Is Medicare Private Health Insurance in Australia? Navigating the Maze

Is Medicare Private Health Insurance in Australia? Navigating the Maze

Is Medicare Private Health Insurance in Australia? Navigating the Maze

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The Australian healthcare system often feels like a labyrinth, especially when distinguishing between Medicare and private health insurance. This article delves into the nuances of these two key pillars of Australian healthcare, providing clarity on a topic that often leaves many confused: Is Medicare private health insurance?

A Private Health Insurance Option In Australia That Complements The Medicare Program.

Is Medicare Private Health InsuranceThe Public Health Backbone

Medicare, Australia’s universal health insurance scheme, is the bedrock of the country’s healthcare system. It’s like the ever-reliable family sedan – not flashy, but it gets the job done. 

Medicare covers a range of services, including hospital, medical, and pharmaceutical costs. When you visit a doctor outside a hospital, Medicare will reimburse 100% of the Medicare Benefits Schedule (MBS) fee for a general practitioner and 85% for a specialist. 

However, Medicare does not cover private patient hospital costs, medical and hospital services overseas, cosmetic surgeries, ambulance services, or certain medical tests and procedures not deemed clinically necessary.

Private Health Insurance: The Complementary Limousine 

In contrast, private health insurance in Australia, often viewed as the limousine of healthcare, offers more personalized and flexible healthcare options. It’s ‘community rated,’ meaning everyone gets the same product at the same price, with some exceptions. Private health insurance covers services not included in Medicare, such as most dental treatments, physiotherapy, and optical services. It also allows for choice in doctors and hospitals and potentially shorter waiting times.

Hospital and Extras Cover: Your Healthcare Wardrobe 

In Australian private health insurance, “Hospital and Extras Cover” represents two key aspects of health coverage. Hospital cover provides the choice of doctor and hospital for private patients, covering a range of treatments listed under the Medicare Benefits Schedule (MBS) and more. Policies vary, offering different levels of cover, categorized as Gold, Silver, Bronze, or Basic. 

Extras cover, or general treatment or ancillary cover includes dental, chiropractic, and physiotherapy services. These services are often covered to a limited extent with various limits applied. It’s crucial to check with insurers for exact coverage details and any applicable limitations or exclusions.

​The Pros and Cons: A Balanced View of Medicare and Private Health Insurance in Australia

When comparing Medicare and private health insurance in Australia, it’s important to consider their advantages and disadvantages to make an informed decision that suits your healthcare needs and preferences.

Medicare Pros and Cons


  • Covers 100% of the Medicare Benefits Schedule (MBS) fee for GPs and 85% for specialists.
  • Bulk billing options eliminate out-of-pocket expenses.
  • Coverage includes many tests, examinations, pathology tests, eye tests, and procedures by doctors.
  • Part of the cost of PBS prescription medications is covered.
  • Hospital care in a public hospital as a public patient is free.


  • Limited choice in selecting doctors or hospitals.
  • Long waiting times for admission in public hospitals.
  • No coverage for private patient costs.
  • Lack of overseas medical and hospital cost coverage.
  • Excludes services not clinically necessary, such as cosmetic surgery.
  • Does not cover ambulance services.
  • No coverage for ancillary services like dental, physiotherapy, and optical

Private Health Insurance Pros and Cons


  • Freedom to choose doctors, hospitals, and admission times.
  • Coverage for services not included in Medicare, like physiotherapy and dental.
  • Option to use public hospitals with private health insurance.
  • Potential access to private rooms in hospitals.
  • Government subsidies through Private Health Insurance Rebate.
  • Different coverage tiers to suit various needs and life stages.
  • Shorter waiting times for elective procedures.
  • Financial protection against high costs of medical treatments.
  • Possible avoidance of the Medicare Levy Surcharge for high-income earners​​​​.


Frequently Asked Questions:

Is Medicare considered private health insurance?

No, Medicare is a public health insurance scheme available to all Australian citizens and permanent residents. It provides basic healthcare coverage.

What does private health insurance cover that Medicare doesn’t?

Private health insurance covers services not included in Medicare, such as most dental treatments, physiotherapy, optical services, and the choice of doctor and hospital.

Can I have both Medicare and private health insurance?

Yes, you can have both. Many Australians use Medicare for general health costs and private insurance for additional services and choices.

The Bottom Line:

In conclusion, while Medicare provides essential coverage for many Australians, it has limitations in terms of choice and the range of services covered. On the other hand, private health insurance offers more flexibility and additional coverage but comes at a higher cost and with its own set of limitations. Understanding these pros and cons can help you decide which option, or combination of both, best suits your healthcare needs and circumstances.

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*The information this blog provides is for general informational purposes only and is not intended as financial or professional advice. The information may not reflect current developments and may be changed or updated without notice. Any opinions expressed on this blog are the author’s own and do not necessarily reflect the views of the author’s employer or any other organization. You should not act or rely on any information contained in this blog without first seeking the advice of a professional. No representation or warranty, express or implied, is made as to the accuracy or completeness of the information contained in this blog. The author and affiliated parties assume no liability for any errors or omissions.