Medicare for Dutch citizens: what it covers, and the deadline migrants miss
As a PR holder — or even as a PR applicant — you simply get into Medicare. What almost nobody knows: the Netherlands has a healthcare agreement with Australia that bridges your landing, and a clock is ticking for whoever wants to avoid a loading on their private insurance: the first anniversary of your Medicare registration, 2% loading per year after that, up to 70%, for ten years.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
If you are a permanent resident (PR), someone with a permanent visa, you can enrol in Medicare, Australia's public health system. You can do so even while your permanent visa is still pending. Medicare carries the basics solidly, but works differently from the Dutch system: it covers the GP, the specialist and the public hospital, but the dentist and glasses not or hardly at all.
For migrants there are two things in it you want to know before your first visit to the doctor:
- an agreement that bridges your landing;
- a deadline that determines your premium for private hospital insurance for the rest of your life.
Who gets in — sooner than you think
You can enrol in Medicare as a citizen, as a permanent resident, and if you are in Australia while your permanent visa is pending. Home Affairs lists it with the skilled visa itself among what you can do with the visa: enrol in Medicare, the public health care scheme. For the skilled route that means: as soon as you have landed with (or waiting for) your PR, you walk into a service centre with passport and visa evidence and you belong.
And the bridging is better arranged than almost anyone knows. The Netherlands is one of the eleven countries with a healthcare agreement (RHCA, Reciprocal Health Care Agreement) with Australia. As long as your Dutch health insurance is still running, that agreement covers medically necessary care, including the public hospital.
But read the small print with it: the agreement leans on your Dutch policy, and that ends on your emigration. So it is a bridge for the first period. It is not structural cover, and no reason to postpone your Medicare enrolment. Nor does the agreement count for the deadline below: only a full or interim Medicare registration starts the clock.
What Medicare covers — and the three gaps
Covered are:
- the GP and specialist (with bulk billing the doctor bills Medicare directly and you pay nothing, otherwise you pay a part yourself);
- tests and scans;
- the public hospital as a public patient: free, including emergency care.
Not or hardly covered, and that invariably surprises Dutch people: the dentist, glasses and hearing aids, and, depending on your state, the ambulance. A trip can cost hundreds of dollars. Some states cover it for residents, others sell a separate subscription for it. Check it for your state in your first week.
The deadline: the first anniversary of your Medicare card
Australia pushes middle and higher incomes towards private hospital insurance (hospital cover). It has two instruments for that:
- The Medicare Levy Surcharge, an extra tax. If you earn above the threshold (for a single person roughly above a hundred thousand dollars) and have no private hospital cover, you pay 1 to 1.5% extra tax.
- Lifetime Health Cover, a scheme in place since 1 July 2000. It is meant to get people to take out hospital cover early in life and keep it.
| Rule of Lifetime Health Cover | What it means |
|---|---|
| Ordinary base day | the 1 July after your 31st birthday |
| Base day for new migrants | the later of: that 1 July, or the first anniversary of your full Medicare registration |
| Loading for joining late | 2% for each year you are aged over 30 on the 1 July before joining |
| Maximum loading | 70% |
| Duration of the loading | stops after 10 years of continuous hospital cover |
| What counts as cover | only hospital cover with an Australian registered insurer; extras don't |
| What does not count | reciprocal Medicare through the healthcare agreement |
For migrants a rule of their own applies, and this is the deadline people miss: you have until the first anniversary of your full Medicare registration to get in without a loading (or until the 1 July after your 31st birthday, if that falls later). Whoever emigrates at forty and lets this year pass pays 20% extra premium after that — for ten years. So put the date of your Medicare card in your diary, with an alarm eleven months later; if in doubt, ask Medicare for a letter with your registration date.
On a couples or family policy the loading is averaged over the two adults: whoever would carry 22% loading alone and has a partner without a loading pays 11% on the joint policy. Whoever cancels their cover later gets their old loading back on rejoining plus whatever has accrued since, and the ten years start again.
If you come on a temporary visa before your PR, the reverse applies: usually no Medicare, but a visa condition to carry suitable insurance yourself (OVHC, Overseas Visitors Health Cover). That is not a choice but a condition on your visa. So the premium belongs in your budget for that interim period. How the enrolment fits into the order of your first weeks is in the article on your first two weeks.
In Vertrekklaar this is phase 5 of 5 of the journey, step 5.6: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Australia or go straight to step 5.6 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- Services Australia — who can enrol in Medicare — servicesaustralia.gov.au
- Services Australia — the healthcare agreement with the Netherlands (RHCA) — servicesaustralia.gov.au
- ATO — the Medicare Levy Surcharge and the income thresholds — ato.gov.au
- PrivateHealth.gov.au — Lifetime Health Cover, the migrant rule, 2% per year, the 70% maximum and the ten years — privatehealth.gov.au
- Home Affairs — subclass 190, with this visa you enrol in Medicare — immi.homeaffairs.gov.au
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