Three different things, one confusing name. The Medicare levy, the Medicare levy surcharge, and private health insurance all interact — and getting them mixed up is quietly costing people thousands.
In this episode, Mia and Leo separate them properly: who actually pays, who's exempt, what kind of cover gets you out of the surcharge, and the policies that look like the real thing but do nothing at all.
We lead with the 2025-26 figures, because that's the return most people are lodging right now, and flag the 1 July increases as we go.
In this episode, we cover:
The Levy vs the Surcharge: The levy is 2% and almost everyone entitled to Medicare pays it. The surcharge is a separate charge, on top, only for higher earners without hospital cover. Same name, different rules.
Who's Exempt: Serving defence force members entitled to full free medical treatment, and DVA Gold Card holders — full exemption if the whole family is in the same position, half if a spouse or dependants still use Medicare. Worth checking, because we see people who've paid it for years.
Visa Holders and the Statement: If you're not entitled to Medicare, you may be exempt — but you need a Medicare Entitlement Statement from Services Australia, and you need to hold it when you lodge.
The Nationality Trap: Australia has reciprocal agreements with eleven countries, including the UK, Ireland and New Zealand. Those citizens do get Medicare access, so they generally can't claim exemption. Two people on the same visa, doing the same job, get different answers based on their passport.
The Surcharge Tiers: For 2025-26, singles start at $101,001 and families at $202,001, rising through 1%, 1.25% and 1.5%. From 1 July 2026 those become $105,001 and $210,001.
A Cliff, Not a Slope: At $118,000 the surcharge is $1,180. At $118,001 it's about $1,481 — because the higher rate applies to your whole income. One dollar costs roughly $301.
Extras Doesn't Count: Only hospital cover exempts you. People pay for private health insurance every month and still pay the surcharge, because their policy is extras-only.
Your Excess Is Capped: To exempt you, the yearly excess can't exceed $750 for a single or $1,500 for a family. Sort a comparison site by cheapest and you'll often land on a policy that doesn't do the one job you bought it for.
Suspending Counts as Uncovered: Suspend your cover while you're overseas and you'll pay the surcharge for every suspended day.
Overseas Visitors Cover Doesn't Work: It's not a complying policy. No surcharge exemption, no rebate. If you're liable, you need a complying Australian policy in addition to the overseas cover, not instead of it.
Do the Sum Properly: Compare the surcharge against the premium after the rebate, not the sticker price — a $1,200 policy is closer to $911 for most people under 65.
The Clock Before You Turn 31: Lifetime Health Cover loading adds 2% for every year you wait past 30, capped at 70%. And the rebate doesn't apply to the loading, so it stings more than it looks. Ten continuous years of cover and it comes off.
Most of this is checkable in an afternoon, and if it's wrong this year it's probably been wrong for a few. Amendments are often available.
Connect with Aevum Accounting: Not sure which of these applies to you? Visit aevumaccounting.com.au to book a session with the expert team today.
Shoutout: A massive thank you to Zoe for the fantastic 5-star review!
Important Disclaimer: The information shared in this episode and description is for general informational purposes only and does not constitute specific tax or financial advice. We are not insurance advisers. Everyone's situation is unique, and tax laws are complex. For personalized advice tailored to your specific situation, we always recommend consulting with a qualified professional at Aevum Accounting.