Skip to content
PREV PAGE Tiers and categories

Medicare

Medicare is run by the Australian Government and is funded by Australian tax payers. Medicare provides Australians with access to free or low-cost public healthcare and the ability to claim some medical expenses.

So why get private health insurance?

Private health insurance aims to fill the gaps in Medicare and for many, it’s about minimising the time you may have to sit on a public hospital waiting list. As a public patient you will have limited choice in the doctor that treats you or the hospital you are treated at. Unless your condition is considered life threatening, you might have to wait in the queue to be treated which could leave you waiting months for treatment.

As a public patient, if you choose to go to a private hospital without the right level of private health insurance, it could cost you thousands and, in some cases, you may need to pay upfront.

Average cost*Median day wait^
Tonsil removal$3,06197
Hip replacement$24,493110
Coronary bypass surgery$47,91413
Knee replacement$21,895195

*Average charge to nib customers for procedures in a private hospital (rounded to the nearest $1), for the period July 2017 - June 2018. Correct as at October 2018. Average costs include all charges for the total hospital procedure (including and not limited to, medical, hospital, prostheses, surgeons’ and specialists’ charges).
^Source: Australian Institute of Health and Welfare, Elective surgery waiting times 2016 - 2017: Australian hospital statistics. Waiting times at the 50th percentile. Report dated December 2017.

nib helps you afford the private hospital treatment you want

Private health insurance helps you avoid public hospital waiting lists, pays benefits toward the cost of private treatment and also allows you to (subject to availability):

Frequently Asked Questions

Q: Who is covered by Medicare?

A: Medicare covers people residing in Australia who are Australian citizens, New Zealand citizens or holders of permanent visas. Some visitors and temporary residents, from countries with which Australia has made reciprocal healthcare agreements, are eligible for Medicare with some restrictions - visit Medicare Australia for more information.

Q:What funds do I contribute to Medicare?

A: Australian taxpayers contribute a Medicare Levy of 1.5% of their taxable income. The Medicare Levy Surcharge is an additional 1% in tax that you may have to pay if your annual taxable income is above the Medicare Levy Surcharge thresholds and you do not have an appropriate level of private hospital cover.

Q:What is covered by Medicare?

A: Benefits covered by Medicare include:

  • A stay in a public hospital as a public patient.
  • Part of the cost of pharmaceutical prescriptions, through the Pharmaceutical Benefits Scheme.
  • Part of the cost of GP and specialist consultants through the Medicare Benefits Schedule.
  • Part or whole consultation fees for doctors, including specialists.
  • Part or the whole cost of tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests.
  • Part or the whole cost of eye tests - undertaken by optometrists.
  • Part or the whole cost of psychology services - you must be referred by your GP, psychiatrist or paediatrician to receive the benefits.

Q: What is not usually covered by Medicare?

A: Items not usually covered by Medicare include:

  • Private patient hospital costs (for example, theatre fees or accommodation)
  • Dental examinations and treatment
  • Ambulance services
  • Glasses and contact lenses
  • Home nursing
  • Physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry
  • Psychology services (unless as part of an agreed procedure referred by your GP, psychiatrist or paediatrician)
  • Acupuncture (unless part of a doctor's consultation)

Q:What is the Medicare Benefits Schedule

A: The Medicare Benefits Schedule (MBS) is a list of medical procedures, consultations and tests that are recognised by Medicare for a benefit. Each item on the MBS has its own Schedule Fee and is set by the Commonwealth Government. If a treatment isn’t listed on the MBS, there’s a good chance we won’t be able to help you cover the cost of it.

More information

For more information about Australia’s healthcare system, visit the Department of Health and Ageing and Medicare Australia website.

Continue to the next page

Related articles

Should I use my private health insurance in a public hospital?

What’s the difference between private health insurance and Medicare?

How do I claim Medicare and can I do it online?