How hospital care works in Australia — what Medicare covers, what private health insurance covers, and how to decide.
| Public hospital (as a public patient) |
Private hospital (with PHI) |
|
|---|---|---|
| Cost to you | Free | Excess + gap fees |
| Choose your doctor | No | Yes |
| Elective surgery wait | Weeks to months | Days to weeks |
| Emergency care | Immediate, free | Immediate, may have costs |
| Room type | Shared ward | Private or shared |
| Who pays | Medicare (taxpayer funded) | Your PHI + Medicare + you |
| Need PHI? | No | Yes (hospital cover) |
As a public patient in a public hospital, Medicare covers everything:
The trade-offs:
With private health insurance hospital cover, your insurer pays the hospital. Medicare pays 75% of the MBS fee for doctor services. You may still pay:
Most policies have an excess of $250–750 per admission. Some have a per-day co-payment instead ($50–100/day). Higher excess = lower premiums.
If your surgeon or anaesthetist charges above the MBS fee, you pay the gap. This can be $0 (no-gap agreement) or $500–2,000+. Always ask for a quote.
Basic and mid-tier policies exclude certain procedures (e.g. cardiac, joint replacements, pregnancy). Check your policy's inclusions before booking.
Most policies cover prostheses on the government's Prostheses List. Some newer or premium devices may have a gap.
The benefits:
Public hospital elective surgery is triaged into three urgency categories:
| Category | Target | Examples |
|---|---|---|
| Category 1 — Urgent | Within 30 days | Cancer surgery, cardiac surgery, some fractures |
| Category 2 — Semi-urgent | Within 90 days | Gallbladder removal, hernia repair, tonsillectomy |
| Category 3 — Non-urgent | Within 365 days | Knee/hip replacement, varicose veins, carpal tunnel |
Private hospital: Usually days to weeks for the same procedures, depending on surgeon availability and hospital scheduling.
You can check estimated public hospital waiting times for your state through the AIHW MyHospitals website.
Yes. If you have private health insurance, you can choose to be treated as a private patient in a public hospital. This means your PHI pays the hospital (not the taxpayer), and you may be able to choose your doctor. You may still have gap fees and an excess.
Hospitals often ask if you want to use your private health insurance when you're admitted. You are never obligated to — you can always elect to be a public patient.
Important: Being a private patient in a public hospital does not necessarily get you a private room or skip the waiting list for elective surgery. The main benefit is choosing your treating specialist.
Public hospital ED: Free. Emergency treatment at a public hospital is always free for Medicare card holders, regardless of whether you have private health insurance.
Private hospital ED: Some private hospitals have emergency departments. If you present to one, you may be charged. Check before attending — or in a genuine emergency, go to the nearest public hospital.
For non-emergencies, consider your GP, an after-hours clinic, or calling Healthdirect on 1800 022 222 for advice on where to go.
No. Medicare covers all essential hospital treatment in public hospitals at no cost. Private health insurance is optional.
Why people get it: To choose their doctor, shorter waiting times for elective surgery, private room, and to avoid the Medicare Levy Surcharge (MLS) — an extra 1–1.5% income tax applied to higher earners ($105,000+ single / $210,000+ family in 2025–26) who don't have hospital cover. From 1 July 2026, the 2026–27 thresholds rise to $105,000 (single) / $210,000 (family).
Lifetime Health Cover (LHC): If you don't take out hospital cover before July 1 after your 31st birthday, you pay a 2% loading on your premiums for every year you're over 30. This loading stays for 10 years. This is an incentive to take out cover early, not a requirement.
Compare policies at privatehealth.gov.au.
Ambulance cover varies by state:
QLD and TAS: Ambulance is free for all residents (funded by the state government).
All other states (NSW, VIC, SA, WA, ACT, NT): Ambulance is not free. A single ambulance call-out can cost $400–$6,000+ depending on the state and distance. Pensioner/concession card holders are often covered. Most private health insurance policies include ambulance cover, or you can take out standalone ambulance-only cover (around $50–90/year).