What “2026 healthcare reforms” actually include?

In Australia, reforms typically land in three buckets:

• Medicare & primary care funding changes (what clinics charge and how many people can access bulk-billing)
• PBS medicine pricing rules (out-of-pocket medicine costs for eligible patients)
• Private health insurance rules & premium approvals (what insurers can charge and how they justify increases)

For overseas cover holders, the biggest impacts are usually price pressures (premiums and gaps) and availability (clinics, hospitals, appointment access).

Reform 1: PBS medicines capped at $25 from 1 January 2026 (but eligibility matters)

A major national reform is the PBS general co-payment cap reducing to $25 from 1 January 2026 (for PBS-subsidised scripts).

What this means for OSHC/OVHC members?

• Most OSHC/OVHC members aren’t PBS-eligible because PBS subsidies are tied to Medicare eligibility.
• If you are Medicare-eligible (e.g., some reciprocal agreement situations), cheaper PBS co-payments can reduce your medication spend.
• Even without PBS, this reform can still influence the broader market: pharmacies, prescribing patterns, and demand for certain meds can shift over time.

Practical takeaway: Don’t assume your medicine cost automatically drops in 2026. It depends on whether your visa status gives you Medicare/PBS access.

Reform 2: Medicare bulk-billing incentives expanded (flow-on effects for overseas patients)

Australia expanded bulk-billing incentives and introduced a Bulk Billing Practice Incentive Program to encourage clinics to bulk bill Medicare-eligible patients.

Why this matters if you’re on OVHC/OSHC (and not Medicare)?

Even though the incentives target Medicare patients, the clinic economics can change in ways overseas patients feel:

• Some clinics may reserve more appointment capacity for Medicare bulk-billed consults.
• Others may increase private (non-Medicare) fees to balance revenue.
• In areas with shortages, you may see longer waits or higher gap fees.

Practical takeaway: 2026 could improve access for Medicare patients, but overseas visitors/students should still budget for private fees and gaps.

Reform 3: Private health insurance premiums approved for 1 April 2026

Australia runs an annual premium approval cycle. Health insurers apply, and approved premium changes take effect on 1 April each year.

For the 2026 premium round, the Government’s process and “public interest” expectations are clearly outlined.

What this means for OVHC/OSHC prices

OSHC and OVHC premiums are not identical to domestic private health products - but insurers still operate under broader cost pressures (hospital contracting, medical inflation, claiming volumes). When the market expects premium movement around April, overseas cover pricing can also reflect those pressures.

Practical takeaway: If your OVHC/OSHC renewal is around March–April, expect pricing to be sensitive around that period.

Reform 4: OSHC distribution/commission rules tighten from 1 July 2026

The current OSHC Deed (effective 1 July 2025) includes specific governance around third-party agent payments, including reporting requirements that begin from 1 July 2026.

Why this matters

Changes to how commissions and third-party payments are controlled can influence:

• how OSHC is marketed and sold,
• which channels dominate distribution,
• and potentially how pricing is structured (where costs sit in the premium).

Practical takeaway: This is a direct OSHC-specific reform in the 2026 window and is one to watch if you buy OSHC via agents.

2026 reforms and what changes for OSHC/OVHC holders

What overseas cover holders should do differently in 2026?

Choose cover based on realistic “out-of-pocket” risks

2026 reforms are not a magic shield from:

• GP gap fees
• specialist fees
• outpatient scans
• medicine limits (within your policy rules)
• non-emergency ambulance costs (where excluded)

The best approach is to choose OVHC/OSHC based on the kinds of healthcare you’re most likely to use in Australia.

Plan renewals around policy continuity

• Premium cycles and rule changes matter less than one big thing: no lapse. A cover gap can restart waiting periods and weaken continuity when you need claims to work smoothly.

Keep expectations clear about Medicare and PBS

• Some reforms are strongly Medicare/PBS focused. If you don’t have Medicare, treat them as indirect market changes, not guaranteed savings.

OVHC & OSHC options commonly explored on GetMyPolicy.online

For trust and clarity, people commonly review cover options from major providers such as:

nib OVHC

• Mid Visitor Cover
• Top Visitor Cover
• Advantage Visitor Cover
• Executive Visitor Cover

Bupa OVHC

• Bupa Working Cover
• Bupa Visiting Cover (selected tiers)

AIA OVHC

• AIA Overseas Visitors Health Cover (eligible hospital levels)

Medibank OVHC

• Medibank Visitors Health Insurance (higher tiers)
• Coverage varies by tier, hospital category, and waiting periods.