk-billed services.
Private Health Insurance: Requires regular premiums, which can vary based on the level of coverage chosen. You may need to pay an excess when claiming.

c. Choice and flexibility

Medicare: As a public patient, you cannot choose your doctor or hospital. Waiting times can be longer for non-emergency treatments.
Private health insurance: Allows you to choose your doctor, hospital, and often the timing of your treatment. This can result in shorter waiting times for elective procedures.

d. Hospital care

Medicare: Covers public hospital care as a public patient, with no choice over your treating doctor.
Private health insurance: Covers private hospital care, allowing you to choose your doctor and potentially have a private room.

e. Eligibility and Requirements

Medicare: Eligibility is based on residency status and citizenship. Some temporary visa holders may not be eligible.
Private health insurance: Available to anyone, regardless of visa status. Some visas require private health insurance as a condition of entry.

f. Out-of-pocket expenses

Medicare: Generally has no out-of-pocket costs for bulk-billed services, but may have copays for non-bulk-billed services.
Private health insurance: Typically includes an out-of-pocket maximum, after which the insurer covers 100% of eligible costs for the remainder of the policy year.

5. Hospitals

a. Public Hospitals

Free for eligible patients: Public hospitals are free for Australian citizens and permanent residents. They provide comprehensive medical services, including emergency care and specialist treatments.
Choice of public or private care: Even in public hospitals, you can choose to be treated as a private patient if you have private insurance.
Emergency Departments (EDs): They are open 24/7 and offer treatment regardless of a patient’s ability to pay. Priority is given based on medical urgency, not order of arrival. EDs provide immediate assessment and treatment for critical conditions such as heart attacks, strokes, severe injuries, and breathing difficulties.

b. Private Hospitals

Costs: Private hospitals require private health insurance or personal payment. They offer more control over your treatment and often shorter waiting times.
Services: Private hospitals provide a wide range of services, including surgery, intensive care, and specialised treatments.

6. General Practitioners (GPs)

How to find a GP: You can find a GP in your area using online tools. It’s a good idea to check if they bulk bill (meaning Medicare covers the full cost).
Bulk billing: Many GPs offer bulk billing, which means you won’t have to pay out of pocket for visits.
Telehealth: Some GPs offer telehealth services, allowing you to have appointments over the phone or video.

7. Nurse-on-Call Services

Purpose: These services offer immediate health advice from registered nurses over the phone, 24 hours a day, 7 days a week. They are designed for non-emergency situations where you need guidance on whether to seek further medical help.
Availability:

Victoria: NURSE-ON-CALL is available on 1300 60 60 24.
Queensland: 13 HEALTH provides similar services on 13 43 25 84.
Other States: Healthdirect offers a national service on 1800 022 222.
Benefits:
- Convenience: Available at any time, these services are particularly useful when you’re unsure if you need to visit a doctor or hospital.
- Accessibility: They provide health advice without the need for a physical visit, which can be especially helpful if you’re far from medical facilities or need advice after hours.
- Cost-Effective: These services are generally free or low-cost, reducing financial barriers to accessing health advice.
What to expect:
- Initial assessment: A registered nurse will answer your call, gather basic information, and assess your symptoms.
- Advice and referral: Based on your condition, the nurse may advise self-care, recommend a visit to a GP, or suggest going to an emergency department if necessary.
Emergencies: These services are not for emergencies. If you believe your situation is life-threatening, you should call triple zero (000) or visit an emergency department.

8. Online medical information

Better Health Channel (betterhealth.vic.gov.au) is a government-funded health information website in Australia, provided by the Victorian Government. It offers reliable, evidence-based, and easy-to-understand health information.

Similar services in Australia:

Healthdirect Australia (www.healthdirect.gov.au) – A national, government-funded service providing trusted health advice, symptom checkers, and links to healthcare providers.
Raising Children Network (www.raisingchildren.net.au) – Government-supported information on parenting, child development, and family health.
My Aged Care (www.myagedcare.gov.au) – Australian Government service providing information and access to aged care support.
Head to Health (www.headtohealth.gov.au) – A mental health and wellbeing resource connecting Australians to digital and local mental health services.
Lifeline Australia (www.lifeline.org.au) – A crisis support and suicide prevention service with 24/7 counselling via 13 11 14.