Eleven. Australia holds Reciprocal Health Care Agreements with the United Kingdom, the Republic of Ireland, New Zealand, Sweden, the Netherlands, Finland, Norway, Belgium, Slovenia, Malta and Italy.
Which countries are on the list, and which are not?
The eleven named above are the whole list. Nothing regional or linguistic holds them together, so read it rather than guess.
The countries people most often assume are on it and are not include Germany, France, Spain, Canada, the United States, Japan, South Korea, Taiwan and Hong Kong. Germany and Japan matter most in practice, being large working holiday populations whose travellers assume a European or developed country reciprocity that does not exist.
What does the cover actually include?
Medically necessary treatment as a public patient: a condition that arises during your stay and cannot reasonably wait until you go home. That covers a GP consultation at the subsidised rate, treatment in a public hospital as a public patient, and prescriptions at the subsidised rate under the Pharmaceutical Benefits Scheme.
It is a safety net rather than health cover, and the exclusions are where people get caught.
- Ambulance transport, which is billed separately in most states and runs to hundreds of dollars for a single trip
- Dental treatment of any kind
- Optometry, glasses and physiotherapy
- Most specialist consultations
- Private hospital treatment
- Elective and cosmetic procedures
- Pre-existing conditions, in most cases
The ambulance gap surprises British and Irish travellers most, because it does not exist at home. A single trip after a fall on a farm outside Bundaberg is a bill, agreement or no agreement.
How do you enrol?
In person at a Services Australia service centre, with your passport, your visa grant evidence and proof of citizenship of the agreement country if that is not obvious from the passport. You are issued a Medicare card valid for the eligible period of your visa.
Enrolling is worth doing if you are eligible: the card makes a bulk billing GP free at the point of use rather than a hundred dollar consultation. It does not replace insurance.
What does an agreement do to your tax?
The 2% Medicare levy applies to people entitled to Medicare, and entitlement is what an agreement creates. An agreement passport therefore generally removes your ability to claim the levy exemption, whether or not you ever enrolled and whether or not you ever saw a doctor.
For a German or Japanese traveller with no agreement, the levy exemption is usually available and is worth about $500 on $25,000 of earnings. For a British or Irish traveller the levy usually applies. Same income, same visa, different passport, different assessment.
More than your passport decides this.
The eleven country list is fixed, but what it means for you depends on more than which passport you carry.
- Your passport, which is the entire test for the health cover and most of the test for the levy.
- Dual nationality, which can flip the answer completely and is worth raising rather than assuming the visa passport governs.
- Whether you enrolled, and when. Enrolment part way through a year can produce a partial levy exemption for the days before it.
- Which state you are in, since ambulance cover is state based and is the largest gap in reciprocal cover everywhere.
- Whether you have a pre-existing condition, which is generally outside the agreement even for the eleven.
The levy position is settled when you lodge your working holiday tax return, and you can estimate your tax refund to see what the 2% is worth on your income either way.