Understanding the Australian healthcare system

We’re here to help you understand the Australian healthcare system and how to navigate it. A little knowledge will help you to be confident you are getting the best healthcare services, when you need them.

Healthcare services in Australia are funded by the Australian Government and by private health insurance. Australia’s public healthcare system is called Medicare. Medicare provides healthcare for Australian residents for free, or at a reduced cost. It is paid for out of taxes that every Australian pays.

Medicare covers many essential treatments but not all of them. It covers things like medically necessary hospital procedures in public hospitals, visits to the doctor and some medicines. It does not cover treatments in private hospitals, ambulance services and extras services like glasses, dental treatment and natural therapies. This is why many Australians choose to have private health insurance.

The benefits you get when you have OSHC are similar to the cover Australians get through Medicare.

This is a list of set benefits for specified medical services that the Government pays for through Medicare.

It is used by private health insurers to calculate benefits for hospital treatments. The same schedule applies to both Australian permanent residents and non-residents such as student visa holders. 

If your doctor’s fees are not covered by the MBS, or your health cover, you may have to pay a gap fee. This is called out-of-pocket expenses. 

You should always talk to your doctor when planning any medical treatment or surgery to make sure you fully understand whether you will have any out-of-pocket expenses. 

This is the time you must wait before you can claim a benefit. Some costs are not covered straight away and you must wait for the period stated on your policy before you can make a claim. This includes pre-existing conditions and pregnancy-related services.

Extras cover gives you money back for non-hospital services including dental treatment, physiotherapy, optical services and more. The amount of money you can claim back depends on the level of cover you have. If you have a higher level of cover, you usually get a higher percentage of costs back. Your annual limit is usually higher as well. 

Your OSHC does not include Extras and if you want to be covered you can contact your OSHC provider.

This is the amount you need to pay yourself if the amount the medical provider charges is more than the benefit you’re allowed under your OSHC. If you like, you can call your doctor or medical centre before your appointment to get an idea of what it will cost you.

This is when your OSHC gives you access to selected doctors in medical centres who bill your OSHC provider directly. The advantage of this is you don’t have to pay upfront and make a claim.

If you need basic medicines like cough and cold remedies or mild painkillers, you can simply walk into any pharmacy and buy them. These are called over-the-counter medicines. Some over-the- counter medicines, like asthma inhalers, can only be sold to you after you have spoken to the pharmacist. 

You can also buy some over-the-counter medicines in supermarkets and health food stores, which have a large range of alternative medicines. 

You can find out more information about the Australian healthcare system at the Department of Health website.