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.
Medicare Benefit Schedule changes
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.
Median day wait^
Tonsil removal
122
Hip replacement
119
Coronary bypass surgery
17
Knee replacement
198
^Source: Australian Institute of Health and Welfare, Elective surgery waiting times 2017 - 2018: Australian hospital statistics. Waiting times at the 50th percentile. Report dated December 2018.
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.
Extras cover also helps cover the cost for services that generally aren’t covered by Medicare such as a visit to the dentist, a new pair of glasses or rehab with a physio.
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):
Medicare is Australia's national health scheme. It’s funded by tax payers and provides eligible enrolled Australians and some overseas visitors with free or subsidised healthcare.
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.
Private health insurance aims to fill in the gaps in Medicare, covering the costs of services not covered, and minimising the time you have to sit on a public hospital waiting list. Head to What’s the difference between private health insurance and Medicare to find out more.
Australian taxpayers contribute a Medicare Levy of 2% of their taxable income. The Medicare Levy Surcharge is an additional 1-1.5% 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.
Psychology services (unless as part of an agreed procedure referred by your GP, psychiatrist or paediatrician)
Acupuncture (unless part of a doctor's consultation)
If you have high out of pocket medical expenses, Medicare Safety Nets can give you extra support. Once you’ve spent over a certain amount on medical expenses, you'll get a higher rebate back from Medicare for the rest of that calendar year. You can read more about how Medicare Safety Nets work and how to register if you're eligible on the Services Australia website.
The Medicare levy is 2% of your taxable income and is an amount you pay to help cover some of the costs of the public health system in Australia. Your Medicare levy is calculated when you lodge your income tax return with the Australian Taxation Office.
There are a number of ways that you can receive a Medicare rebate after using certain medical services. The fastest way to claim is usually on the spot after you pay for an eligible medical visit. You can also claim using your Medicare online account, using the Medicare app, by mail or at a Service Centre. You can read more about how Medicare rebates work and how to claim on the Services Australia website.
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.
The Australian Government has announced changes to more than 900 items on the Medicare Benefits Schedule (MBS) following an extensive review by the MBS Review taskforce. These changes are effective 1 July 2021, and are designed to support Australians in continuing to receive high quality care in line with current best medical practice.
These changes will provide greater consistency across procedures for both members and providers, helping members to avoid unnecessary treatment and reduce any unexpected out of pocket costs.
Learn more about why the Australian Government is making changes to the MBS on their website.
There won’t be any impact to your nib policy as a result of these changes. However, we will be updating our systems and MediGap Schedule to reflect these changes.
If you have a surgery or treatment scheduled after 1 July 2021, we encourage you to ask your specialist or medical provider for a written breakdown of expected costs or identify any out of pocket expenses. This is known as informed financial consent.
If you make a claim for a treatment included in your cover and the item number is invalid, contact your provider and ask for a new item number which is included in the new MBS changes.
For more information about the MBS changes or help with your cover, please contact us.