The Reciprocal Health Care Agreement between the UK and Australia is narrower than most British travellers assume. It is not the NHS transplanted and it is not health cover.
What does the agreement actually cover?
Treatment that is medically necessary, meaning care a doctor considers cannot reasonably wait until you return to the UK. That is a narrower standard than NHS cover, and the point British travellers most often misread.
- Emergency hospital treatment as a public patient
- GP visits at the Medicare rebate, which is free at a bulk billing clinic and leaves a gap at others
- Subsidised medicines under the Pharmaceutical Benefits Scheme
- Out-patient hospital treatment
- Maternity care where the pregnancy was not known before arrival
The rebate is not the fee. Many Australian GPs do not bulk bill, so the visit costs you the difference between the doctor's fee and the Medicare rebate.
What is not covered?
The exclusions are substantial and cover most of what a backpacker actually needs. Ambulance is the expensive one: not funded by Medicare for anyone in most states, and a single callout runs into several hundred dollars.
- Ambulance in most states
- Dental treatment, beyond limited public dental in some circumstances
- Optical treatment, glasses and contact lenses
- Physiotherapy and allied health outside hospital admission
- Elective treatment, or anything booked before you travelled
- Private hospital treatment, or private patient status in a public hospital
- Treatment outside Australia, including a side trip to Bali or New Zealand
- Repatriation to the UK
How does this change your Medicare levy position?
This is where the money is, and where the intuition runs backwards. The 2% Medicare levy is charged to people who are entitled to Medicare, and the exemption exists for people who are not. The agreement gives British nationals that entitlement, so the exemption generally is not available and the levy applies.
Entitlement counts, not whether you ever enrolled, saw a doctor or used the card. A British backpacker who never went near a clinic is still entitled, and the levy still applies. German and Japanese nationals have no such agreement, are generally not entitled, and can therefore claim the exemption if they obtain the paperwork. Our guide to the Medicare levy for working holiday makers sets out the exemption for those who do qualify.
How do you enrol?
Enrolment happens in person at a Services Australia office with your UK passport, your visa grant notice, a UK address and an Australian address. It is free, usually completed the same day, and the card is posted to the Australian address within a few weeks.
Do it in the first weeks rather than after something goes wrong. Until the card arrives the enrolment record works at hospitals and bulk billing practices; an unenrolled patient is billed and left to reclaim afterwards.
Do you still need insurance on top?
Yes, because of the gaps. Ambulance, dental, optical, physiotherapy and repatriation are all outside the agreement, and repatriation for a serious injury is the one that reaches five figures.
State ambulance cover deals with the most likely large bill for a few tens of dollars a year. Our guide to travel insurance versus OVHC covers which product fills which gap; the two are not interchangeable.
What does a GP visit actually cost you?
Nothing at a bulk billing practice, because the doctor accepts the Medicare rebate as full payment. At a practice that does not bulk bill, you pay the fee and Medicare refunds the rebate, leaving a gap of a few tens of dollars.
Bulk billing is far less universal in Australia than British visitors expect, and scarcer in city centres and some regional towns than in outer suburbs. Asking when booking is normal. Prescriptions are charged at Pharmaceutical Benefits Scheme prices, the same as an Australian resident pays.
Where does the agreement leave you at a hospital?
In a public hospital emergency department you are treated as a public patient, which is what the agreement is designed to produce. Admission as a public patient carries no charge, and treatment decisions are clinical rather than financial.
What it does not give you is a choice. You cannot elect to be a private patient, cannot choose your surgeon, and are not covered in a private hospital at all. Anything elective generally waits until you are home, which is what medically necessary means in this context.
What decides your position in a given year?
Three facts, and the first two are fixed by your passport. Whether your country has a reciprocal agreement at all, which for the UK it does. Whether you are therefore entitled to Medicare, which follows from the agreement rather than from enrolment. And whether anything changed part way through the year, because a part year of entitlement produces a partial levy position and the dates have to be right.
Part year cases are the ones worth flagging. Someone who arrived in March is entitled from arrival and not before, and someone who left in November is entitled only for that portion of the year. Getting those dates right on a tax return is worth real money, and a return prepared quickly tends to round them to the wrong whole number.