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A Guide to Health Insurance in Australia

Jacaranda Team

Jacaranda Team

April 15, 2021 5 minute read
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A Guide to Health Insurance in Australia

If you are an Australian considering whether purchasing a private health insurance plan is worth it or not, let’s dive into the Australian healthcare system, the different levels of cover available and more in this guide to health insurance in Australia.

How the Medicare System Works

Medicare is the universal health scheme in Australia. It guarantees all Australians and people from other countries with reciprocal healthcare agreements access to a wide range of medical treatment and hospital treatments at low or no cost. Health services that you can access for free or at a lower cost with a Medicare card include:

  • Doctors visits, some specialists and other health professionals
  • Hospital treatment
  • Prescribed medicines
  • Diagnostic imaging services (ultrasound, CT scans, X-rays, MRI scans)

The Medicare Benefits Schedule (MBS) lists all of the Medicare services subsidised by the Australian government. These services are not completely free but you will receive a government rebate either after paying the full price or the rebate will be factored into the price before you pay. 

What is the Medicare Levy Surcharge?

The Medicare Levy Surcharge (MLS) is a levy paid by the Australian tax-payers that don’t have private health insurance and earn above a certain income. The surcharge encourages these individuals to purchase private health insurance and to use the private system where possible, to reduce the demand on the public health system. 

What is Private Health Insurance Australia?

Health insurance is used to help cover the costs of health services like medical and surgical expenses. There are two main types of health insurance premiums available in Australia: hospital cover and extras cover. 

Hospital Cover

Hospital cover covers the costs of a patient to be treated as a private patient in a public or private hospital. This allows the patient to choose the doctor they’d like to treat them, accommodation to stay in a ward, and any incurred theatre fees for surgery. You may also be covered for elective surgeries and emergency/medically necessary surgeries. This means that if you are admitted to a hospital, you can choose to stay in a private or public hospital depending on your preferences. You may choose to use your private cover if you will be in for a longer stay, or stay public for a short visit. You have this choice with hospital cover.

Ambulance Cover

Not all states provide Medicare coverage for the use of ambulance services. Queensland and Tasmania residents are covered by the state government; for everyone else, they can either purchase an ambulance subscription or private health insurance. Otherwise, they will have to pay the full price of the ambulance. 

  • NT, SA, VIC and rural WA can subscribe to their state’s ambulance service or buy ‘ambulance insurance’ through private health funds. It may be included in a hospital cover or extras insurance plan.
  • NSW, ACT and metro WA – ambulance cover is included in private hospital insurance and some extras cover.

Extras Cover

Extras cover provides a benefit towards the cost of treatment outside of the hospital, including medical services and non-medical/allied health care. There are different levels of extras cover available, which can often include benefits including dental, optical, physiotherapy and/or chiropractic care. Other extras treatments and medical services may include:

  • Osteopathy
  • Antenatal/postnatal 
  • Pharmacy medicines
  • Dietary services
  • Psychology
  • Podiatry
  • Speech therapy
  • Eye therapy
  • Occupational therapy
  • Health aids and appliances

Combined Hospital and Extras Cover

A combined policy includes both hospital and extras cover in one plan. In this way, you only have to deal with one company and make one payment which can simplify things if you require both types of cover. It is important to determine that you will get value for money for both levels of cover; for example, if you do not require hospital cover, it may only be beneficial to purchase extras cover. 

Waiting Periods

If you decide to switch health insurance providers/policies, you may be required to wait a period of time before you can claim for some treatments included in your plan. 

Extras Cover Waiting Period

Waiting periods can vary between different companies, though typically, it will be two months for most services and up to 12 months for major dental and orthodontics. For other major services like hearing aids, you may have to wait up to 36 months to access your hospital cover benefits. You may wish to check with your health insurance provider. 

Hospital Cover Waiting Period

If you have a pre-existing condition or are having a baby, waiting periods are usually 12 months. If you switch to a hospital cover considered the same or lower level than your existing policy, the waiting period may be carried over. If you are unsure, it may be helpful to ask your insurance provider. 

Health Insurance Australia Providers: Compare Health Insurance Policies

There is a range of health insurance providers in Australia for you to choose from. To ensure that you purchase the type and level of cover most suited to your needs, it may be helpful to compare health insurance policies. Here are just a few health insurance companies you may wish to investigate further:

  • AHM Health Insurance
  • NIB Health Insurance
  • Qantas Health Insurance
  • Medibank Health Insurance
  • HCF Health Insurance
  • Bupa Health Insurance
  • CUA Health Insurance
  • Westfund Health Insurance

Medical Loans from Jacaranda Finance

Is private health insurance not for you? Have you recently switched insurance providers and can’t spend a month waiting to be covered under your new plan? In any instance you are not covered for your medical expenses, you may wish to consider a medical loan from Jacaranda Finance. Jacaranda Finance offers medical loans from $300 to $10,000 to cover any unmanageable medical expenses that cannot be put off. 

Jacaranda Finance is a quick cash loan specialist. We process our loans within 60-minutes* and you can receive your cash within 60-seconds of approval**. We are an award-winning online lender specialising in short term financial solutions. Whether you have medical expenses or personal expenses, consider Jacaranda Finance as your lender of choice.

*If you apply within our standard business hours

**If you have an NPP-enabled bank account


Jacaranda Team
Jacaranda Team

Written by Jacaranda Team

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