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How coverage works here: Australia.
A take-home sheet for people at the session. Other countries: United States · United Kingdom · Canada.
Moraph for Good · Reach
How coverage works here: Australia
Handout · moraph.org/commons/sessions/reach/how-coverage-works-here
This sheet explains how health care gets paid for, in general and where you live. It is general information, not medical advice or advice on choosing a plan.
Four ways care gets paid for
- A public system, paid for through taxes.
- Public programs for particular groups.
- Insurance, through work or bought yourself.
- Paying yourself at the point of care.
The words
- Premium: what you pay to be covered.
- Deductible or excess: what you pay before cover starts.
- Co-payment or coinsurance: your share of each visit or prescription.
- Out-of-pocket cost: anything you pay yourself.
Before you get care, ask
- Is this covered, and is anything not?
- Do I need a referral or a particular provider?
- What will I pay, and does anything need approval first?
Stay safe
- If it might be an emergency, call the emergency number first.
- Real programs don’t cold-call to sell cover or ask for your details.
- Check anything you’re unsure about on the official sites below.
In Australia
- Medicare. Medicare is the government insurance scheme that gives Australian citizens, permanent residents and other eligible people free or lower-cost health care. Visitors from countries with a reciprocal health care agreement may be covered for some care.
- Public hospitals. Anyone with a Medicare number can get free treatment as a public patient in a public hospital, including the emergency department, though some planned treatments have a waiting list.
- Doctors and bulk billing. If a doctor bulk bills, Medicare pays the full cost and you pay nothing. If not, you pay the doctor and claim part back from Medicare; the rest is called the gap fee. Not all doctors bulk bill, so ask first.
- Medicines. The Pharmaceutical Benefits Scheme (PBS) lowers the price of listed prescription medicines when you show your Medicare card. You usually still pay a co-payment, and medicines not on the PBS cost full price.
- What Medicare usually doesn’t cover. Medicare doesn’t cover ambulances, and covers dental care only in limited cases, such as public dental clinics for eligible people and the Child Dental Benefits Schedule for some children.
Official places to check:
- healthdirect Australia (Australian Government): www.healthdirect.gov.au/healthcare-and-services/costs-and-financial-support/what-is-medicare
- healthdirect Australia (Australian Government): www.healthdirect.gov.au/healthcare-and-services/costs-and-financial-support/how-do-i-pay-for-healthcare
- healthdirect Australia (Australian Government): www.healthdirect.gov.au/healthcare-and-services/costs-and-financial-support/bulk-billing-for-medical-services
- healthdirect Australia (Australian Government): www.healthdirect.gov.au/medicines/pharmaceutical-benefits-scheme-pbs
General information, not advice about your own situation. Checked 19 October 2026. If an official source says something different, it is right. Free to copy and adapt. moraph.org/commons/sessions/reach/how-coverage-works-here