How to use Medicare and what to do if you need to claim insurance in Australia

Moving to Australia is an adventure that opens doors, but it also poses significant challenges, especially when it comes to health. For those migrating or considering it, understanding how healthcare works in Australia—and what to do if you need to claim health insurance—is essential to feeling safe and prepared. We want this blog to help you understand your rights, options, and practical steps to avoid being compromised in critical moments.

1. The public pillar: Medicare.

In Australia, the public health system is covered by the Medicare program. This system allows Australian citizens, permanent residents, and certain visa holders to access publicly covered medical care.

What does Medicare cover?

Treatment in public hospitals for public patients.

Visits to a general practitioner or specialist, and medical tests, although you may have to pay part or all of the costs depending on the case.

Medications through the Pharmaceutical Benefits Scheme (PBS), which reduces the cost of many drugs for those with Medicare.

What is not covered by Medicare or what should be considered with caution?

Ambulances, in many cases, are not fully covered.

General dental treatment, opticians (glasses, contact lenses), hearing aids.

Private patient care in a private hospital, or certain out-of-hospital benefits.

📌 Advice for migrants: Check if your visa gives you access to Medicare. If not, you'll need private insurance. And even if you have Medicare, consider supplementing it to cover services that are not covered.

2. The Private Supplement: Health Insurance and Private Coverage

To cover what Medicare doesn't cover, or to have greater choice (private hospital, doctor of your choice, shorter wait times), you can turn to private health insurance.

Types of Private Coverage:

Hospital Coverage: for when you're in the hospital as a private patient (either in a private hospital or as a public hospital)

"Extra" or General Coverage: treatments outside the hospital such as physical therapy, dental care, optician's, etc.

How Payments and Claims Work:

You pay periodic premiums for your policy.

There may be "waiting periods" before certain services are fully covered.

If you have both Medicare and private insurance, they can sometimes be combined in a single claim (“Medicare Two-way Claim”).

Special attention for migrants

If you are a temporary visa holder, make sure the private insurance policy is accepted for your visa type.

If you decide to purchase private insurance, compare your options carefully and understand what is covered and what is not.

3. How to claim health insurance and practical steps.

Here's a step-by-step guide to what to do when you need to claim health insurance (whether public or private) in Australia:

Have your Medicare card or private insurance policy on hand: When you receive medical care, be sure to present your Medicare card (if you have one) or your private policy.

Request a bill/receipt for the medical service: Keep the documents: hospital bill, doctor's receipt, any forms you are given.

Check which part is covered by Medicare and which part is covered by private insurance:

If you received treatment under public Medicare, you may not have to pay anything additional.

Whether you were a private patient or had insurance, check how much you can claim.

Some policies require you to file a claim first with Medicare, then with private insurance ("two-way").

Submit your claim to the private insurance company (if applicable): Include all documents: invoices, receipts, and the insurance company's claim form. Check your policy's terms and conditions.

Understand gap fees (differences you may have to cover): Some private doctors or hospitals may charge more than the standard Medicare Benefits Schedule (MBS), and you must cover the difference.

Keep records and review your rights: If you believe your insurer denied you without reason, you can go to the Commonwealth Ombudsman or other complaint bodies.

4. Specific advice for Spanish-speaking professionals and migrants.

Make sure your visa allows access to Medicare or requires private insurance.

Consider purchasing private insurance even if you have Medicare, for greater peace of mind.

Keep all receipts, even for seemingly "minor" services (eye care, dental care, physical therapy), because they may not be covered by Medicare.

If English isn't your strong language, ask for the forms to be explained to you or get help from a translator.

Check the policy's waiting periods: you may not be able to claim certain services until the waiting period expires.

Join communities of Latinos in Australia who can share experiences and recommend good insurers or bilingual doctors.

Understanding how healthcare works in Australia—both the public system with Medicare and private insurance—is key to living with confidence, especially when you're migrating or working as a Spanish-speaking professional. Knowing how to file a health insurance claim, what steps to take, what documents to keep, and what to expect will give you peace of mind and control.

With advice from AustraliaPRO, you can review your immigration profile, your health rights, and make informed decisions for your well-being and that of your family.

💡 Don’t improvise your adaptation to Australia, do it with professional guidance and planning. At AustraliaPRO, we are ready to help you. Write to us on WhatsApp and request your free consultation here.

To stay updated with the latest news on migration and Skills Assessment—and to connect with other professionals on the same path—we invite you to join our exclusive WhatsApp group. There, you can share experiences, solve doubts in real time, and receive continuous support from our team and fellow migrants. You’re not alone in this journey! Join now and be part of a community of professionals committed to their future in Australia.