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Medicare: Australian Healthcare System

Medicare: Australian Healthcare System

Before leaving abroad it is important to learn about the healthcare system of the country you plan to settle/travel. The Australian health care system, called Medicare, is unique to Australia and is a complex mix of services funded by the Commonwealth, individual states and territories on the one hand and private health insurance on the other. It is therefore important to understand how it works before you go Down Under. Here is an article to help you understand it.

What is Medicare?

In Australia, the health insurance system is called Medicare. It is similar to the NHS. It is the Commonwealth Government’s universal health insurance scheme, founded in 1984.

This Australian health system offers its beneficiaries free treatment as a public patient in public hospitals, as well as free or partially subsidised treatment for certain optometry, dental care and psychological services.

Note that in certain circumstances, rebates are applicable for certain specialist treatments (physiotherapists, dieticians and speech therapists).

Who can benefit from the Australian health system?

Medicare health cover is restricted to Australian Citizens and Permanent Residents. Therefore, most foreign residents are not eligible for Medicare and take out private insurance instead.

Some countries, such as Belgium, Switzerland, Italy and the UK, have signed reciprocal health agreements with Australia. Their nationals can therefore partially benefitfrom the Australian health system. Beware, however, that the coverage offered is much less than that enjoyed by Australians themselves. Indeed, only essential care will be covered.

How is Medicare funded?

The Australian health system is partially funded by an income tax surcharge. All employees in the country with an income above a certain threshold pay a Medicare levy (2% of salary). The contribution is deducted directly from the salary, the Medicare Levy.

Note that people with higher incomes and no private insurance pay a higher Medicare levy.

Temporary residents are exempt from the Medicare Levy. In order to apply the exemption, you have to mention it on your tax return at the end of the tax year.

What is covered?

The Australian health system covers a number of benefits such as;

  • consultations with a general practitioner or a specialist
  • tests or examinations prescribed by your doctor
  • eye tests carried out by optometrists
  • hospitalisation costs
  • surgery reccomended by a doctor

In general, dental costs, alternative medicines and drugs are not reimbursed (except under certain conditions).

Medicare reimbursement

The Medicare reimbursement percentage is based on a standard list of charges for medical services (Schedule fees). In practice, if doctors are licensed, they use the fees set by the Australian health system.

Despite this, doctors are free to set their own fees for consultations and treatments given. Australia’s health insurance will then reimburse 85% of the fee charged. The patient will have to pay the difference (gap fee) between the Medicare rate and the rate charged by the doctor out of their own pocket. However, many doctors follow the Australian Medical Association’s suggested fee list. This list has been indexed to keep up with costs and recommends higher fees than those covered by health insurance.

If you are admitted to a public hospital and are considered a ‘public patient’, you will not be charged anything. In this case, everything is 100% covered by the Australian health system. If you go to a hospital, public or private, as a ‘private patient’, Medicare will only pay 75% of the cost. The rest will be paid out of pocket or by your supplementary health insurance if you have one.

In any case, you will need to present your Medicare card at all medical appointments or in case of hospitalisation.

What is Bulk Billing?

Bulk-billing is when the doctor follows the Australian health system’s fee schedule (either 85% or 100% of the fee schedule) as full payment for the consultation. You don’t have to pay anything out of pocket. This includes X-rays, blood tests, vaccinations, tests and other medical examinations. Please note that minors are always bulk-billed.

If you are bulk-billed, your Medicare card will be run through the system and you will have to sign a form. You do not have to pay anything. The doctor collects the cost of the consultation directly from the Australian health system. Currently, the grid rate for a standard consultation with a general practitioner is $36.30. As there is a large gap between the Medicare reimbursements that doctors can recover and the costs of running a medical practice, the majority of GPs do not bulk-bill.

How do I enrol for Medicare?

Every Permanent Resident or Australian Citizen is automatically and compulsorily enrolled in Medicare. The member is then issued with a card that allows them to be reimbursed for their medical expenses.

Citizens of countries with recirpocal agreemaents are also covered to certain degrees, as mentioned above. Click here to read about the UK’s agreement.

To enrol, you need to visit a Medicare Centre or call 132 011. You can also find more information on the government website: www.humanservices.gov.au/customer/dhs/medicare .

Documents you will need

  • Your passport or other valid travel document
  • Your visa (valid of course)
  • A document proving your dates of arrival and departure from Australia (e.g. your airline tickets)
  • Proof of health cover in your home country (if you are not from England, this could include your European Health Insurance Card (EHIC), health insurance card)
  • a document proving your country of residence (identity card, passport, bank statement etc.)

We strongly advise you to take all the above documents with you, even if you are not sure of their usefulness. It is better to have more documents and be able to apply there and then than have to go back another time. Even if they are not stated as necessary online, it would be a pity to have to postpone your registration.

Even if you are covered by the Australian health system, it is still advisable to take out supplementary insurance. And for those who are not eligible for Medicare, only private health insurance will cover your medical costs.

The paperwork

You will be given a fairly long form to fill out with all of your personal details. You can do this in person or online. In this form, you will have to declare that:

  • You have read and understood the privacy notice,
  • You are aware of the legal obligation to provide true and accurate information,
  • the information you have provided in this form is complete and correct.

You also state that you understand that:

  • You must inform Medicare of any changes in information,
  • The identity documents provided will be verified,
  • It is a serious offence to give false or misleading information.

Returning the paperwork

You must return this form and any supporting documents either:

By email to the following address MES@servicesaustralia.gov.au
(You are advised of the risks involved in sending personal documents via unsecured email.)

Or by post to the following address:
Services Australia
PO Box 7856

Once you have given your Medicare enrolment form to an agent, there are a few more steps. These include creating a MyGov account and installing the Medicare application on your mobile phone.

Finally, all you have to do is wait for your Medicare card to arrive by post within 2-3 weeks. In the meantime, don’t worry, you will already be covered by Medicare. Once you have your card, remember to take it with you when you go to the doctor or for other health care. It is best to put it in your bag with your ID to make sure you never forget it.

Future reforms of the Australian health system

Australia is one of the countries with the best health systems in the world. It ranks 6th behind South Korea, Taiwan, Denmark, Austria and Japan.

However, like many healthcare systems around the world, Medicare has been experiencing major difficulties in recent years. It is one of the issues that regularly comes to the forefront of Australian politics. A task force, comprising GPs, nurses, paramedics and academic experts, has been set up by the government to find ways to strengthen Medicare in Australia and repair a system that many believe is in crisis.

Several ideas have already been put forward at the beginning of 2023. These include launching a reform to improve access to care and putting more money on the table for a sustainable system. The population is getting older and sicker, while many Australians living in rural areas are disadvantaged. This working group also wants to encourage multidisciplinary care to support GPs. GPs often find themselves overwhelmed and unable to treat each of their patients properly. Improving digital patient data was also mentioned, as was the need to find more carers in remote areas.

In the end, the issues facing the Australian health system are the same as others around the world, despite its ranking as one of the best coverages in the world.

Frequently asked questions

How do I get treatment without Medicare?

If you are not an Australian citizen or permanent resident, you will not benefit from this health system. It is therefore imperative that you take out private insurance during your stay. However, you can still get medical treatment in Australia without insurance, you will just need to have some money in your wallet. You can find many articles on various insurance options on our site: Travel insurance

How much does it cost to see a doctor without Medicare?

If you get sick in Australia and you don’t have Medicare, be aware that the fees are quite high (hence the importance of having good insurance). You can expect to pay between AU$50 and AU$70 for a short consultation (10 to 15 minutes). Beyond 15 minutes, the price of the consultation can increase to almost $200. Prices vary depending on the doctor you go to see or the hospital where you will be treated. Make sure you know in advance. Find out more: How to get medical treatment in Australia

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  1. Thank you so much for sharing the post with everyone. People can easily understand the terms of this health care system. The post is full of information, and it talks with the process of signing up with this program, what is covered under the policy and also how it is funded. People can really get proper help after reading the post.


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