What Does Health Insurance Cover?

In the U.S., the public health insurance option created by the Affordable Care Act looks very different from the public option in Australia. With the complexity of its seemingly ever-shifting policies surrounding coinsurance, deductibles, and coverage for people with preexisting conditions, it may seem impossible to find out what’s actually covered until you receive a bill for it.

Medicare in Australia is the health insurance offered to every citizen by the federal government. It covers much of the out-of-pocket costs associated with basic medical procedures without having to pay a monthly premium. However, many citizens choose to purchase individual health insurance plans in addition to Medicare.

Let’s look into what’s covered by the public option, and why you may need an individual health plan to increase the money in your wallet as well as your peace of mind. Don’t wait until next year. Start your search today to find out which health insurance provider is right for you and your family.

Medicare in Australia


If you take an emergency trip to a hospital, make sure you go to a public hospital because Medicare will cover those expenses. If you go to a private hospital, it generally covers 75% of the costs associated with your visit. For visits to a general practitioner, Medicare will cover 100% of that cost or 85% for you to see a specialist. Your public insurance also provides benefits toward common procedures such as x-rays, eye exams, or even some surgical operations. Beyond these basic procedures, Medicare doesn’t cover anything, including your ambulance ride to the hospital.

If you feel that ambulance services need to be a part of your insurance plan, you’ll have to purchase those privately. Cover for ambulance services varies from state to state. In some states, you’re entitled to free ambulance transport services if you hold a Health Care Concession Card or Pensioner Concession Card. In others, emergency ambulances are covered if you hold any level of private insurance. And in some states, you must purchase separate ambulance coverage. Find out today if you qualify for free emergency paramedic and transportation services through your current health care provider.

Finally, some pharmaceuticals are covered under Medicare.

To find out how much you’ll have to pay out-of-pocket for your medications, look at the A-Z listing of medications covered under the Pharmaceutical Benefits Scheme (PBS).
If you are an NDIS participant, there are high-ticket equipment pieces crucial to assist people with disabilities that will be covered by the scheme. Apart from mobility tools, other items that fall under reasonable expenses as per NDIS guidelines are considered valid. Check with your NDIS plan manager to understand the entirety of your entitlements.

Private Insurance in Australia


Private medical insurance covers all or part of certain health-related services, depending on the policy. There are two main types of health coverage in the private model: hospital cover and extras cover. You can purchase one or the other or bundle them into a single insurance plan.

With hospital cover, you may be able to get full coverage for treatments in private hospitals, allowing you to choose not only your provider but also the time at which your appointment is scheduled. Extras cover, otherwise known as general treatment cover or ancillary cover, can include a range of health treatments such as psychology, chiropractic services, and even orthodontics. These services not covered by Medicare may also include physiotherapy, optical, and dental procedures. Since most people need these services at some point in their lives (if not annually), it’s a good idea for all citizens to have at least basic health insurance coverage in addition to Medicare.

The model for health insurance plans is not risk-based, meaning that everyone is eligible to pay the same monthly premium for the same policy instead of paying more if you have a preexisting health concern. It’s still important to shop around to see which plan and which provider will offer exactly the services you need with a monthly premium that you can afford.

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