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Understanding the Medicare Levy Surcharge (MLS)

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Written by Joshua Malin

Reviewed by Steven Spicer

Updated 1 July 2024

Key takeaways

The Medicare Levy Surcharge is an additional tax for high-income earners who don’t hold an appropriate level of hospital cover
Depending on your income and where you live, you may be able to save money by taking out a hospital cover policy and avoiding the MLS moving forward
The Australian Government uses a slightly different definition of “income for Medicare Levy Surcharge purposes” than you might be used to
Even if you’re a high-income earner, you may be exempt from the MLS If you meet certain criteria

What is the Medicare Levy Surcharge?

The Medicare Levy Surcharge (MLS) is a surcharge imposed on Australian taxpayers who earn over $97,000 as a single or $194,000 as a couple/family each financial year but don’t hold an eligible private hospital insurance policy throughout the financial year. The surcharge is intended to ease pressure on the public health system by encouraging high-income earners to take out private hospital cover.

You may incur a surcharge of 1%, 1.25% or 1.5% depending on your annual taxable income for MLS purposes. You’ll be subject to the MLS for any period during a financial year that you don’t hold suitable private health cover that includes hospital admissions.

Your MLS is calculated based on the following criteria:

Your family status
Number of dependent children (if applicable)
Individual or combined annual income
Whether you hold an eligible private hospital cover

Expert tips on the Medicare Levy Surcharge

Our health insurance expert, Steven Spicer, has some expert tips on the Medicare Levy Surcharge and private health insurance.

Steven Spicer

Executive General Manager – Health, Life & Energy

Consider your needs and avoid junk policies

Carefully consider what level of hospital cover will be suitable for your needs. While it’s tempting to just get the cheapest option so you can avoid the MLS, many of these policies are nicknamed “junk policies” as they can provide next to no coverage.

Maximise your tax savings

It’s a good idea to hold hospital cover for the entire financial year to maximise tax savings. If your income exceeds the MLS threshold and you didn’t hold hospital cover for part of the year, you’ll still incur the MLS for each day of that tax year that you did not hold an eligible hospital policy.

You may also need to pay LHC

If you don’t have hospital cover by 1 July following your 31^st birthday, there’s also the Lifetime Health Cover (LHC) loading to consider. If you miss that date, LHC would increase your hospital premium from the age of 30 by 2% for every year you don’t have private hospital insurance. Depending on your age, you can either stop this loading from increasing or avoid it all together by taking out hospital cover before the cut-off.

How much is the Medicare Levy Surcharge?

Medicare Levy Surcharge income thresholds

The first MLS income threshold is $97,000 for singles and $194,000 for couples and families. The MLS is charged as a percentage of your total income for MLS purposes – this means that the higher your income is over the threshold, the more you will have to pay.

The table below illustrates the MLS rate that higher-income earners will pay if they don’t hold an eligible private hospital cover for the full financial year.¹

Medicare Levy Surcharge – Income Thresholds
Surcharge	0%	1%	1.25%	1.5%
Single income thresholds	Under $97,000 ($0 payable)	$97,001 – $113,000 (~$970 – $1,130 payable)	$113,001 – $151,000 ($1,413 – $1,888 payable)	$151,001+ (~$2,265+ payable)
Family income thresholds^	Under $194,000 ($0 payable)	$194,001 – $226,000 (~$1,940 – $2,260 payable)	$226,001 – $302,000 ($2,825 – $3,775 payable)	$302,001+ (~$4,530+ payable)
Retrieved from the Australian Taxation Office \| Information current from 1 July 2024. Dollar amounts payable are rounded up. ^For families with children, thresholds increase by $1,500 for each child after the first. Families include couples, de facto couples, and single parents.

What is considered ‘income’ when it comes to the Medicare Levy Surcharge?

In addition to what you earn from employment, other factors can determine your income for MLS purposes. When these are taken into consideration by the Australian Taxation Office (ATO), you could end up paying a higher surcharge than what your income alone might suggest. The ATO considers the following when calculating the surcharge:¹

Your taxable income
Any reportable fringe benefits
Total net investment losses
Exempt foreign employment income
Your partner’s share of the net income of a trust account which has not otherwise been included in their taxable income
Reportable super contributions.

For MLS purposes, you’re considered to be part of a family if you have a partner or child/dependant (who are Australian residents) for any part of the financial year. If you earn over the threshold, each member of the family will require valid private patient hospital cover for the full financial year to avoid the surcharge.

Avoiding the MLS

How to avoid the Medicare Levy Surcharge

If you earn over the income threshold, you will require a valid private hospital cover policy for the entire financial year to avoid paying the MLS at tax time. For private hospital cover to be valid, it must be taken out using a registered Australian health fund. All the funds on our site are registered, but some private health insurance policies on the market won’t exempt you from the surcharge.

Some health insurance policies that won’t exempt you include:

A standalone extras cover policy (i.e. not combined with eligible hospital cover)
Cover provided by insurers that aren’t registered in Australia
Most policies offered to overseas visitors
Hospital policies with an excess greater than $750 for singles and $1,500 for families/couples.

Am I exempt from the Medicare Levy Surcharge?

You may have an exemption from paying some or all of the surcharge for the financial year if you:

Aren’t entitled to Medicare benefits
Are a foreign resident for tax purposes
Are a blind pensioner
Have obtained sickness allowance from Centrelink
Can claim medical treatment on a Veterans’ Affairs Repatriation Health Card or through defence force arrangements.

Medicare Levy Surcharge vs private health insurance

You may wonder if it’s worth taking out private health insurance to avoid the MLS. Depending on your income and personal circumstances, you could save money by taking out private health insurance. Plus, you get the benefit of being covered for some of your private healthcare costs.

Example income	MLS percentage	Total MLS
$100,000	1%	$1,000
$120,000	1.25%	$1,500
$150,000	1.5%	$2,250

Health insurance policy	Average annual cost of hospital insurance
Basic	$1,224.6
Bronze	$1,469.16
Silver	$2,197.68
Gold	$3,071.64
Source: Based on data from privatehealth.gov.au, current as of June 2023. This is the average cost for single-only hospital policies with an excess of $750 that exempts you from the MLS. This does not include any rebates, discounts or loadings.

As you can see, a person with a yearly income of $120,000 could potentially take out a Bronze hospital policy for around the same cost as the MLS they would otherwise pay. Keep in mind, this is based on the average cost of hospital insurance policies across Australia, so it’s possible you could find a policy at a significantly lower price.

Medicare Levy vs Medicare Levy Surcharge

While the Medicare Levy Surcharge applies to those who earn over the MLS threshold without private hospital cover, the Medicare levy is something most taxpayers pay regardless of whether they hold private hospital insurance. The purpose of the Medicare levy is to support the public health system, while the surcharge is designed to encourage high-income earners to take out private hospital cover, reducing their burden on the public system.

The Medicare levy is a surcharge of 2% in addition to your income tax. Like the MLS, the Medicare levy is paid when you file your tax returns. If your taxable income means you are a low-income earner, you may be eligible for a reduction to Medicare levy, depending on your circumstances.³

Keep in mind that if your income is over the MLS threshold and you don’t hold valid private health insurance for hospital admissions, you’ll pay both the Medicare levy and the surcharge unless an exemption applies.

Meet our health insurance expert, Steven Spicer

Steven Spicer

Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.