Section 1: Australian Healthcare Systems

Understanding the Australian Healthcare System

John Connor avatar
Written by John Connor
Updated over a week ago

We get it… health insurance, like all insurances can be complex and at times a little confusing. We, the government initiatives that make health insurance more attractive and affordable, everything you need to know about waiting periods.

Section 1.1 - The Public System

The public system is run by the Government through Medicare, and is partly funded by Australian tax payers who all pay the Medicare Levy. Medicare gives eligible Australian residents access to things like:

  • Seeing a doctor or specialist, in or out of hospital

  • Medical tests like x-rays or blood tests

  • Prescription medicines listed on the Pharmaceutical Benefits Scheme (PBS)

  • Treatment in a public hospital ward or public emergency facility

  • Select Allied Health services, where a Medicare benefit is available

Some things to remember about public healthcare and Medicare:

Public Waiting Lists: if your treatment is not considered an emergency, you may be placed on the Public Hospital waiting list, and could face lengthy waits for your treatment.

Limited Choices: whilst you may not have to pay anything to be admitted into a public hospital, you also may not get to choose where you’re treated or who treats you.

Out of pocket costs: Medicare doesn’t usually cover the full cost of doctor’s visits, tests and prescription medicines, so you may have to pay some money towards the costs of these things.

Section 1.2 - The Private System

The private, or non-government part of the healthcare system, is made up of private hospitals, private health insurance companies and other health specialists. The private healthcare system can fill the gaps in Medicare’s coverage, and gives you more choice in where, when and who you receive treatment from. Private health includes coverage for things like:

  • treatment in a private hospital of your choice

  • treatment by your choice of doctor

  • Ambulance

  • General treatment where no Medicare benefit is payable for services like Dental, Optical, Physio and many more

Having Private Health Insurance is about giving you the choice…

When you are treated – you don’t have to wait on a public waiting list, so you’ll get treated sooner.

Where you are treated – it’s up to you which hospital you’d like to receive treatment in.

Who treats you – there is nothing more personal than your health, so you need to trust who you’re receiving treatment from.

Private Health Insurance will cover the cost of your doctor’s fees, up to the Medicare Benefit Scheduled Fee (MBS) – anything they elect to charge above the MBS will become an out of pocket cost to the member.

Section 1.3 - What is Health Insurance?

Health insurance helps subsidise the cost of being treated in the private system. I's made up of two components Hospital cover (See Section 1.4) and Extras cover, ExtrasJar offers a health savings account as an alternative to Extras cover (Section 1.5).


Unlike say car insurance, which only gives you a benefit when something happens to your car; Hospital cover and a Health Savings Account and/or Extras cover can provide you with peace of mind for the unknown but helps towards maintaining your health and wellbeing everyday.

Section 1.4 - What is Hospital Cover?

Hospital Cover provides benefits to help pay towards the cost of treatment you receive whilst admitted into hospital. When you’re admitted into hospital as a private patient you’re covered for things like your medical treatment and hospital accommodation.

Taking out Private Hospital Cover is all about providing you with choice. You have more choice and flexibility in choosing who treats you, where you’re treated, and often when you’re treated.

ExtrasJar hospital cover is broken into different tiers ranging from Bronze through to Silver Plus Advantage, each providing cover for a different range of services. You can learn more about Phoenix Health Hospital covers here.

Did you know… Whether you have a gold, silver or bronze hospital cover the quality of the treatment you receive in hospital is the same. The tier is just about the services included on each level, giving you more flexibility in choosing a hospital cover best suited to you.

Section 1.5 - Extras Cover and Health Savings Accounts

Extras Cover, provides benefits for everyday non-hospital treatments that aren’t covered by Medicare. They’re services that help support your health and wellbeing like Dental, Optical and Healthy lifestyle services.

A health savings account can be used an alternative to Extras cover or supplement Extras cover for out-of-pocket expenses. At ExtrasJar, we listened to our customers who said they weren't getting value for money from their Extras cover, that is why we have replaced Extras cover with the ExtrasJar health savings account.

With a health savings account, you set up an investment plan and make periodic contributions into your account. The amount and frequency is set by you. Savings are invested and you can access your investments to pay for health services using your digital ExtrasJar Mastercard. No more expiring limits or benefits... any unused funds roll over to the next year.

Section 1.6 Why have Private Health Insurance

Everyone has their own reason to take out and maintain private health insurance, with a major one being for peace of mind.

If the unexpected happens and you need to go to hospital, you know that you have choices; the hospital, the surgeon, and probably most importantly the ability to avoid the waiting lists in the Public system. Plus by taking private hospital cover, you may also avoid penalties like the Medicare Levy Surcharge (See section 2.2) or Lifetime Health Cover loading (See section 2.3).

Extras cover or health savings accounts are really about supporting your health and wellbeing and getting something back for the things you use everyday like when you go to the dentist, get a new set of glasses or contacts, have a massage and plenty more.

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