Medicare vs private health insurance: what's the difference?

The medical services and expenses subsidised by Medicare include:

• public patient hospital care – including emergency treatment, most surgeries and procedures, medicines provided in hospital and follow-up care. 
• some GP, specialist and health practitioner consultations as well as other medical services. 
• select tests, imaging and scans, such as X-rays, eye tests by optometrists, some pathology tests, and other diagnostic services.
• prescription medications that are subsidised through the Pharmaceutical Benefits Scheme (PBS).

Medicare does not cover the costs of:

• ambulance services
• health services provided through the private health system
• most dental services
• glasses, contacts and hearing aids
• cosmetic surgeries
• services not on the Medicare Benefits Scheme (MBS) 

Learn more about what Medicare covers.

Private health insurance is designed to give you more flexibility, choice and quicker access to some health services.⁴ It can be purchased from a registered health insurer, like Medibank. It’s usually paid for in monthly or annual instalments called 'premiums.'

There are different levels of cover to choose between, from basic to the most comprehensive. Your level of cover depends on your health needs, how much you'd want to claim back, excess, and whether you want access to other programs and services.

The benefits paid towards treatment depends on the type of cover you choose: 

When you take out a combined Hospital and Extras policy, your premium pays for both kinds of cover at once. You can choose the level of cover to suit you, from comprehensive cover to the essentials. And you can choose a policy that combines cover for you as well as your partner or dependents. 

Learn more: What is the difference between hospital and extras cover?

You can choose to include:

• Available to every Australian citizen and permanent resident. Some services may be available to residents of countries with a Reciprocal Health Care Agreement. 
• Access to necessary treatment in a hospital. 
• May be eligible to access free or subsidised support from other programs.² 
• Low or no cost treatment for common services, emergencies and GP visits.

• Some treatments and services aren’t covered
• There are longer wait times³, because patients are prioritised based on how urgently they need medical treatment.⁵
• You can’t choose your doctor, hospital, or when you are treated. 
• High-income earners who don’t hold an appropriate level of Hospital cover could be required to pay an additional tax every year, called the Medicare Levy Surcharge.