Health cover
What Medicare covers
What Medicare covers without private cover.
Before the surcharge and the loading: what you get anyway, and how long a new policy makes you wait.
| What applies | |
|---|---|
| In a public hospital | Free as a public patient. You cannot choose your doctor and may wait. |
| A GP | Medicare pays 100% of the schedule fee. |
| A specialist | Medicare pays 85% of the schedule fee. |
| Not covered | Private patient hospital costs, care overseas, cosmetic surgery, ambulances and emergency department facility fees. |
| Private hospital cover waiting periods | At most 12 months for pre-existing conditions, and 12 months for pregnancy and birth. |
Premiums rose 4.41% on average from 1 April 2026, against 3.73% the year before; privatehealth.gov.au compares every insurer’s products. Sources: Private Health Insurance Ombudsman; Department of Health.
Private health
Work out the surcharge and the loading from your pay.
Private health insurance pays for private hospital care and extras like dental. Two government rules make going without hospital cover cost more: the Medicare levy surcharge on higher incomes and a loading if you take cover later in life.
Medicare levy surcharge
Anyone entitled to Medicare without hospital cover
Above an income threshold, going without hospital cover costs 1% to 1.5% extra tax. Packaged benefits count toward that income, so a full packaging cap can push a nurse over.
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2026–27 thresholds. A full public hospital packaging cap shows as about $17,000 on your income statement. Families use combined income. Source: ATO.
Lifetime Health Cover
Anyone over 31 without hospital cover
Take hospital cover after your deadline and you pay 2% more for every year you are over 30, up to 70%, until you have held cover for 10 years in a row.
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New arrivals over 31 have 12 months from registering with Medicare. There are no exemptions once the deadline passes. Source: privatehealth.gov.au.
From overseas
On a temporary visa, health cover.
On most temporary work visas you must hold health cover from the day you arrive, and a reciprocal agreement changes what Medicare covers.
What to know