What about my health needs?

What's the difference with public and private health care?

Public	Private
Doctors
You are assigned a doctor	Choose your own doctor
Why is this? Doctors One drawback of free hospital care is that you get whatever doctor is assigned to your case – this might be absolutely fine, as the quality of care is generally high across the board, and most doctors work in both public and private hospitals. Private hospital insurance will let you stick with a doctor of your choice who will manage and be familiar with your case. In public hospitals you may be cared for by a junior doctor under the supervision of a specialist. Close
Rooms
You'll probably share the room (not the bed!)	You could have a room to yourself
Why is this? Rooms This one's pretty obvious – you could be sharing a public hospital room with three other people, for example. If your roommates are noisy, have loud visitors, or just aren't good company, your stay might not be very restful. It's worth noting that private hospital insurance doesn't guarantee a room to yourself – it depends on the hospital you visit and whether one is available at the time. Close
Emergencies
Covers all medical emergencies and serious illnesses.	Mainly used for non-life-threatening conditions.
Why is this? Emergencies If you get hit by a bus or need your appendix out, you don't have to worry about copping a bill for tens of thousands of dollars – whether you have private insurance or not. Medicare covers emergency care. Some private hospitals do offer emergency treatment, so it's possible to see one in an emergency. Close
Waiting times
Waiting times might be lengthy	Shorter waiting times
Why is this? Waiting times Elective surgery – which is surgery for conditions which, while they may be debilitating or painful, are not immediately life-threatening – can have waiting lists in public hospitals. The length of the wait depends on the hospital and the procedure, but can range between a few days up to more than a year. Private hospital insurance can basically help you jump the queue by giving you access to private hospitals. Close
Ambulance fees
You'll pay the ambulance fees You'll pay the ambulance fees (or a subscription fee) You'll pay the ambulance fees Covered by state government You'll pay the ambulance fees (or a subscription fee) You'll pay the ambulance fees (or a subscription fee) You'll pay the ambulance fees (or a subscription fee) Covered by state government	Emergency ambulance is covered Depends on the policy Emergency ambulance is covered Covered by state government Depends on the policy Depends on the policy Depends on the policy Covered by state government
Why is this? Ambulance fees All hospital policies in NSW are required to come with at least emergency ambulance cover. It's also included with some extras policies. Ambulance in Victoria is provided under a subscription model. You can buy a subscription directly from the ambulance service. Alternatively, private health funds offer ambulance cover in some hospital and extras policies. All hospital policies in ACT are required to come with at least emergency ambulance cover. It's also included with some extras policies. You are also covered by reciprocal arrangements in all other states and territories except SA and Queensland. If you are travelling in these states you can take out domestic travel insurance or health insurance with ambulance cover. Ambulance in country South Australia is provided under a subscription model. You can buy a subscription directly from the ambulance service. In metro SA private health funds offer ambulance cover in some hospital and extras policies. Ambulance in country Western Australia is provided under a subscription model. You can buy a subscription directly from the ambulance service. In metro WA private health funds offer ambulance cover in some hospital and extras policies. Ambulance in the Northern Territory is provided under a subscription model. You can buy a subscription directly from the ambulance service. Alternatively, private health funds offer ambulance cover in some hospital and extras policies. Ambulance costs are covered by the Queensland government. As a Queensland resident you're also covered for emergency pre-hospital ambulance elsewhere in Australia. Close

What about hidden costs or gaps?

Hidden costs are everywhere

All healthcare in public hospitals is free for Medicare-eligible Australians and residents. Some out of hospital services such as GP and specialist appointments or pathology are partially subsidised by Medicare. This is true with or without private health insurance. Sounds complicated? It is - but our Medicare explainer should help.

But procedures, consultations and services that are covered by private hospital and extras insurance can all have "gaps" sometimes - the difference between what's covered and what you're being charged.

Certain providers might have an agreement not to charge patients more than what's covered. See how to avoid or minimise gaps.

Talk to your providers upfront as much as possible so you know what numbers to expect, and if there's any way to minimise your out-of-pocket costs.

How's it work with medication or services?

Costs vary for medications and services

Tests and scans
A particularly murky area of medical costs, tests and scans can be free under Medicare or you can be hit with full fees or gap payments. Tests and scans done in hospital are covered by Medicare or private health insurance.

Medicines
The PBS helps with the costs of many medications, and there's a safety net to help limit excessive costs.

The best thing to do is contact the provider and ask if there are any fees involved.

What about pregnancy?

Private insurance isn't a must if you're having a baby

Pre- and post-natal and birth care in the public system is free and tends to be very high quality - they've had a lot of practice. In terms of value for money, it's hard to beat.

But if you want to stick with your choice of obstetrician the whole way through or have a private hospital room, you might want private insurance.

Lastly, buyer beware: many people take out top private cover because they want the comfort of a private hospital, only to be hit with thousands of dollars in gap fees.

There are 12 month waiting periods for birth and baby cover, so if this is important to you, make sure you take out your chosen policy early enough.