What is Bulk Billing in Australia and How Does it Work?
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If you’re enrolled in Australia’s Medicare scheme and have a Medicare card, you might be eligible for bulk billing, meaning you might not have to pay any fees for the appointment or service provided by a healthcare practitioner that bulk bills. However, this depends on whether the medical professional accepts bulk billing or does private billing.
Not all health professional bulk bill or only bulk-bill certain patients, for example, pensioners or children under a specific age. It’s important to check whether a doctor bulk bills or not before making an appointment.
In this article, we'll take a closer look at how bulk billing Medicare works and how you can benefit from it.
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What is bulk billing Medicare?
If your doctor bulk bills, it means they send your bill directly to Medicare and accepts the Medicare Benefit Schedule (MBS) fee for the service provided. By doing this, your doctor gets 85% to 100% of the MBS fee directly from Medicare. Bulk billing doctors do not have to deal with billing or debt collecting and you, as the patient, pay little or nothing for the service they provide.
The Medicare Benefit Schedule (MBS) is a document published by the Australian government, listing the baseline pricing for medical services they subsidize.
Bulk billing can be defined as your doctor billing Medicare directly and accepting the MBS fee as full payment for their service. Thus, if bulk billed the cost of your Doctor’s visit and the service provided could be entirely covered by Medicare, so you have no out-of-pocket expenses.
When visiting a non-bulk billing medical professional, you’ll generally need to make payment upfront and then claim the full or partial amount back from Medicare if the service is listed on the Medicare Benefit Schedule and you're a Medicare cardholder.
Bulk billing may not cover everything or everyone:
- When a Medicare benefit is not payable for a service, for example, most physiotherapy.
- If you have more than one service during the same GP visit.
- When only select groups are covered, for example, concession card holders, pensioners or children under a specific age.
- If your medical professional does not accept the Medicare benefit as full payment for their service.
The only exception is when the doctor gives you a vaccine form their own supply held at their premises, which is not available free of charge through Commonwealth or state funding arrangements or the PBS (Pharmaceutical Benefit Scheme).
Because medical professionals are free to set their own pricing, they might charge you more than what the Medicare benefit pays, in which case you can usually claim that part of the bill back from Medicare as a rebate if the services are listed on the MBS.
Medicare bulk billing rates vary across regions
Bulk billing is generally more prominent in areas with significant levels of socioeconomic disadvantages, like Western Sydney, where the need for free or subsidised medical practitioners and services are high.
Greater price competitions in regions with a high density of health care practitioners, for example in a metropolitan area, might also result in higher rates of bulk billing.
Private health insurance might cover health services not listed on the MBS
Medicare generally does not cover the costs of:
- Private hospital
- Ambulance services
- Psychological services
- Some dental work, and
You might want to consider getting private health insurance to help pay for treatments and services not covered by Medicare. Shop around and gather quotes for some of Australia’s leading health insurers before making a decision.
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Frequently asked questions and answers
How to find bulk billing medical professionals
A medical professional can decide whether they want to bulk bill or not. You can use the 1800 Bulk Bill website to help you find Medicare bulk billing practices near you or use the HealthEngine website, which allows Australians patients find and book appointments with bulk billing GPs.
Alternatively, contact the doctor’s offices directly and ask them whether they bulk bill or not before making an appointment.
Why don't all doctors bulk bill?
Bulk billing in Australia is not mandatory and being a concession card holder does not automatically mean you’ll be bulk billed. Medical practitioners can decide whether they want to bulk bill or privately bill a patient. Generally, health professionals that choose not to participate in bulk billing do so because the Medicare benefit might not be an appropriate remuneration for the services they provide.
Smaller practices, with one or two health professionals, might be more inclined to offer bulk billing because they might have less capacity to compete on the basis of service offerings and might choose to instead differentiate themselves by providing increased bulk billing rates.
What’s the difference between private billing vs bulk billing
Private billing generally involves a mix of Medicare contributions and private health insurance payments for patients that are issued an account by non-bulk billing doctors, which you must usually pay upfront and can then claim rebates from Medicare and your private health fund. Whereas with bulk billing, patients do not need to pay anything upfront, the doctor simply sends your bill to Medicare who pays the medical professional directly.
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- Find out if you qualify for the pharmaceutical benefits scheme & how you can save money on your prescription medications, including non-PBS pharmaceuticals.
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- Find out if you have to pay the 2% Medicare Levy & up to 1.5% Medicare Levy Surcharge (MLS) or whether you’re eligible for an exemption. Calculate your MLS!
- Discover what is & what is not covered by Medicare, whether you’re eligible & how to enrol. Get clarification on whether you also need private health cover.