Health Insurance and Healthcare in Australia Explained

How Healthcare Works in Australia

The Australian healthcare system is one of the most comprehensive and best in the world. It is a hybrid system made up of two parts: public and private. People seeking healthcare in Australia should opt for primary healthcare first. This is given through a doctor or general practitioner (GP), nurse, pharmacists, or dentists. Medical specialists are also an option in Australia. They offer services in specific areas of medicine such as cardiology or gastroenterology. Learn more about finding a doctor, specialist, or dentist in Australia here.

We go over Australia’s public healthcare system in this section. For information on private health insurance in Australia, refer to the section below.

Australia Healthcare Facts

• Australia’s healthcare scheme is a universal public and private healthcare system with private options available.
• Everyone who is a permanent resident has access to the public system while half of the population have additional private insurance.
• Emergency room and doctor visits are free through the public scheme.
• Number of pharmacies: more than 5,000.
• Number of hospitals: around 1,300 (700 public and 600 private).
• More than 25,000 doctors and approximately 24,000 specialists.
• Specific healthcare programs are available for certain groups, such as Indigenous Australians and veterans.
• Two national health subsidy schemes: Medicare Benefits Scheme and Pharmaceutical Benefits Scheme.

How Does Healthcare Work in Australia?

The public system is made of several parts, including public hospitals, community-based services, and government-owned health organizations. It is run by all levels of the government—federal, state and territory, and local.

Eligible expats wishing to register with the public system must do so within a week of arrival to Australia. To register and receive their Medicare (government-run healthcare system) card, they will need

• a passport;
• travel documents;
• permanent visa.

The process can take up to a month, and you can sign up online or in person at a Medicare office.

Does Australia Have Free Public Healthcare?

Yes. Australian citizens and permanent residents in the country, including those applying for permanent residency, can access the public health system at no or little cost via Medicare—Australia’s way of making healthcare accessible to all. Medicare has been in place since 1984 and is nationwide, available in all states.

Medicare is also available to expats from eleven countries because of the Reciprocal Health Care Agreement with Australia. These countries are:

• Belgium
• Finland
• Italy
• Malta
• Netherlands
• New Zealand
• Norway
• Ireland
• Slovenia
• Sweden
• United Kingdom

Expats from other countries are advised to take out private health insurance. Otherwise, in an emergency, you will be expected to pay out-of-pocket for any treatment during your time abroad.

What Does the Public Healthcare Cover?

Medicare in Australia covers the following:

• costs of treatment for public patients in public hospitals including doctors’ services, hospital costs, and more;
• 75% of the fee for certain doctors’ services in hospital if you are treated as a private patient;
• all or some of the cost of a GP or specialist;
• some tests and examinations ordered by your doctor;
• reduced costs on some prescription medication.

Australia Healthcare Costs

Medicare is paid for through taxes. Taxpayers contribute 2% of their taxable income to fund the system. Between 2016 and 2017, Australia spent about 181 billion AUD (more than 125 billion USD) on their healthcare system—10% of its GDP (1 AUD (nearly 1 USD) in every 10 AUD (7 USD)). It was funded by the

• Australian government (41%);
• state and territory governments (27%);
• individuals (for products and services not fully covered) (17%);
• private health insurers (9%);
• non-government organizations (6%).

The Australian government is in charge of funding medical services and subsidized medicines. They also spent 5.5 billion AUD (more than 3.8 billion USD) for health research between 2016 and 2017.

State and territory governments are responsible for funding most of the spending on community health services.

Both the Australian, along with the state and territory governments, fund public hospital services jointly.

Australia Healthcare System Pros and Cons

Pros 

• Tax-funded, affordable healthcare system which offers free healthcare to the public.
• Government subsidizes private insurance, which covers dental care and private hospitals.
• Covers medical prescriptions.
• Death rate in Australia is one of the lowest in the English-speaking world—lower than the UK and US.
• Life expectancy is the sixth highest in the world, according to the OECD.

Cons 

• Long waiting periods for hospital medical procedures and emergency rooms.
• Lack of life insurance policies.
• Dental, vision, and long-term care not covered by the public system.

An Overview of Private Health Insurance

How does health insurance work in Australia? Private health insurance in Australia is “community-rated” meaning everyone is entitled to buy the same product at the same price, except for Lifetime Health Cover (learn more about this below) and Age-based Discounts. Everyone has a right to renew their policy, and an insurer cannot refuse to sell you any plan you wish to purchase.

Do You Need Health Insurance in Australia?

Private medical insurance in Australia is not a requirement. However, the Australian government strongly suggests those who can afford to purchase private health insurance to do so, to ease the burden on the public system. Fifty percent of the population in Australia buys additional private health insurance. This is because the public scheme does not cover everything, such as ambulance transportation.

Keep in mind that while health insurance is not required, if you do not purchase at least hospital coverage by July 1 following your 31st birthday, you will end up paying Lifetime Health Cover loading for any hospital stay. This is a government initiative that began in 2000 to encourage people to purchase private insurance.

Health Insurance Coverage

Private health insurance in Australia is broken down into three main groups: hospital cover, “extras” cover, and ambulance cover. Read on to learn about each of these categories.

Hospital

With hospital cover, you choose which doctor and hospital you see and attend, respectively. You can choose to be treated as a public or private patient in either a public or private hospital. If you decide on a private hospital, you avoid the long wait times of the public sector. If you choose to be treated as a private patient in a hospital (whether private or public) Medicare will cover you for 75% of associated medical costs. The remaining 25% will be billed to you—your private insurer may cover some or all. This could be for:

• hospital stay;
• intensive care;
• operating theater fees;
• drugs, dressing, and consumables;
• surgically implanted prostheses;
• diagnostic tests;
• pharmaceuticals, and
• any additional doctor’s fees.

Extras

Extras involve general treatment, and can include things like:

• dental exams and treatment;
• physiotherapy, occupational therapy, eye therapy, speech therapy, chiropractic services, podiatry or psychology services;
• acupuncture;
• vision care (glasses and contact lenses);
• hearing aids, and
• home nursing.

Typically, insurance plans only cover extras up to a specific limit per year. Make sure you inquire about this and are clear on this limit before settling on a provider.

Ambulance

Medicare does not cover ambulance rides. Therefore, this is one of the principal reasons people opt for private insurance. Most health insurers offer combination packages with these services.

Be sure to ask what exactly is covered by your insurer—some cover all travel while others are limited.

How Much is Health Insurance?

This depends entirely on the plan you purchase, what is included in your coverage, and the level of coverage. The average cost of health insurance in Australia in 2018 was 166 AUD (115 USD) per month. The average hospital insurance was roughly 2,000 AUD (1,382 USD) per year, and extra policies cost approximately 850 AUD (587 USD) annually. The following outlines the average cost per month, which includes general treatment and hospital insurance, based on level of coverage for 2019.

Basic 200 AUD 140 USD Medium 300 AUD 205 USD Top 300 AUD 210 USD

In April 2019, the Australian government also introduced a new tiering system for hospital insurance: basic, bronze, silver, and gold. The average price per month based on a single policy across ten funds in Sydney was as follows:

Basic 80 AUD 55 USD Bronze 90 AUD 60 USD Silver 130 AUD 90 USD Gold 170 AUD 120 USD

Types of Health Insurance Plans

The following is a list of various policies from different funds across Australia, and their cost per month.

Plan AUD USD HBF’s Ultimate with GapSaver 624 430 Medibank’s Ultra Health Cover 460-530* 320-370 Westfund’s Platinum Plus 490 340 Bupa’s Ultimate Health Cover 460-470* 320 com.au’s High 85 460 320

*Cost varies dependent on Australian territory.

HBF, Medicare, and Westfund are among Australia’s most expensive providers, while the cheapest three combined came from ahm health insurance in the Northern Territory. Other affordable health insurance plans include the cheapest extras policy in the Northern Territory from HCF for 6 AUD (4 USD) a month, followed by the second cheapest from Mildura at 11 AUD (8 USD) per month, available across Australia. The most expensive policy in the country is from GU Health at 155 AUD (107 USD) a month.

How to Get Health Insurance in Australia

To obtain health insurance, you should contact your chosen company once you have compared and settled on the right coverage for you and your family. Once you sign up, be aware that you will be subject to a waiting period before you can claim any of your benefits or receive particular treatment. For pre-existing conditions or pregnancy, you may need to wait up to twelve months.

How to Find a Doctor or Dentist

All the information you need to know on how to find a doctor or dentist, even specialists in Australia can be found in this section. To help get you started, you can search on the Australian Doctors Directory. This guide lists specialists, doctors, and even services across all states.

How to Find a Family Doctor

In Australia, family doctors are referred to as general practitioners (GPs). You will have no problem finding a doctor in major Australian cities and capitals. If you happen to be an expat in a rural area, you might have to travel some distance to get to one. Unlike in some countries, it is not necessary to be registered with a specific doctor in Australia—you can see any doctor either as a public or private patient.

To see a GP, you must have an appointment. This is usually made a couple of days in advance. If it is urgent, you may be seen immediately, but whenever possible, it is best to make an appointment at least a day before.

How to Find Specialists

Public patients must be referred to specialist doctors by a GP. Private patients can make appointments directly with specialists, although most insurance companies still prefer you to be referred. If not from their doctor, private patients may also get recommendations for specialists from friends, family, work colleagues, or through their research.

How to Find a Dentist

You do not need to register with a specific dentist to see a dentist. An excellent starting point to help you in your search is the Australian Dentists Directory. It lets you search by state, and the type of dentist (denture specialist, orthodontist, cosmetic dentistry, etc.) and service you need.

Average Wait Time to See a Doctor in Australia

Even with an appointment, doctor’s offices are usually packed full so it may be well past your appointment time before you are finally seen. Medicare patients must also be prepared to wait a long time to see specialist doctors as there are long waiting lists.

For example, for a hip replacement, half of the population across the country waits more than a month for the procedure, and 10% of patients wait more than six months. In Australia’s smallest state, Tasmania, 10% of patients wait approximately one year for an elective procedure. This is without counting the time it takes to get on the waitlist.

For specialist dentist procedures such as root canals, fillings, and extractions, 9% of the population in New South Wales and roughly 25% in South Australia wait more than a year for public services. In other states, here are the percentages of people who waited more than a year for public dental services:

• Western Australia—16%
• Queensland—16%
• Tasmania—17%
• Victoria—17%

One-third of patients with acute mental illness will wait more than eight hours in an emergency room at the hospital before being treated.

Giving Birth in Australia

For non-residents giving birth in Australia, if you are from one of the countries outlined above, covered under the Reciprocal Health Care Agreement, you will be covered through Medicare. This means you will be entitled to free or subsided essential treatment.

If you plan on having a baby in Australia as a foreigner, it is recommended you take out private insurance. Otherwise, you will be responsible for covering the expensive costs yourself.

Unlike in some other countries, birth tourism is not so popular in Australia due to the high prices of having a baby here.

Cost of Having a Baby in Australia

Giving birth in Australia without health insurance will be pricey if you are a foreigner with no coverage. Without private health insurance, you will be responsible for paying the following average costs out-of-pocket.

Reason for Visit AUD USD Prenatal doctor visit and care 75-150 per visit 50-100 Prenatal ultrasound 60-280 40-190 C-section 14,000 9,700 Regular birth 9,000 6,220 Home birth and delivery with midwife 3,000-5,000 2,070-3,450

If you use a public hospital, your fees will generally be lower versus if you choose private care. New mothers who have a natural birth can expect to stay in the hospital anywhere between four and 48 hours. Those who give birth via C-section should plan to stay in the hospital anywhere between three to four days.

Documents to Bring

When you are ready to give birth, make sure you bring along the following documentation with you in your hospital bag:

• Antenatal card
• Copies of your birth plan
• Private health insurance details (if applicable)
• Medicare card (if applicable)
• Money for fees (if applicable)

Benefits of Giving Birth in Australia

Unfortunately, giving birth in Australia for citizenship (for the child) does not automatically mean that your child will be Australian. However, one of the benefits of giving birth in Australia as a permanent resident is that your newborn will acquire Australian citizenship (at least one parent must have permanent resident status). But if you are in the country as a temporary resident only (on a Temporary Work visa, for example), then your child will receive the same visa status as you.

For those eligible, there are plenty of other benefits of giving birth in the country. The Australian Government Department of Human Services offers monetary help and services for those having a baby here to assist new parents. Some payments include:

• Parental Leave Pay—Working parents get time off to care for their newborn.
• Dad and Partner Pay—Fathers and partners get up to two weeks off work to care for a newborn.
• Family Tax Benefit (FTB)—This is a two-part payment to help with the costs of raising a child.
• Parenting Payment—An income support payment if you are a young child’s caregiver.

The government also offers a Child Care Subsidy and an Additional Child Care Subsidy. If your child is born with a disability, you may be eligible for the Child Disability Assistance Payment, which is an annual payment to caregivers of a disabled child.