What does the UK-Australia Medicare reciprocal agreement cover for British working holiday makers?

The RHCA is one of the most useful agreements available to working holiday makers, but it is also one of the most misunderstood. British travellers regularly assume it provides full UK-style NHS cover, which it does not.

What is covered under the RHCA?

The agreement covers "medically necessary treatment" that cannot reasonably wait until you return to the UK. In practice, this means:

• Emergency hospital treatment (admission as a public patient)
• GP visits at the bulk-billed Medicare rate (though many GPs in Australia do not bulk-bill)
• Subsidised medicines on the Pharmaceutical Benefits Scheme (PBS)
• Out-patient hospital treatment
• Maternity care if pregnancy was not known about before arrival

The standard is "medically necessary", meaning treatment that a doctor considers needs to be provided before you would normally return home.

What is not covered?

The RHCA explicitly excludes:

• Treatment booked or planned before travelling to Australia
• Elective surgery or treatment that can wait until you return home
• Dental treatment (except for limited public dental in some cases)
• Optical treatment, glasses, or contact lenses
• Physiotherapy, chiropractic, or other allied health unless part of in-patient hospital care
• Private hospital treatment
• Ambulance services in most states (ambulance is not Medicare-covered for anyone)
• Treatment in a private hospital or as a private patient in a public hospital
• Cosmetic procedures
• Treatment outside of Australia (for example, if you travel to New Zealand or Indonesia)

The exclusions are substantial, and most of the things working holiday makers actually need (dental, physio, glasses, ambulance) are not covered.

How do you enrol in Medicare under the RHCA?

British citizens enrol in Medicare at a Services Australia (Medicare) office in person, presenting:

• A valid UK passport
• The working holiday visa grant notice
• A UK residential address (proof not always required)
• An Australian residential address

Enrolment is free and usually completed on the same day. A Medicare card is issued and posted to the Australian address within a few weeks. Until the card arrives, the enrolment record can be used at hospitals and bulk-billing GPs.

Enrolment should be done within the first few weeks of arriving in Australia. Some hospitals will provide emergency treatment without a Medicare number and bill the patient, with the option of reclaiming the cost later, but it is much smoother to be enrolled before any treatment is needed.

How does the RHCA interact with the Medicare levy?

The Medicare levy is a tax of 2% on Australian residents' taxable income, used to fund Medicare. Working holiday makers are not Australian residents for tax purposes, so the Medicare levy generally does not apply. However, the levy interaction depends on how your tax residency is assessed. For most working holiday makers, no Medicare levy is paid even if Medicare is used.

Why you still need private or travel insurance

The gaps in the RHCA mean that British working holiday makers should still have either travel insurance or Australian private health insurance for:

• Ambulance (not Medicare-covered in most states; can cost over $1,000 for a single ride)
• Dental emergencies
• Optical needs
• Repatriation home if seriously ill or injured
• Loss of personal items, trip cancellation, and travel-related risks
• Elective treatment

See our article on travel insurance vs health insurance for the difference between the two and which fills which gap.

What happens if you need treatment that the RHCA does not cover?

If you need treatment not covered by the RHCA, you have three options:

1. Pay out of pocket, which can be very expensive for hospital care
2. Claim through travel insurance, if your policy covers the treatment
3. Return to the UK for treatment, if it can wait

Repatriation to the UK is the standard travel insurance fallback for serious injuries or illnesses that need ongoing care. Without travel insurance, the cost of repatriation can be tens of thousands of dollars.

How does our service support British working holiday makers?

The Medicare and RHCA process is handled by Services Australia, not by our team directly. Where our service connects is on the tax side, where Medicare enrolment status affects:

• Whether the Medicare levy applies to your tax return
• How the Medicare Levy Surcharge applies (rarely relevant for working holiday makers)
• How private health insurance premiums interact with the tax system

When you lodge your tax return through our service, we account for your Medicare status correctly so the levy is either applied or excluded as it should be. Get in touch with our team if you are uncertain about how Medicare and the levy affect your tax position.