Medicare is the Australian Government health insurance scheme that provides access to a wide range of hospital and health services at low or no cost to Australian residents when they need it, regardless of where they live or their ability to pay. Medicare is known as the public system and covers three main areas of healthcare – hospital, medical, and pharmaceutical.

The Medicare Benefits Schedule (MBS) is the list of services that the Australian Government helps pay for and is a key part of the Medicare system. Each service included on the schedule has a unique item number and description and includes the percentage that the government will pay towards the cost of the service and/or treatment.

A patient is responsible for any difference between the MBS benefit for a service and the actual fee charged by the health professional. This difference is known as an ‘out-of-pocket’ cost or the ‘gap’ It’s recommended that people check what they may have to pay prior to making an appointment or receiving treatment.

The Pharmaceutical Benefits Scheme (PBS) is a government program in Australia that helps reduce the cost of prescription medications. If you’re eligible for Medicare through a Reciprocal Health Care Agreement, you may pay less for a range of prescription medications.

Australia has Reciprocal Health Care Agreements (RHCA) with certain countries to allow the citizens of those countries to receive any immediate essential medical treatment either for free or at a reduced cost through Medicare.

Medically necessary treatment is any ill-health or injury which occurs while you are in Australia that requires immediate attention and treatment before you return home. In other words, RHCA only covers emergency care.

It’s important to note that many health services are not available via an RHCA, including treatment in a private hospital or treatment in a public hospital as a private patient, ambulance cover, and dental care. That's why it's a good idea to get private health insurance for peace of mind, even if you're covered by an RHCA.

The Australian Government currently has RHCA’s with:

You can find more information on the Services Australia website.

Hospitals play an important role in Australia’s healthcare system, providing care to millions of Australian residents each year. Australia has public and private hospitals, and both offer exceptional care and services.

Below are some key differences between public and private hospitals:

Hospital management and funding

Public hospitals are largely owned and managed by state and territory governments, with funding also provided by the Australian Government.

Private hospitals are owned and managed by private organisations (some of which are non-profit) and are funded by many different sources, including Medicare, private insurers, and patient fees.

Emergencies

Public hospitals prioritise treatment for patients with the most medically urgent needs and are best suited for emergencies and urgent medical conditions.

Public patients do not get to choose the doctor who treats them, or the hospital they’re admitted to unlike private patients.

Choice and range of services

Private hospitals typically offer additional services and facilities beyond what public hospitals provide, such as private rooms, access to advanced medical technologies, and shorter waiting times for elective procedures.

Private hospitals also have access to a broader range of specialists and offer a more comfortable and exclusive healthcare experience. Private patients can choose their doctor, hospital, and treatment time (subject to availability).