For most Australians heading overseas, purchasing travel insurance to cover accidents or serious illness seems like a no-brainer.

But what if you’re travelling interstate in Australia and need to be taken to hospital by ambulance, or even airlifted from the scene of an accident? 

The case of a Canberra woman who received a $45,000 bill after being rescued by Air Ambulance during a hike in Tasmania has shone a spotlight on the potential costs of using ambulance services while travelling interstate.

While all Australians are entitled to free public hospital services, Medicare doesn’t cover ambulance services. 

State and territory government subsidies for ground and air ambulance services vary from jurisdiction to jurisdiction, and interstate visitors often aren’t entitled to the same subsidies as locals.

Experts have urged Australians to check if they will be covered for ambulance services when travelling domestically, and whether they need to purchase insurance for this. 

It depends on where you live

Australian Capital Territory 

The ACT has a ”user pays” ambulance service for its residents, although the government will waive fees in certain circumstances, such as for motor vehicle accidents on public roads.

ACT school students on excursions and in cases of domestic or family violence or sexual assault are also exempt from fees.

Residents of the ACT can purchase private health insurance which covers ambulance services.

But it’s more complicated when those from the ACT travel interstate.

Those without ambulance insurance, or an appropriate travel insurance product, face paying full fees if they need an ambulance in another jurisdiction.

New South Wales

The NSW government provides a 49 per cent subsidy for the cost of road and air ambulance services for its residents.

People living in NSW can also purchase ambulance cover through private health insurance funds. 

NSW residents without ambulance insurance, or a travel insurance product, may have to pay full fees if they need an ambulance interstate.

Northern Territory 

The Northern Territory is another “user pays” jurisdiction, although ambulance cover is available through private health insurance funds and St John NT Ambulance Cover. 

A 21-day policy is available for visitors through St John NT Ambulance, but it doesn’t cover air ambulance services.

When travelling interstate, NT residents without ambulance membership, private health insurance with ambulance cover or travel insurance, face full fees.

Queensland

The sunshine state might be the best place to live if you need an ambulance in an emergency. 

That state government pays for emergency road and ambulance services for its residents.

If they travel interstate, Queenslanders who need emergency ambulance services can send the bill to the Queensland Ambulance Service.

South Australia

Residents can avoid being charged for emergency ambulance services by subscribing to South Australia Ambulance Cover or taking out ambulance insurance through a private health fund.

Travelling interstate, those without ambulance cover, or appropriate private health or travel insurance face full fees.

Tasmania

Ambulance services for Tasmanians are generally fully covered by the state government.  

Tasmanians are covered for emergency road ambulance services in all other states and territories, except South Australia and Queensland. 

But they aren’t covered for air ambulances in the ACT, WA, or the NT.

Victoria 

Fees are charged for Victorian ambulance services but there are some exceptions, for example some road and workplace accidents and exemptions are available for pension and healthcare card holders.

Residents can take out Ambulance Victoria membership, or get ambulance cover through a private health fund. 

Victorian residents without ambulance cover, or appropriate private health or travel insurance face full fees interstate.

Western Australia

WA has a “user pays” system for ambulance but there are exceptions; for example, road accidents may be covered under the Insurance Commission of Western Australia, WorkCover or victims of crime schemes.

Ambulance insurance is available through private health funds, or in regional areas through the Country Ambulance Benefit Fund. 

The state’s emergency rescue helicopter service is free to locals and interstate visitors. 

WA residents without ambulance cover, private health insurance or travel insurance face full fees interstate.

Check your cover, say the experts 

Insurance expert Jodi Bird, of consumer group Choice, said Australians travelling interstate should check if they would be covered for emergency ambulance services under their health insurance or a reciprocal state scheme.

Mr Bird said domestic travel insurance could be a good option for people without an existing ambulance insurance policy.

“Double-check if it includes medical evacuation and that will cover you in terms of if you need an ambulance or an air ambulance,” Mr Bird said. 

“If you’re going on a less expensive trip and you don’t think you need domestic travel insurance for other high-value things, you should be able to get it much cheaper if you buy, for example, what is known as an emergency ambulance-only private health insurance policy.”

Australasian College of Paramedicine chief executive officer Ryan Lovett also urged people to check if they had adequate ambulance cover before travelling interstate, particularly if they were going to take part in activities such as bushwalking. 

The college is a professional body for paramedics who work in a range of settings.

Mr Lovett said they believed all Australians should be entitled to free ambulance services.

“We believe every Australian should have access to universal health care and there’s decades of evidence that indicates that early access to health care through that provided by paramedics does result in improved outcomes, does result in reduced length of hospital stays for some conditions,” Mr Lovett said.

Consumers Health Forum of Australia chief executive Elizabeth Deveny said a national approach was needed to ensure that Australians were confident they could access ambulance services in emergencies. 

“We don’t want someone, for example, to put a person with a spinal injury in the back of a car and drive them to hospital because they are worried about the cost of an ambulance.” 

Insurance overseas

The old rule, that if you can’t afford insurance, you can’t afford to travel overseas, holds true.

The Australian government does not pay for Australians’ medical bills incurred overseas, even if the traveller can’t pay them.

It warns that people who receive medical care while overseas could be arrested or jailed if they do not pay the bill for that treatment.

Failure to pay could also see Australians prevented from leaving the country, or sued by the hospital that treated them.

While Australia does have reciprocal health care arrangements with some other countries, there are limits on what they cover.

The Australian government won’t cover medical evacuation back to Australia, which is extremely expensive.