Understanding your options in Australia’s health system
Navigating the health system can be confusing! It has its own language, you deal with many health professionals and organisations, and when you actually need health care is when you are least likely to have the time to learn about it.
In this section, you’ll find some useful information to help you find your way and get the most from your health care.
The Australian health system provides all Australian residents with access to affordable, accessible and high-quality health care.
This Government scheme, known as Medicare, is typically referred to as ‘public health care’. To find out more visit www.medicare.gov.au
Private health insurance allows people to choose a higher level of cover and greater flexibility about how and where their health care is delivered.
You can choose whether to have Medicare cover only or a combination of Medicare and private health insurance. The Private Health Insurance Administration Council has an easy to read booklet that explains the Australian health system. It’s called Insure? Not Sure?
Please note: overseas students and visitors on temporary visas are not eligible for Medicare benefits, unless they are from a country with which Australia has a 'Reciprocal Health Care Agreement'. See the sections on overseas students and overseas visitors for further information about health insurance products appropriate for your needs.
Why private health insurance?
Private patients have more control in choosing their treating doctor in hospital. And in some instances, a privately insured patient can reduce their waiting time for elective surgery by receiving their treatment in a private hospital.
Private health insurance also offers cover for some or all of the costs of other services not covered by Medicare, such as ambulance transport, dental, optical items, physiotherapy, pharmaceutical (not covered by the Pharmaceutical Benefits Scheme) and a wide range of other services.
See our ‘About Health Insurance’ section for more details about the range of benefits available through private health insurance, whatever your stage of life.
If you already hold private health insurance, check that your health cover best meets your needs with a free consultation with one of our consultants at a Medibank store or call us on 13 23 31. You should be aware that all health funds have waiting periods and other conditions that apply before benefits are payable.
How is private health insurance regulated?
The Australian Government regulates private health insurers, who must be registered under the Private Health Insurance Act. The policies they sell must comply with statutory regulation. These are the only health insurance products which can be sold in Australia and attract a Government rebate (see Calculating your Premium).
Australia’s private health insurers are also monitored and regulated by an independent statutory authority known as the Private Health Insurance Administration Council (PHIAC). A second independent authority, the Private Health Insurance Ombudsman (PHIO), is a service to help consumers with private health insurance problems and enquiries.
All private health insurers are required to keep up-to-date standard information statements (SIS) of every resident product they sell. You can visit www.privatehealth.gov.au to access these statements.
Calculating your premium
Unlike other insurances, health insurance premiums are not calculated on ‘risk’ factors. This is called community rating. Factors such as age, gender, race, health status, lifestyle choices or claiming history cannot be taken into account in calculating your premium. Community rating means everyone pays the same premium for their private health insurance.
The Australian Government offers a rebate on private health insurance premiums to Australian residents who are eligible for full Medicare benefits. The Federal Government 30% Rebate on private health insurance premiums (administered by Medicare Australia) makes health cover more affordable for eligible members (and can be up to 40% in certain circumstances).
Lifetime Health Cover is another Australian Government initiative to encourage people to take out hospital cover early in life and maintain it. For each year an individual remains uninsured after the age of 31, there is a loading increase of 2% on top of the base premium. The maximum loading is 70%. The loading must be removed after the member has held appropriate hospital cover for a period of 10 continuous years.
About to go to hospital?
We understand that going to hospital can be quite a daunting experience and you're probably not entirely sure what to expect. Before you go, check out our Going To Hospital Guides.
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