Health Insurance Cover & Medicare

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Australian health services such as doctors, specialists and hospitals can be expensive. While you do have to pay the medical fees you incur, you might not always have to pay the full fee.

How much you have to pay depends on the kind of health cover or health insurance that you have.

  • Public health cover through Medicare - which is available to everyone - can cover part or all of the cost of some services
  • Private health insurance offers coverage for extra services and benefits over and above what public health cover offers

If you are an overseas student, you must have private health insurance while you are studying in Australia. To find out more about health services for international students, visit the Victorian Department of Health website (new window).

Medicare and bulk-billing

Medicare (new window) is Australia's public health system. You need a Medicare card to use it. If you're still living at home you are probably included on your parent's card. You can apply for your own Medicare card (new window) when you turn fifteen.

The two main services covered through Medicare are:

  • Visiting a doctor
  • Using a public hospital as an "out-patient" (someone who needs to go to the hospital but doesn't stay there overnight) 

Medicare sets prices for all medical services. These prices are called "schedule fees". Schedule fees differ according to how much Medicare thinks the operation or appointment should cost.

Some health professionals charge more than the schedule fee for their services. In these cases Medicare will pay the schedule fee for you, but you have to pay any extra. 

Some health professionals and services only charge you the schedule fee, which means you don't have to pay anything for your  appointment. A surgery or clinic that does this is called a "bulk-billing" service. If you use a service that is bulk-billed, all of the costs of your appointment are paid for by Medicare.

The health providers that charge more than the schedule fee usually make you pay the full fee and then apply to Medicare for a refund of the schedule fee. Usually the way this happens is that you pay for the appointment on the day, and then Medicare gives you part of that payment back - either by sending you a cheque or paying money straight into your bank account.

It's important to remember that not all health services are covered by Medicare so you might be stuck with paying part of a medical bill. Ask your health service provider what services - and how much of their cost - are covered by Medicare if you're not sure.

For more about what Medicare covers and how bulk billing works, check out the Medicare website (new window).

Private health insurance

Private health insurance is insurance that you have to pay for yourself (usually monthly) so that you can get medical treatment quicker, and so that you can have more types of medical treatment for free or for a small cost.

Private health insurance covers visits to the doctor and hospital stays and can also cover specialised services such as physiotherapy or psychology. It can be especially useful if you have a serious illness or injury, or are having a baby. 

The cost and coverage (i.e., which medical procedures the insurance company will pay for) of your private health insurance varies. You may only need basic hospital cover, or you may want "extras" like physiotherapy.

Choice (new window), an independent consumer advocacy organisation, has a comparison of private health insurance funds (note that some fact sheets on the Choice website are available to members only, for a fee) that is worth checking out.

Advantages of private health insurance

  • Choice of where you receive healthcare
  • Choice of doctors or specialists to treat you
  • Reimbursement for some medical costs not covered by Medicare
  • Less time to wait for treatment or elective surgery
  • Government rebate of around 30 percent (a refund to you from the government, based on your age and income)
  • You may be covered under your family's private health insurance until you're 18

Disadvantages of private health insurance

  • It can be an expensive ongoing financial commitment
  • You might not need to use all the health services on offer
  • You may still have to pay extra money to cover any "gap" or "excess" after seeing a specialist or staying in hospital

Other types of health cover

Public and private health insurance cover a lot - but they don't automatically  cover everything. Here are some other kinds of health cover to consider:

Ambulance

Medicare doesn't cover the cost of using an ambulance, although some private health insurance schemes do. You can take out separate ambulance cover (new window) in the event of an emergency dash to hospital.

Ambulance cover costs around $40 per year for individuals, and can save you hundreds - or even thousands - of dollars if you ever end up needing an ambulance.

Road or work accidents

Two Victorian Government schemes can help you out if you are injured on the road or at work.

  • The Transport Accident Commission (TAC) (new window) pays for treatment and benefits for people injured in transport accidents
  • WorkSafe (new window) may be able to provide health support and compensation if you're injured at work - for more about WorkSafe, check out our WorkSafe page

Sports-related injuries

If you're an active kind of person, you might want to look into getting personal accident (sports injury) insurance through your sporting associations. This can cover you for injuries received during practice, games and related travel, and may include ambulance cover. Talk to your sports club or association to find out more

If you enjoy cycling, you can join Bicycle Network Victoria (new window) for a small annual fee and get the benefit of many services including bike crash insurance. This will cover you if you injure yourself while riding your bike.

Links

Medicare
Find out more about about Medicare, including services covered and how to apply for your own Medicare Card.

Ambulance Victoria
Find out about ambulance services and how much it costs to buy ambulance cover.

Transport Accident Commission (TAC)
Provides information about the type of benefits TAC provides.

WorkSafe
WorkSafe may be able to provide health support and compensation if you're injured at work.

Choice - Health Insurance Comparisons
Independent research offering advice on private hospital insurance and what to look for in health cover 'extras'. (Some fact sheets on the Choice website are available to members only, for a fee).

Bicycle Network Victoria
Find out about Bicycle Network Victoria's membership benefits, bike crash insurance and joining fees.