Medicare - Services Australia

Australia’s Medicare system is one of the most comprehensive and successful universal healthcare programs in the world. Established in 1984 under the Hawke Labor government, Medicare guarantees that every Australian citizen and permanent resident can access essential medical services without facing financial hardship. Whether you need to see a general practitioner for a routine check-up, visit a specialist for a complex condition, receive emergency treatment at a public hospital, or fill a prescription at your local pharmacy, Medicare is designed to ensure that cost is never a barrier to receiving the care you need.

Unlike private insurance systems where coverage depends on your employer or your ability to pay premiums, Medicare is funded primarily through general taxation and the Medicare levy—a modest percentage added to your taxable income. This means that everyone contributes according to their capacity, and everyone benefits regardless of their income, employment status, or health history. There are no pre-existing condition exclusions, no waiting periods for essential services, and no lifetime caps on benefits. From the moment you are enrolled, Medicare provides a safety net that covers the fundamental healthcare needs of you and your family.

For millions of Australians, Medicare is the foundation of their healthcare experience. It covers visits to general practitioners (GPs), referred specialist appointments, diagnostic tests like blood work and imaging, eye tests, surgical procedures performed in public hospitals, and much more. When combined with the Pharmaceutical Benefits Scheme (PBS), which subsidizes the cost of prescription medications, and the Medicare Safety Net, which provides additional support for individuals and families with high out-of-pocket medical costs, Australia’s public health system delivers world-class care that is accessible to all.

Opportunity Snapshot

How Medicare Works

Medicare operates as a single-payer public health insurance system funded by the Australian government. The program is financed through two primary mechanisms: general taxation revenue and the Medicare levy. Understanding how these work together helps clarify why Medicare is able to provide universal coverage without individual premiums.

The Medicare Levy

Most Australian taxpayers pay the Medicare levy, which is currently set at 2% of taxable income. This levy is collected through the tax system and contributes directly to the funding of Medicare services. The levy is designed to be progressive—low-income earners may be exempt or pay a reduced rate, while higher-income earners who do not hold an appropriate level of private hospital insurance may be required to pay an additional Medicare Levy Surcharge (MLS) of 1% to 1.5% on top of the standard levy.

The Medicare Levy Surcharge is designed to encourage higher-income Australians to take out private hospital cover, thereby reducing demand on the public hospital system. If your income exceeds certain thresholds and you do not have appropriate private hospital insurance, the surcharge applies. The thresholds are adjusted periodically and vary depending on whether you are single or a family.

The Medicare Benefits Schedule (MBS)

At the heart of Medicare is the Medicare Benefits Schedule (MBS), a comprehensive list of medical services that attract a Medicare benefit. Each service on the MBS is assigned a schedule fee—the amount the government considers appropriate for that service. Medicare pays a benefit based on a percentage of this schedule fee:

• In-hospital services (as a public patient): Medicare covers 75% of the schedule fee, with the state or territory government covering the remaining 25%, resulting in no cost to the patient.
• Out-of-hospital services (GP visits, specialist consultations, diagnostic tests): Medicare covers 85% of the schedule fee for GP services and 75% of the schedule fee for specialist and other services performed outside of hospital.
• Bulk-billed services: When a doctor bulk bills, they accept the Medicare benefit as full payment, meaning the patient pays nothing out of pocket.

The MBS is regularly updated to include new medical services and technologies, ensuring that Medicare coverage evolves alongside advances in healthcare.

What Medicare Covers

Medicare provides coverage across a broad spectrum of healthcare services. Understanding exactly what is covered helps you make the most of the system and plan for any additional costs.

Public Hospital Treatment

As a Medicare-enrolled patient, you are entitled to free treatment as a public patient in any public hospital in Australia. This includes emergency department visits, inpatient care, surgical procedures, and outpatient clinics. When treated as a public patient, you do not choose your doctor—you are treated by the hospital’s medical staff. However, you receive all medically necessary treatment at no personal cost, including accommodation, nursing care, medications administered during your stay, and follow-up appointments.

General Practitioner (GP) Visits

Medicare covers visits to general practitioners, who serve as the primary point of contact for most healthcare needs in Australia. GPs provide consultations, health assessments, chronic disease management, mental health treatment plans, immunizations, and referrals to specialists. Many GPs bulk bill all or some of their patients, meaning there is no out-of-pocket cost for the consultation. Where a GP charges above the Medicare schedule fee, you pay the difference (known as the gap payment).

Specialist Consultations

Medicare covers consultations with specialists, including cardiologists, dermatologists, endocrinologists, neurologists, oncologists, psychiatrists, and many others. To claim a Medicare benefit for a specialist visit, you generally need a referral from a GP or another specialist. Medicare pays 75% of the schedule fee for out-of-hospital specialist consultations, and the specialist may charge above this amount, resulting in a gap payment.

Diagnostic Imaging and Pathology

Medicare covers a wide range of diagnostic services, including blood tests, urine tests, biopsies, X-rays, ultrasounds, CT scans, MRI scans, and other imaging procedures. These services must be requested by a treating doctor and performed by a Medicare-approved provider. Many pathology and diagnostic imaging providers bulk bill, particularly for services referred by a GP.

Eye Tests and Optometry

Medicare covers eye examinations performed by optometrists, typically once every three years for adults (or more frequently if clinically indicated). This benefit helps detect vision problems and eye diseases early, enabling timely treatment.

Mental Health Services

Medicare provides substantial support for mental health through the Better Access initiative. With a Mental Health Treatment Plan from your GP, you can receive up to 10 individual and 10 group sessions per calendar year with eligible psychologists, social workers, or occupational therapists, with Medicare rebates applying to each session. Psychiatrist consultations are also covered under the standard specialist rebate structure.

Allied Health Services

Under certain programs such as Chronic Disease Management plans, Medicare provides rebates for a limited number of allied health services per calendar year. These may include physiotherapy, podiatry, dietetics, exercise physiology, speech pathology, and audiology services.

Surgical and Therapeutic Procedures

All medically necessary surgical procedures performed in public hospitals as a public patient are fully covered by Medicare. This includes everything from minor outpatient procedures to major surgeries such as cardiac bypass, joint replacement, and cancer surgery.

The Pharmaceutical Benefits Scheme (PBS)

The Pharmaceutical Benefits Scheme is a closely integrated companion to Medicare that ensures Australians can access essential prescription medications at affordable prices. Under the PBS, the Australian government subsidizes the cost of a wide range of prescription medicines, meaning patients pay only a fraction of the actual cost.

How the PBS Works

When your doctor prescribes a PBS-listed medication, you pay a patient co-payment up to a set maximum amount. As of recent years, the general patient co-payment is approximately $30 per prescription, while concession card holders (pensioners, healthcare card holders, and Commonwealth Seniors Health Card holders) pay approximately $7.30 per prescription. The government covers the remaining cost, which for some medications can be hundreds or even thousands of dollars.

PBS Safety Net

The PBS also includes a safety net for individuals and families who require a large number of prescriptions. Once you or your family reach a certain threshold of PBS co-payments in a calendar year, further PBS prescriptions are provided at a reduced rate or at no cost. Concession card holders reach their safety net threshold more quickly, ensuring that those with the greatest need receive the most support.

What the PBS Covers

The PBS covers over 5,000 medicines used to treat a vast range of conditions, including antibiotics, blood pressure medications, cholesterol-lowering drugs, diabetes treatments, asthma inhalers, antidepressants, pain medications, cancer treatments, and many specialty drugs. The list of PBS-subsidized medicines is regularly reviewed by the Pharmaceutical Benefits Advisory Committee (PBAC), an independent expert body that evaluates the clinical effectiveness and cost-effectiveness of medicines.

Medicare Safety Net

The Medicare Safety Net provides additional financial protection for individuals and families who accumulate high out-of-pocket medical costs during a calendar year. There are multiple tiers of the safety net, each offering increasing levels of support.

Original Medicare Safety Net

Once your out-of-pocket costs for out-of-hospital Medicare services exceed a set annual threshold, Medicare will pay a higher percentage (typically 80% or more) of the schedule fee for subsequent services for the remainder of the calendar year. The threshold is lower for concession card holders and families receiving Family Tax Benefit Part A.

Extended Medicare Safety Net

The Extended Medicare Safety Net provides additional benefits once your annual out-of-pocket costs (the gap between what Medicare pays and what you are charged) exceed a higher threshold. Once this threshold is reached, Medicare pays 80% of your out-of-pocket costs for out-of-hospital services for the rest of the year, subject to per-service caps. This is particularly valuable for people undergoing extensive treatment such as IVF, cancer therapy, or management of chronic conditions requiring frequent specialist visits.

How to Register for the Safety Net

You should register for the Medicare Safety Net through your Medicare online account via myGov, by calling Services Australia, or by visiting a service centre. Registration allows Services Australia to track your out-of-pocket expenses and automatically apply the additional benefits once you reach the relevant threshold. Families should register together so that all family members’ expenses are combined toward the threshold.

Eligibility for Medicare

Australian Citizens

All Australian citizens are eligible for Medicare, regardless of their age, income, employment status, or state of health. This includes citizens living overseas who return to reside in Australia.

Permanent Residents

Holders of permanent visas are eligible for Medicare from the date their visa is granted, provided they are residing in Australia. This includes skilled migration, family reunion, and humanitarian visa holders.

New Zealand Citizens

New Zealand citizens living in Australia are generally eligible for Medicare under the special arrangements between the two countries. They can enrol and receive the same benefits as Australian citizens.

Applicants for Permanent Residency

In some cases, individuals who have lodged a valid application for a permanent visa and are residing in Australia may be eligible for interim Medicare coverage while their visa application is being processed.

Reciprocal Health Care Agreements (RHCA)

Australia has Reciprocal Health Care Agreements with several countries, including the United Kingdom, Ireland, New Zealand, Belgium, Finland, Italy, Malta, the Netherlands, Norway, Slovenia, and Sweden. Visitors from these countries may access medically necessary Medicare services during their stay in Australia, including doctor visits and public hospital treatment. The exact scope of coverage varies by agreement.

Who Is Not Eligible

Temporary visa holders (such as tourists, most student visa holders, and working holiday visa holders) are generally not eligible for Medicare unless they are from an RHCA country. These individuals typically need to arrange private health insurance to cover their medical costs in Australia.

How to Enrol in Medicare

Enrolling in Medicare is a straightforward process that can be completed through several channels.

Online Enrolment

You can enrol in Medicare online through the Services Australia website. You will need to provide proof of your identity and your eligibility (such as your Australian passport, birth certificate, or permanent visa). Online enrolment is the fastest method, and your Medicare number can be issued immediately.

In-Person Enrolment

You can visit a Services Australia service centre to enrol in person. Bring your identity documents, including your passport, visa documentation, and proof of Australian residency. Staff will process your enrolment and issue your Medicare card.

Postal Enrolment

You can download and complete a Medicare enrolment form from the Services Australia website and mail it along with certified copies of your identity documents. This method takes longer but is available for those who cannot enrol online or in person.

Medicare Card

Upon enrolment, you will receive a Medicare card—a green plastic card that displays your Medicare number and the names of individuals covered on the card. You should present this card whenever you visit a doctor, hospital, or other healthcare provider to claim your Medicare benefits. A digital version of your Medicare card is also available through the Medicare app or the Express Plus Medicare app on your smartphone.

Bulk Billing Explained

Bulk billing is one of the most important features of Australia’s Medicare system and is the reason many Australians pay nothing out of pocket for their doctor visits.

What Is Bulk Billing?

When a healthcare provider bulk bills, they accept the Medicare benefit as full payment for the service. This means the provider bills Medicare directly, and the patient pays nothing. The provider receives the scheduled Medicare rebate amount and agrees not to charge the patient any additional fee.

Who Bulk Bills?

Many GPs, particularly those in larger medical practices and in suburban and rural areas, bulk bill all their patients. Others may selectively bulk bill certain groups, such as children, concession card holders, elderly patients, or patients with chronic conditions. Some specialists and diagnostic providers also offer bulk billing, especially for referred services.

How to Find Bulk-Billing Providers

You can search for bulk-billing doctors on the Services Australia website or through health directory services like Healthdirect. When booking an appointment, simply ask the practice whether they bulk bill. Some practices advertise their bulk-billing status prominently.

Why Some Providers Do Not Bulk Bill

Providers who do not bulk bill charge a fee above the Medicare schedule fee. The reason for this is that the Medicare rebate may not fully cover the cost of providing the service, including rent, staff, equipment, and professional time. In these cases, you pay the full fee upfront and claim the Medicare rebate back (which can be done electronically at the point of service in many practices), or the practice may process a partial bulk bill and charge you only the gap.

Gap Payments and Out-of-Pocket Costs

While Medicare provides substantial coverage, there are situations where you may face out-of-pocket costs, known as gap payments.

What Is a Gap Payment?

A gap payment is the difference between what your healthcare provider charges and what Medicare reimburses. If your GP charges $80 for a consultation and the Medicare rebate is $41.40, the gap is $38.60, which you pay out of pocket.

How to Minimize Gap Payments

• Choose bulk-billing providers wherever possible.
• Ask about fees before your appointment so there are no surprises.
• Register for the Medicare Safety Net so that your out-of-pocket costs count toward the annual threshold.
• Consider private health insurance with gap cover if you frequently see specialists who charge above the schedule fee.
• Use public hospitals for elective procedures where possible, as public patients pay no gap.

Private Health Insurance and Medicare

Many Australians choose to supplement Medicare with private health insurance, which can provide benefits such as choice of doctor in hospital, shorter waiting times for elective surgery, coverage for services not covered by Medicare (such as dental, optical, and physiotherapy), and treatment in private hospitals. However, Medicare remains the foundation of healthcare coverage, and private insurance is supplementary rather than a replacement.

Medicare for Families

Medicare provides important benefits specifically designed for families with children.

Newborns and Infants

Newborn Australian citizens are eligible for Medicare from birth. Parents should enrol their newborn by adding them to the family Medicare card or creating a new card. This can be done through the birth registration process, online via myGov, or at a Services Australia service centre. Once enrolled, the child has full access to all Medicare benefits, including immunizations covered under the National Immunisation Program, developmental check-ups, and all standard medical services.

Children and Adolescents

Medicare covers all standard medical services for children, including GP visits, specialist consultations, hospital treatment, pathology, and diagnostic imaging. Many GPs bulk bill children under 16, making routine healthcare completely free for families. The Child Dental Benefits Schedule (CDBS) provides eligible children aged 2 to 17 with up to $1,095 in dental benefits over a two-year period for basic dental services, including examinations, X-rays, cleaning, fillings, extractions, and root canals.

Family Safety Net

When you register as a family for the Medicare Safety Net, the out-of-pocket costs for all family members are combined. This means families reach the safety net threshold faster than individuals, providing additional financial protection for households with multiple members accessing healthcare services.

Pregnancy and Maternity Care

Medicare covers comprehensive maternity care, including GP and obstetrician consultations during pregnancy, prenatal blood tests and ultrasounds, delivery in a public hospital as a public patient (at no cost), postnatal check-ups, and midwifery services. Women who choose to deliver in a public hospital receive full care from the hospital’s maternity team at no personal expense.

Tips for Maximizing Your Medicare Benefits

To get the most out of Medicare, consider the following strategies:

1. Register for the Medicare Safety Net. This is free and ensures your out-of-pocket costs are tracked toward the annual threshold. Once reached, you receive higher rebates for the rest of the year.

2. Choose bulk-billing doctors whenever possible. This eliminates gap payments entirely. Many areas have numerous bulk-billing GPs, and increasingly, telehealth consultations are also bulk billed.

3. Always ask about fees before your appointment. Providers are required to inform you of their fees. Knowing the cost in advance lets you make informed decisions and compare providers.

4. Use your Medicare card for every healthcare encounter. Even when you pay upfront, presenting your Medicare card ensures your rebate is processed and your safety net totals are updated.

5. Claim your rebates promptly. Many practices offer electronic claiming at the point of service, with rebates deposited directly into your bank account within minutes. If you pay upfront, you can also claim online through myGov or the Medicare app.

6. Take advantage of preventive health programs. Medicare covers a range of preventive services, including health assessments for specific age groups, cancer screening programs (bowel, breast, and cervical), and immunizations. These are fully covered and can detect health issues early.

7. Explore your mental health benefits. If you are experiencing mental health challenges, ask your GP about a Mental Health Treatment Plan. This unlocks Medicare-rebated sessions with psychologists and other mental health professionals.

8. Keep your PBS prescriptions at one pharmacy. This makes it easier to track your PBS safety net threshold and ensures your pharmacist has a complete picture of your medications for safety checks.

9. Use the Medicare app. The Express Plus Medicare app lets you claim benefits, view your claims history, access your digital Medicare card, and manage your safety net registration—all from your smartphone.

10. Know your rights as a public patient. If you are admitted to a public hospital, you have the right to be treated at no cost as a public patient. You do not need private health insurance to receive medically necessary treatment in a public hospital.

Common Questions and Frequently Asked Questions

Do I need to pay anything to enrol in Medicare? No. Enrolment in Medicare is completely free. The Medicare levy is collected through the tax system and is based on your taxable income, not a separate premium or enrolment fee.

Can I see any doctor with Medicare? Yes. Medicare allows you to visit any doctor, GP, or specialist in Australia. However, the amount you pay out of pocket depends on whether the provider bulk bills or charges above the schedule fee.

What happens if I need emergency treatment? Emergency treatment at any public hospital emergency department is fully covered by Medicare, regardless of whether you have a Medicare card with you at the time. You will not be turned away or charged for emergency care.

Does Medicare cover dental treatment? Medicare generally does not cover routine dental treatment for adults. However, the Child Dental Benefits Schedule covers eligible children, and some public dental services are available through state and territory health programs for concession card holders. Private health insurance with extras cover is the primary way most Australians fund dental care.

Does Medicare cover ambulance services? Ambulance coverage varies by state and territory. In Queensland and Tasmania, ambulance services are provided free to residents. In other states, you may need ambulance cover through your state ambulance service subscription or private health insurance.

Can I use Medicare overseas? Medicare generally does not cover healthcare received overseas. If you are travelling internationally, you should purchase travel insurance that includes medical coverage. However, in countries with Reciprocal Health Care Agreements, you may be able to access some medical services under the local public health system.

How do I replace a lost Medicare card? You can request a replacement Medicare card online through myGov, by calling Services Australia, or by visiting a service centre. In the meantime, you can use your digital Medicare card on your smartphone, or providers can look up your Medicare number using your personal details.

What is the difference between Medicare and private health insurance? Medicare is the universal public health system that covers essential medical services for all eligible Australians at no or low cost. Private health insurance is optional and provides additional benefits such as choice of doctor in hospital, private hospital rooms, shorter elective surgery wait times, and extras cover for services like dental, optical, and physiotherapy. Many Australians hold both Medicare and private insurance.

Can international students use Medicare? Most international students are not eligible for Medicare and are required to hold Overseas Student Health Cover (OSHC) for the duration of their visa. Students from RHCA countries (such as Belgium, Norway, and Sweden) may be able to access Medicare for some services.

What is the Medicare Levy Surcharge? The Medicare Levy Surcharge is an additional tax of 1% to 1.5% of taxable income for higher-income earners who do not have appropriate private hospital insurance. It is separate from the standard 2% Medicare levy and is designed to encourage higher-income Australians to take out private cover and reduce demand on the public system.

How to Get Started

1. Check your eligibility by reviewing the criteria on the Services Australia website
2. Gather your identity documents, including your Australian passport, birth certificate, or permanent visa grant letter
3. Enrol online through myGov, in person at a Services Australia service centre, or by post
4. Receive your Medicare card and add it to the Express Plus Medicare app on your smartphone
5. Register for the Medicare Safety Net to ensure your out-of-pocket costs are tracked
6. Find a bulk-billing GP in your area for no-cost consultations
7. Start accessing your healthcare benefits immediately—visit a GP, fill prescriptions under the PBS, or attend a public hospital as needed

Australia’s Medicare system represents a commitment to the principle that access to quality healthcare is a right, not a privilege. By enrolling and understanding how to use the system effectively, you and your family can access comprehensive medical care with confidence, knowing that the financial burden of illness will never stand between you and the treatment you need.