Bulk billing for medical services
Key facts
- Bulk billing refers to healthcare services provided at no cost to eligible people in Australia.
- The 'Medicare benefit' is the sum that Medicare will cover for a particular health service, which may be less than the full fee charged by your doctor or health service.
- The difference between the amount your doctor charges and the amount that is paid by Medicare (the 'Medicare benefit') is known as a 'gap payment' or 'out-of-pocket' cost.
- If your doctor bulk bills, it means that they accept the Medicare benefit as full payment for their service and bill Medicare directly, so you won't pay anything out-of-pocket.
- If your doctor doesn't bulk bill, you will need to pay upfront and later submit a claim to Medicare to receive your Medicare benefit, if applicable.
What is bulk billing?
Bulk billing means you don't have to pay for your medical service from a health professional. Instead, Medicare covers the entire cost and pays your health professional directly.
For example, if you see a doctor who bulk bills, after your visit, the doctor will bill Medicare directly and accept the Medicare benefit as full payment for their service. This means you do not have any out-of-pocket costs.
It is called bulk billing because the medical practice bills Medicare in 'bulk' — that is, a range of visits and services are billed to Medicare at the same time.
You can be bulk billed for a medical service if you are:
- enrolled in Medicare, and
- your health professional chooses to bulk bill
What is covered by bulk billing?
Bulk billing can cover:
- visits to GPs and specialists
- tests and scans such as x-rays and pathology tests
- eye tests performed by optometrists
Bulk billing for additional services with MyMedicare Providers
If you have a regular GP who is registered with MyMedicare, they can also give you access to:
- longer Medicare Benefits Schedule (MBS)-funded telehealth phone calls (levels C and D) with your usual general practice
- triple bulk billing incentive for longer MBS telehealth consultations (levels C, D and E) for children under 16, pensioners, and concession card holders
Both you and your doctor need to be registered with MyMedicare to provide these additional services.
Do all doctors and medical services bulk bill?
Not all health professionals bulk bill. Before you see a doctor, it's a good idea to ask if they bulk bill and if there will be any out-of-pocket costs. Sometimes your doctor will only bulk bill you if you have a concession or health care card.
FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.
If your doctor does not bulk bill, you will have to pay for your services at the time of your appointment. If a Medicare benefit applies to the service, you can claim this amount back from Medicare.
If you have more than one service during a visit to your doctor or medical practice, you may not be bulk billed for everything. It's always good to ask about the costs before your appointment.
How can I submit a claim for my Medicare benefit?
At the doctor's office: You can ask if they can submit an electronic claim on your behalf. This means that Medicare will process your claim. The Medicare benefit will then be electronically paid into the bank account registered with Medicare or the account linked to the card that you paid with.
Online, by mail or at the service centre: If you did not claim your benefit at the doctor's office and your doctor did not make a claim for you, then you can claim:
- online through your myGov account, your Medicare online account or the Express Plus app on your mobile phone
- by posting a complete Medicare claim form
- by visiting a Services Australia service centre.
If you are unsure whether you are still eligible to submit a claim, you can call the Medicare general enquiries phone 132 011.
What is a co-payment or gap fee?
Sometimes, you will need to contribute to the cost of health services yourself with a 'co-payment'. The difference between the amount the doctor charges and the Medicare benefit is known as a 'co-payment', 'gap payment', 'gap fee' or 'out-of-pocket' cost.
What is the Medicare schedule fee?
Medicare determines a 'schedule fee' for each medical service based on the costs of the doctor or service. Medicare benefits are based on fees determined for each medical service regarded as being the reasonable, average cost for that service.
Medicare will cover:
- 100% of the schedule fee for GPs
- 85% of the schedule fee for specialists
- 75% of the schedule fee for services provided during a hospital treatment as a private patient
This means that if your specialist or the hospital bulk bills, they agree to accept the Medicare benefit (which is only part of schedule fee) as their full fee, and you will have no out-of-pocket costs.
Where can I get more information on Medicare services?
For more information on bulk billing visit the Services Australia bulk billing page. The Australian government’s Medical Costs Finder tool can help you find and understand the cost to see a GP or medical specialist.
To find out more about costs for GPs and other medical specialist services, visit The Medical Costs Finder.
To learn more about MyMedicare, go to the Department of Health and Aged Care's website.
There are other services related to Medicare, such as the Australian Immunisation Register and the Australian Organ Donor Register.
A list of all Medicare services is available at the Services Australia website. For all Medicare general enquiries phone 132 011 (24hrs a day, 7 days a week).
Read more on the healthdirect page What is Medicare?
Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: June 2024
