It is important to be aware that there are some major differences between public and private health in Australia. Who treats you, when and where you are treated and how quickly you receive treatment for non-life threatening health problems will often be determined by whether or not you have Medicare or a private health insurance.

Established in 1984, Medicare is a public healthcare program run by the Australian Government. The purpose of Medicare is to give Australian residents free or inexpensive medical services and hospital care. 

Medicare covers a majority of health care costs for hospital, medical and pharmaceutical expenses and entitles you to be treated publicly in a public hospital for treatments listed on the Medicare Benefits Schedule (MBS).

A downside associated with this is that you don’t get to choose when or where you are treated or who will perform your procedure.

However, you don’t get to choose when or where you’re treated and who performs your procedure.

Individuals who have private health insurance can still decide to use the public health system when undertaking treatment but they also have the additional option to go privately.  This additional choice means that they can seek treatment without incurring significant out-of-pocket fees, when compared to expenses accumulated by individuals without private health insurance would have to pay if they were treated in a private hospital. This additional option comes at the cost of ongoing premium payments.

Private healthcare also gives you the ability to say who you’re treated by and the option of having your own private room where available.

By having private healthcare, you can generally avoid lengthy waiting periods and generally have more say in your treatment with private hospital insurance. Furthermore, there in most cases are some extra health services and costs that aren’t covered by Medicare such as; physiotherapy and certain optometry services that your health insurance policy may cover.

There are three types of policies a person can take out through the private health system, either individually or together through a combined cover policy. These options are:

• Hospital Cover – This includes the hospital costs for treatment you receive when you are an inpatient at a hospital.
• Extras Cover – This is commonly referred to as ancillary or general treatment. This covers out of hospital treatments that aren’t included in Medicare, such as physiotherapy, dental, optical and more.
• Ambulance Cover – this pays for ambulance costs in some states and territories. Unlike, the rest of Australia ambulance trips are free in Queensland and Tasmania as they are paid for by the State Government of those two jurisdictions.

Pros and Cons of Medicare

Pros

Some of the major pros associated with Medicare include;

• Medicare covers patient’s 100 percent for the MBS fee for GPs and 85 percent for the MBS fee for specialists.
• Furthermore, if the doctor you visit bulk bills, you be required to pay nothing out of pocket.
• Medicare also covers many tests, examination, pathology tests, eye tests, and procedures by doctors.
• It also covers you for part of the cost for PBS prescription medications and hospital care when staying in a public hospital as a public patient is free.

Cons

In comparison to all the positives, there are plenty of downsides associated with Medicare these include;

• Medicare doesn’t allow you to choose your preferred doctor or hospital. The options you are given will be based on where you live.
• You also usually can’t choose when you will be admitted. It is important to be aware that waiting times can be longer for private hospitals than what it is for public hospitals.
• Medicare also doesn’t provide coverage for private patient costs.
• Medicare also doesn’t offer any form of overseas cover for medical and hospital costs.
• Medicare also doesn’t cover services that aren’t clinically necessary such as; cosmetic surgery.
• Medicare doesn’t cover ambulance related services,
• Medicare also doesn’t provide coverage for ancillary services such as; dental, physiotherapy, occupational therapy, and other services and products, such as optical.

The Pros and Cons of Private Health Insurance

Some of the major benefits associated with Private Health Insurance include;

Pros

• Individuals who have signed up to private health insurance get to choose their doctor, hospital and their admission time
• You also get covered for ancillaries such as; physiotherapy, dental, optometry and podiatry, that are not covered by Medicare.
• You still retain the option of choosing to stay in a public hospital
• You increase the likelihood of gaining the opportunity of having your own private room if you need hospital treatment.
• There is also subsidies paid by the government for some of your premiums that you have via the Private Health Insurance Rebate. You might need to pay the Lifetime Health Cover loading and Medicare Levy Surcharge if you don’t have hospital insurance.
• There are different tiers to suit your life stage, requirements, and your budget.

Cons

Despite having plenty of advantages there are still a few downsides associated with Private Health Insurance;

• Private Health Insurance might not cover you for all of the services you are provided in hospital. This means that you might be required to pay out-of-pocket expenses.
• Waiting periods can apply and vary for different types of treatments.
• Private Health Insurance comes with exclusions and restrictions thus limiting some of your coverage
• Private Health Insurance doesn’t cover long-stay patients. A long-stay patient is someone who is in hospital for 35 successive days. Once you reach the 35th day you will be required to pay more money out of your own pocket.