The Australian healthcare system is complex, comprised of public services (universal access via Medicare) and private health insurance options (fee-for-service). This article presents data from a qualitative study investigating patients’ trust in Medicare and private healthcare in Adelaide, Australia. Interviews were conducted with 37 patients with coronary heart disease between October 2008 and September 2009. The findings suggest that private health insurance holders are fearful and distrusting of public healthcare. Additionally, the findings indicate that both public and private healthcare users are concerned about, and many are distrustful of, the role of government in public healthcare services. These findings are discussed in relation to Niklas Luhmann’s social theories of trust, which provide an analytic framework for understanding private health insurance subscribers’ distrust in Medicare.