Private health insurance and Medicare - Medicare (2024)

What insurance covers

There are 2 types of private health insurance:

• hospital cover for things like accommodation and theatre fees
• general treatment cover for services like dental and physio.

Many insurers offer combined hospital and general cover. Most private health insurance lets you:

• choose your own surgeon or other specialist
• have treatment in a private hospital or as a private patient in a public hospital.

Insurers can tell you what they’ll pay for and how much they’ll pay. This will help you choose a level of cover that suits your needs and budget.

You can read more about:

• what private health insurance is on the Department of Health and Aged Care website
• what insurance covers on the PrivateHealth.gov.au website.

You can still use our services even when you have private health insurance. For instance, you can choose to go to a public hospital as a public patient.

Read more about health care and Medicare.

What insurance doesn’t cover

Private health insurance doesn’t cover:

• GP visits
• some specialist visits
• visits to a public or private hospital emergency department.

Unless you’re a patient in hospital, it also doesn’t cover:

• any x-rays or other scans
• any blood tests or other pathology tests.

Medicare normally covers these things. Read more about what Medicare covers.

How to save money with private health insurance

Private health insurance rebate

You may be able to get a rebate on what you pay for private health insurance if you:

• earn less than the income threshold
• have a high enough level of hospital cover.

Your income must be within the threshold to get the rebate. It can either:

• reduce your insurance premium
• be a tax offset on your income tax return.

Read more about the Australian Government rebate on private health insurance.

Use the private health insurance rebate calculator to work out your rebate amount on the Australian Taxation Office website.

Private health insurance and tax

You may also have to pay an extra charge on top of the normal Medicare levy if you:

• don’t have private hospital insurance
• earn over the income threshold.

You pay this Medicare levy surcharge as part of your income tax.

Read more about Medicare and tax.

Lifetime health cover

Australia’s lifetime health cover system can save you money if you:

• get private hospital insurance before you turn 31
• keep this private cover for the rest of your life.

If you get private hospital insurance before you turn 31, you’ll qualify for lifetime health cover. This means you only pay the base rate for your insurance.

If you first get private hospital insurance after you turn 31, you’ll:

• pay an extra 2% for every year older than 31 you are when your cover starts
• keep paying this higher rate for at least 10 years after that.

You can use the Lifetime Health Cover calculators on the PrivateHealth.gov.au website to determine how much the loading might be.

Example

James and Max are twins aged 41. James has had private hospital insurance since he was 29. Max got it for the first time this year. Although he chose the same insurer and the same level of cover as James, he pays more for it. This is because James qualifies for a lifetime health cover rebate and Max doesn’t. Max now pays 2% more each year because he waited 10 years after turning 31 to get private cover.

Find out more about lifetime health cover on the PrivateHealth.gov.au website.

How to claim Medicare when you have private health insurance

If you have private health insurance, you can still use Medicare services.

There are times when you can claim Medicare benefits and use your private health insurance at the same time. For example, you go to a public hospital as a private patient. You may be able to claim the costs we cover from us and some or all of the other costs through your private insurance.

This means you’ll need to claim from 2 places for the same bills. You’ll need to submit a Medicare claim form and a Medicare Two-way claim form.

If you submit your forms to us, we’ll pass on your insurer’s share to them. If you submit your forms to your insurer, they’ll pass on our share to us.

Learn more about how to submit a claim using Medicare Two-way.

You can also use Medicare Two-way to claim for a treatment that we don’t cover, like physio, dental and optical.

Not all insurers offer Medicare Two-way. You’ll need to check with yours. If yours doesn’t, you’ll need to make claims with us and with your insurer.