Every travel health guide gives the same instruction. Carry a letter from your doctor describing your conditions, your medicines and your allergies. Bring your prescriptions with the generic names on them. Keep everything in its original packaging.
It is good advice. What almost none of them tell you is the part that matters:
- What that letter actually has to say.
- What you do at two in the morning in a country where nobody reads English.
- Which of your medicines could get you arrested instead of treated.
This is the Australian version of that checklist. Most of what you will find online is written for Americans, and the two situations differ. Starting with the biggest one: Medicare stops at the airport.
Disclosure before we start: I am a doctor and I founded exora, which is software for holding your own health record. It appears once, near the end. Everything before that works regardless of what you use, including paper.
Medicare does not travel with you
This is the single most common misunderstanding, and it is worth being blunt about. Medicare does not cover you overseas. Not partially, not for emergencies, not for the first few days. The moment you leave, you are paying.
There is one narrow exception. Australia has Reciprocal Health Care Agreements with eleven countries. In those, you can get some medically necessary care on the same terms as locals:
- Belgium, Finland, Ireland, Italy, Malta
- The Netherlands, New Zealand, Norway
- Slovenia, Sweden, the United Kingdom
Read “some” carefully. These agreements cover care that cannot wait until you get home. They do not cover:
- Medicines and treatments that are not subsidised.
- Anything elective.
- Medical evacuation - the one that actually bankrupts people.
A flight home from Europe with a medical escort costs six figures. No reciprocal agreement touches it.
So: travel insurance is not optional if you have a condition, and the agreements are a supplement to it rather than a substitute. Declare the condition when you buy the policy. An undeclared pre-existing condition is the most reliable way to have a claim refused at exactly the moment it matters.
The doctor’s letter, and what it has to say
”Get a letter from your doctor” is the standard advice and it is usually followed by nothing at all about content. Having written a few of these, here is what makes one useful abroad rather than decorative.
It needs your diagnoses in plain clinical terms, not abbreviations. “IHD, AF, T2DM” means nothing to a triage nurse in Osaka. “Ischaemic heart disease, atrial fibrillation, type 2 diabetes” can at least be looked up or translated.
It needs your medicines with their generic names, doses and frequencies. Brand names are national. The pill you call Panadol is paracetamol in most of the world and acetaminophen in the United States and Japan, and it is the same drug in all three. A letter that says “Panadol Osteo twice daily” is close to useless outside Australia and New Zealand; one that says “paracetamol modified release 665mg, two tablets twice daily” works anywhere.
It needs your allergies, and what the reaction was. “Allergic to penicillin” gets you a worse antibiotic. “Penicillin - rash aged 12, no swelling or breathing difficulty” lets a doctor make an actual decision, and roughly nine in ten people who believe they are penicillin-allergic are not.
It needs devices and implants - pacemaker, stent, joint replacement, insulin pump - with the model if you have it, because airport security and MRI scanners both care.
And it needs to be dated and signed on letterhead. An undated letter is worth very little to a border official deciding whether to believe you about the box of pills in your bag.
Carrying your medicines legally
The rule that catches Australians out is simple. A medicine being legal here tells you nothing about whether it is legal where you are going.
This is not a technicality. Some real examples:
- ADHD medication. Japan bans amphetamine-based drugs such as Adderall outright, with penalties of up to ten years. The UAE treats carrying it as a criminal offence even with a valid Australian prescription.
- Codeine. Prescription-only here, controlled in the UAE, and enough to have travellers detained without prior approval from their health ministry.
- Pseudoephedrine - the decongestant in many cold and flu tablets. Restricted in Japan and the UAE, and one of the most common things Australians are stopped for.
- Strong painkillers and sleeping tablets. Japan requires a permit called a Yakkan Shoumei for narcotic analgesics. Arriving without one is treated as illegal importation.
None of that is unusual or obscure. They are ordinary medicines that ordinary people take, and the consequence of getting it wrong is not a fine at the airport.
The practical steps, which come from Smartraveller and the TGA and cost you nothing:
Keep everything in its original, labelled packaging. Do not decant a fortnight of tablets into a daily pill organiser for the flight - that is precisely the situation where you cannot prove what they are.
Carry copies of your prescriptions as well as the letter. Two separate documents, because they do different jobs: the prescription proves it was dispensed to you, the letter explains why you need it.
Pack medicines in your carry-on, not checked luggage. Bags get delayed. Insulin and anticoagulants do not wait politely.
Take more than the trip needs. A fortnight extra covers a delayed flight, a lost bag and a closed pharmacy on a public holiday.
And check the destination before you pack, not at the airport. The embassy of the country you are visiting is the authority on what you may bring in, and a permit is sometimes required and usually free.
Vaccinations, and the part people leave too late
Destination vaccines need lead time. Some courses run over several weeks.
A yellow fever certificate is a good example. It is only valid ten days after the dose. So a last-minute appointment does not just leave you unprotected - it can leave you unable to enter a country that checks for proof at the border.
Four to six weeks ahead is the standard advice and it is the right one. Take your immunisation history with you to that appointment; a travel clinic that cannot see what you have already had will either re-vaccinate you unnecessarily or guess.
What happens when you actually need care
Here is the scenario that all the preparation is for. You are unwell somewhere unfamiliar, possibly in a language you do not speak, and a clinician is asking what you take and what you have had.
What they need, in order:
- Your current medicines.
- Your allergies.
- Your main diagnoses.
- Any recent results or procedures relevant to why you are there.
That is the same list as the letter. It is why the letter exists.
Two things make this go badly. The first is paper you did not bring, because the folder is in the hotel safe and you are in an ambulance. The second is a language gap at exactly the wrong moment - a printed English letter is better than nothing, but it is not the same as a record the clinician can read.
One practical note. In most reciprocal agreement countries you have to show your Medicare card and your passport to be treated under the agreement. Pack them together. Without both, the agreement may as well not exist.
The version of this that fits in your pocket
Everything above works on paper, and paper has the considerable advantage of not needing a battery or a signal. Carry the letter. Genuinely.
But I built exora because of two things the letter cannot fix. It is out of date the day after it is written. And the person most likely to need it is the person least likely to have it on them.
You upload what you already have - photograph the paper, add the PDFs - and it reads them into one profile: conditions, medicines, allergies, operations, vaccinations, each with a date, each linked back to the document it came from. Three parts of it are for this trip specifically:
- Medical terms change with where you are, so the record saying paracetamol at home says acetaminophen in the United States. That is the generic-names rule above, handled for you.
- It can be handed to a clinician who has no account and nothing to install, from any browser, in about thirty seconds - and you end the access when you are done.
- There is a travel vaccine planner: give it your destination and it checks your history and tells you what is missing, early enough to actually do something about it.
None of that replaces insurance, declaring a pre-existing condition, or checking whether your medicine is legal where you are going. It replaces the folder you would otherwise leave in the hotel safe.
If you are not visiting but moving countries permanently, the job is a different one and worth its own read.
The short version
Medicare stops at the airport, and the eleven reciprocal agreement countries cover less than people assume. Get a dated letter with generic drug names, real diagnoses and what your allergy actually did. Keep medicines in original packaging, in your carry-on, with the prescriptions, and check the destination’s rules before you pack. Start vaccinations four to six weeks out. And have the list of what you take somewhere that is not a folder at home.
