Medicare Australia’s Health Care System


Medicare is Australia’s health care system and can be very confusing

It is tricky enough finding Doctors, Dentist’s, grocery stores and pharmacies let alone knowing how to navigate health insurance and medicare and what is covered by what!

So we’ve got some top Joy tips to make it as simple as possible.

Ok, now Medicare is universal health care that is a tax payer funded medical safety net here in Australia.

For residents living here it entitles them to free health care at all public hospitals throughout the country. This also means if you are seen by a GP or private specialist i.e gastroenterologist, surgeon, dermatologist (optometrists also are covered in this group) etc that you can claim some of the out-of-pocket expenses that you pay, back from medicare.

If you have moved here temporarily then you probably have arrived with overseas health insurance.

Being a temporary visitor of course excludes you from accessing the medicare system, however your health insurance, depending on the level of cover you have, will allow you to access all services available which includes

.Private hospitals, GP’s, specialists

.Any ancillary services such as chiropractor, Dentist’s, Physiotherapists, Podiatrists, Osteopath’s etc.

It just means that you will need to pay your account first and then claim it back from your health insurance later.

If you have overseas cover and you are admitted to hospital this is dealt with a little differently.

We have two major funds here that have overseas cover that a lot of people have when they move here it are

BUPA and Medibank Private.

If you have had a hospital stay then BUPA will allow your Dr/specialist to send in an account and claim the benefits on your behalf.

You must remember though that the surgeon may still charge you an out-of-pocket expense as well, just check this prior to having any treatment.

Medibank private on the other hand don’t do this. You will be sent an account and you can either pay the account and claim it back or you can forward the account on to the fund and they will forward the monies directly to the specialist. You must also check that your specialist will do this , some do and some don’t.

If you are in need of private health insurance check out our blog on it here

Obviously if you are planning on residing here in our beautiful country forever ,

Then once you become a permanent resident or are a permanent visa holder and/or have applied for a permanent visa you will be entitled to Medicare however there is usually a waiting period of 104 weeks (2 years) before you can access Medicare. See the following link for more information. Newly Arrived Resident’s Waiting Period.

Now if you are here temporarily and have come from any of these countries:

– United Kingdom
– The Republic of Ireland
– New Zealand
– Sweden
– The Netherlands
– Finland
– Belgium
– Norway
– Slovenia
– Malta
– Italy

Then you are entitled to some subsidised health services for essential medical treatment while visiting. Please see the following link for more information on what you are eligible for. Reciprocal rites in Australia

What is bulk billing,HIC online claims and HICAPS?

Now if a Dr has agreed to bulk bill you, it means they will bill medicare directly for you, if you are eligible, and there will be no out-of-pocket expense.

Some Dr’s may also just charge you the Medicare scheduled fee which means there will only be a very small out-of-pocket expense. Most GP’s now have the ability to send your account directly off to Medicare for you, which is called HIC online claiming, and the rebate will go directly to your bank account, or if Medicare do not have your details they will send you a cheque.

Specialist’s previously did not have the ability to do this but now most do, just check prior to your appointment. This takes away the need to take your account into a Medicare office.

There is also now HICAPS available. This is a service that is available, that bills your health fund directly and you pay the gap for any services that do not attract a medicare rebate. Which also means the claiming is done for you.

Here is a list of what is covered by Medicare and a list of what is only covered by health insurance

Medicare Rebatable Services:
General Practitioners (although some may bulk bill you which means there is no out-of-pocket expense for you)
specialist/Surgeons (if you have a hospital stay in a private hospital then your account is claimed back through medicare and your private health insurance)
Radiology (X-Rays) Some of these practices also bulk bill

Services that are only claimable from your private health insurance:

If you need any further information on the Medicare system please click on Medicare and it will link you to the Medicare website.


The Joy Girls xx

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