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What is Medicare in Australia?

Medicare is Australia’s health care system that provides free or low-cost hospital, medical and optometrical services to all Australian citizens. The benefits you’ll receive are based on a scheduled fee set by the Australian Government. While Medicare provides access to free treatment as a public patient in a public hospital, you are also free to choose Private Health Insurance.
Fact Checked

Updated: 28 May 2024

The health fund is jointly funded by the Australian Government and your compulsory Medicare Levy. The levy is added to your tax assessment and based on your income.

Medicare also provides you access to subsidised treatments by doctors, some specialists and participating optometrists and dentists (specified services only). However, it’s important to know that Medicare does not cover everything.

Whether your choose Medicare alone or combine it with private health insurance, make sure that you base your decision on your specific needs and circumstances.

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Who is eligible to receive it?

You are eligible to receive Medicare if you:

How to enrol in Medicare

If you are over the age of 15, you must visit a service centre and enrol in person.

How does Medicare work?

You are eligible for subsidised treatment when you are a Medicare card holder. The public health fund covers a wide range of health care services, both in-hospital and out-of-hospital. These services are usually privately provided, and you pay the providers on a fee-for-service basis. What you’ve paid will then be fully or partially reimbursed by the government.

Each service is assigned a Medicare Benefits Schedule (MBS) item number. The MBS is a document published by the government to stipulate what doctors’ consultation fees should be. The document includes a comprehensive listing of all contracted medical providers and suppliers used by Medicare.

The CMS (Centre for Medicare and Medicaid Services) sets the Medicare fee schedule. This gets done through federal legislation and can change annually, depending on decisions made by the Australian Medical Association.

The Medicare Benefits Schedule (MBS) fee generally falls into 3 categories:

Medicare Category
What is covered by Medicare?
What is not covered under Medicare?
Hospital
Covers you for any treatment you receive as a public patient in a public hospital. You will not be charged for care, treatment or after-care by the treating doctor. As a private patient in a public hospital, you can choose the doctor who treats you and Medicare will pay 75% of the MBS fee.
Medicare will not pay for any private hospital costs or Ambulance services. Fees from GPs who do not bulk bill is not covered. As a public patient you won’t be able to choose your doctor and can’t decide the date or time of your admission to hospital. Any medical and hospital costs you might have incurred while travelling overseas are also not covered.
Medical
Specialist and doctors’ consultation fees. Some surgical procedures performed by approved dentists. X-rays and pathology tests. Therapeutic procedures performed by doctors. Specific items under the Cleft Lip and Palate Scheme. Specific items under the Enhanced Primary Care (EPC) program. Specified items for allied services because of the Chronic Disease Management Plan.
Any surgery that is done for cosmetic reasons or if your medical and hospital services have not been validated as necessary. Most dental exams and treatments. Hearing aids and other appliances. Acupuncture (unless specified by a doctor). Most occupational therapy, physiotherapy, speech and eye therapy. Chiropractic services. Podiatry. Psychological services. Home nursing.
Optometrical services
Eye tests done by optometrists will be covered.
Delivering and dispensing visual aids. Adjustments or repairs of visual aids, like glasses. Glasses and contact lenses.

Medicare will also not pay for examinations for superannuation, life insurance or memberships for which someone else is responsible e.g. a compensation insurer, employer or government authority.

Why is dental care not covered by Medicare?

Dental care is not covered by Medicare unless it is considered essential for the well-being of the patient. This is because usually, each Australian state provides its own public oral health care to its residents. This includes general dentistry, such as examinations, fillings and dentures, at health centres and hospitals in metropolitan areas with mobile dental clinics in regional areas.

Medicare Safety Net

The Medicare Safety Net stops your medical expenses from spiralling out of control. You’ll receive a higher benefit for out-of-hospital medical expenses once your reach a Medicare Safety Net threshold.

Your Medicare Safety Net threshold is worked out annually. Medicare combines your medical costs so that you can reach your threshold sooner. When you reach it, you become eligible to receive a higher benefit for the rest of that year. When you are close to reaching your threshold, medicare will contact you.

There are two types of Safety Nets:

OMSN (Original Medicare Safety Net):
  • Increases your rebate from 85% to 100% of the Benefits Schedule once your threshold has been met, meaning that the costs you pay for regular treatment or doctor visits are reduced.
  • Original threshold Applies to all Medicare cardholders. The 2017 threshold amount is $453.20.
EMSN (Extended Medicare Safety Net):
  • Covers 80% of your out-of-pocket-expenses.
  • Extended general threshold applies to all card holders who don’t have concessions cards or get Family Tax Benefit Part A. The 2017 threshold amount is $2,056.30
  • Extended concessional threshold applies to Commonwealth Seniors Health Card holders, Health Care Card holders and Pensioner Concession Card Holders. The 2017 threshold amount is $656.30

In order to make use of this benefit, you need to be registered with Medicare Safety Net.

Medicare Bulk Billing

Bulk Billing is when your doctor bills Medicare directly for the medical or health services you received. You will not have to pay any fees. To qualify for bulk billing you must either be a pensioner or have a Medicare Card.

However, if you have received more than one service per visit, you may not be bulk billed for everything. Also, be aware that your Doctor might charge more than the Medicare Benefits Schedule, meaning you will have to pay the shortfall.

If this happens, you may claim back some of the costs as a rebate. The easiest way to do this is to submit a claim at your doctor. Alternatively, your claim can be submitted by using your Medicare Online Account or your Express Plus Medicare Mobile App.

To submit a claim you must have: