Medicare vs Private Health Insurance

When it comes to medical cover there is a question that’s on most people’s minds, will Medicare cover me or will I need a private health insurance cover?  Medicare is our public health scheme providing free or subsidised healthcare to all Australians that are permanent residents. Medicare is made up of three main areas: hospital, medical and pharmaceutical. 

Each eligible person in Australia is issued a Medicare card to present every time you see a doctor, go to hospital, or get a medical test done. 

Comparing private health insurance plans with Medicare is the best way to ascertain whether you will have the correct cover and whether you require a mix of both Medicare and private health to give you the most affordable private health insurance. In this month’s blog we will cover everything you need to keep in mind when making your final decision.  

The Advantages of Medicare 

No Cost to You – supplemented by the Australian Government 

  • medical services provided by doctors, specialists, and other health professionals (if your doctor bulk bills, you won’t have to pay for anything)
  • Free or at a lower cost prescription medicine
  • Save money on medical costs by registering your family for the Medicare Safety Net 

What is covered by Medicare 

Medicare partially or fully covers:

  • seeing a GP or specialist
  • tests and scans, like x-rays
  • most surgery and procedures performed by doctors in the public system
  • eye tests by optometrists

For instance, when you are visiting your GP and they have a bulk billing service, Medicare will cover the costs of the visit and you will not have any out-of-pocket expenses. It’s always a good idea at the time of booking to ask your medical practice if they bulk bill and if not enquire how much you will get back as a rebate from the overall fee. 

A great reference tool to find a practitioner that bulk bills can be found here, simply choose the service required and add your postcode or location. It will also give you an idea of what providers offer a competitive charge so you have a comprehensive health plan.

What’s not covered by Medicare 

Unfortunately, Medicare does not cover ambulance levies so you will need to find and organise an Ambulance provider or make sure you’re covered through a private health policy for this service. 

Other items not covered under the Medicare scheme:

  • hearing devices
  • workers’ compensation check-ups or life insurance
  • in home nursing assistance
  • most dental services
  • Chinese medicine, alternative therapies, or complementary medicine (unless it has been ordered by a doctor)
  • Glasses and contact lenses.

About the Medicare Safety Net

A provider of larger rebates to those that have substantial healthcare costs, the Medicare Safety Net offers further assistance with out-of-pocket costs. For example, when you spend a certain amount on healthcare over the course of a year and reach the Medicare Safety Net threshold, Medicare will provide a larger rebate for a wide range of services, including:

  • biopsies
  • blood tests
  • healthcare professional consultations
  • pap smears
  • psychiatry
  • radiotherapy
  • scans
  • ultrasounds
  • x-rays.

Mixing Medicare with Private Health Insurance

Even if you have private health insurance you can still access benefits from Medicare. Some customers opt to have their hospital insurance through their private health fund which allows you to have treatment in a private hospital or as a private patient in a public hospital. The private health system is divided into three areas: hospital, extras, and ambulance.

Advantages of private health cover:

  • Nominate your own doctor/ specialist
  • Less waiting time for non-elective surgeries
  • Choice of hospital 

Private health insurance doesn’t cover:

  • GP visits
  • some specialist visits
  • visits to hospital emergency departments, both public and private
  • any x-rays or other scans
  • any blood tests or other pathology tests.

It’s all about Affordability 

Whether you can afford to pay for private health insurance is a big factor. You may choose only to have Medicare cover, due to the cost of private health cover. It really comes down to your budget and what works best for your financial situation.  Medicare is still a great alternative option for your health and well-being.

Some important things to keep in mind

If require non-urgent, elective surgery or treatment the waiting times can be longer in the public Medicare system. So, choosing a private health policy that will cover your surgery and speed up the process may be something to think about.  

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To compare private health insurance  – speak to one of our team members today on 1300 861 413 or email us

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I’ve exhausted my extras this year, what can I do?

Each calendar year, your extras cover on your private health policy resets on January 1. Some funds vary, but mostly all extras policies reset around this time. Extras policies can cover such services as dental, optical, and physiotherapy. So, what can you do if you’ve exhausted all your extras limits for this year? Don’t worry, there are still options available to you. Let’s explore some practical solutions to help out if you’ve used up all your extras cover.

Prioritise essential treatments:

1. When you’ve exhausted your extras limits, it’s important to plan ahead so you know when the limits reset and prioritise your essential treatments. Focus on services that are necessary for your health and well-being. For example, if you have ongoing dental issues, make sure to book your regular check-ups to avoid extra out-of-pocket expenses if you need extra fillings or dental work done. By prioritising essential treatments, you can ensure that you’re taking care of your health while making the most of the coverage you have left before the ailment becomes a major issue.

Source discounted packages from health providers:

2. Look for professionals who offer competitive rates or discounted packages. Some providers may also offer a combination of bulk-billing and payment plans to help out. By researching and comparing different provider options, you might find more affordable alternatives for the health services you need.

Review your policy:

3. Take the time to review your current private health policy. Check if there are any additional benefits or options that you may have overlooked. Some policies offer loyalty bonuses or additional coverage for specific services. By understanding the details of your extras component of your private health policy, you can make informed decisions about utilising your benefits and potentially find hidden perks that you haven’t taken advantage of yet.

Consider waiting until the new year:

4. If you’ve exhausted all your extras limits and can afford to wait, you may consider postponing non-urgent treatments until the new year. By doing so, you’ll be able to take advantage of the refreshed limits and maximise your extras coverage once it resets. 

Seek professional advice:

5. Talk to your private health fund, they can provide guidance based on your specific policy and circumstances. They’ll help you navigate the policy, understand your options, and give suggestions for strategies to make the most of your extras coverage.

Reaching the extras limits on your private health cover doesn’t mean you’re out of options. By prioritising essential treatments, exploring alternative providers, reviewing your policy or waiting until the new year, you can still make the most of your coverage. Remember, the key is to be proactive when it comes to your healthcare needs and plan ahead. 

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To compare private health insurance extras and discuss what’s  best for you – our friendly team are ready to talk you through the options. Call us on  1300 861 413 or email us

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Just married. Do we need couples’ private health cover?

Just got hitched? You might be wondering whether switching to a couples private health policy is right for you. Well, the good news is, there’s no hard and fast rule that says married couples have to switch to a joint private health insurance policy. Ultimately, the decision is up to you and your spouse, and it will depend on your specific situation.

One of the advantages of opting for a couples private health policy is that it can potentially lower the overall cost of your private health insurance premium compared to having two separate single policies. 

Here are some benefits of couples’ private health insurance to consider:

  1. Lower overall cost: Couples policies may come with lower premiums compared to two individual policies. More convenient, as you’ll only have one policy to pay, and managing just one account will definitely simplify things.
  2. Flexibility: Some private health insurers offer the flexibility to choose a policy with a combined annual limit. This allows each partner to select the extras services that suit their individual needs. For example, one partner could choose to spend more on optical while the other opts to spend more on dental care.
  3. Enhanced coverage for family planning: Couples private health policies tailored towards individuals in their 20s and 30s typically offer more comprehensive coverage for family planning needs such as fertility treatments and pregnancy services.

It’s important to remember that your private health cover needs may change over time due to various factors like getting married, a long-term relationship, starting a family, health conditions, or changes in your lifestyle or life stage. These factors can greatly influence your private health insurance requirements.

For example, if you’re at the stage of planning a family, comparing private health insurance options becomes really important. There are numerous options available when it comes to pregnancy and starting a family. It’s worth noting that pregnancy, birthing, and reproductive services like IVF typically fall under top-tier Gold hospital cover. Some private health insurers may also offer specific Silver Plus policies tailored for couples looking to start a family.

It’s important to keep in mind the waiting periods that come with obstetric services such as pregnancy, birthing, and IVF; they usually have 12-month waiting periods. So, if you want to take advantage of the benefits offered by top-tier cover, it’s essential to take out a policy well ahead of time before you start to try for a baby.

Does couples’ private health cover provide double access to extras treatments?

The answer is no. Usually, when it comes to an extras policy, claim limits still apply per person but some private health providers allow couples to combine their extras annual limits. It’s worth checking with your private health fund if they offer this option. 

Before deciding on a joint private health policy once married, it’s important to ask yourselves these five questions:

What kind of coverage do we need?

1. Even though you’re now married, it’s a good idea to consider your individual health needs and the level of coverage that suits you both best. Take a look at options such as Gold, Silver, Bronze, or Basic levels of hospital cover, ambulance cover, extras cover, or a combined hospital and extras policy. 

What are your partner’s requirements?

2. It’s essential to understand your partner’s health needs as well. Do their requirements align with yours, or would both of you benefit from different types of coverage?

Will your health needs change in the future?

3. Keep in mind that all hospital policies have waiting periods of up to 12 months, and some extras policies may have even longer waiting periods. Consider this if you anticipate changes in your or your partner’s health needs. 

Are either of you subject to LHC loading?

4. If either of you obtained a hospital policy after your 31st birthday and on or after July 1, you’ll need to pay the government’s LHC loading in addition to your hospital policy premiums. This loading fee increases by two percent for each year you didn’t have hospital cover. For a couples hospital policy, the applicable LHC loading will be averaged out between the two of you and added to your premiums. 

Are either of you eligible for the age-based discount?

5. The age-based discount offers premium discounts on certain hospital policies if you take out health insurance before turning 29. On a couples policy, the discount is averaged between both individuals. So, if you qualify for a 10% age-based discount on a singles policy but your partner doesn’t, a couples policy would receive a 5% discount, averaged between the two of you.

As you build a future together, making sure your private health cover aligns with your new life stage and individual needs will give you peace of mind. Find the policy that’s right for you and get the most out of your coverage today by comparing private health plans.

Call our friendly team today on 1300 861 413 or email

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