The Australian Government helps to keep down the cost of healthcare for most people who live here. This article will explain how to pay for healthcare.
What is Medicare?
Not everyone is eligible for Medicare. Medicare is available for:
- Australian citizens
- New Zealand citizens
- Australian permanent residents
- people who are applying for permanent residency (some conditions apply)
- a temporary resident covered by a ministerial order
If you are visiting Australia, you may be eligible for Medicare benefits if you come from a country that has a reciprocal healthcare agreement with Australia: Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, Republic of Ireland, Slovenia, Sweden and the United Kingdom.
If you are a visitor from another country, you should consider buying private health insurance to cover the costs of medical treatment in Australia.
You can check whether you are eligible for Medicare on the Services Australia website
What services does Medicare cover?
Medicare covers a range of services:
- Seeing a doctor or specialist: Medicare will pay the whole cost. If the doctor does not bulk bill, you will have to pay for the consultation then claim part of the cost (called a rebate) back from Medicare.
- Going to hospital: If you are a public patient receiving care in a public hospital, Medicare will cover all your costs. If you go to the emergency department of a public hospital, Medicare will pay for everything.
- Tests and scans: Medicare covers a range of tests including x-rays and pathology tests. Read more here about paying for tests and scans.
- Eye tests: Medicare pays for eye tests conducted by optometrists. If you are under 65 this can be claimed once every three years. Over 65 year-olds can claim once a year.
- Mental health services: You can claim a Medicare rebate for up to 10 sessions (increased to 20 during the COVID-19 pandemic) each calendar year with a mental health professional. To do this, you need a mental health care plan and referral from your doctor.
- Other support: Medicare covers the costs for some long-term conditions, some allied health services such as physiotherapy, and some prescription medicines.
Read more about what's covered by Medicare on the Services Australia website.
Are dental services covered by Medicare?
Medicare does not pay for most dental procedures. You must pay yourself. Many people use private health insurance to help them pay for dental costs.
However, Medicare does cover some of the costs of dental care for some children under a scheme called the Child Dental Benefits Schedule. Find out here whether your child is eligible.
Read more here about how to pay for dental costs.
How much of my doctor's fee is covered by Medicare?
If the doctor or specialist bulk bills, Medicare covers the full cost of the visit. You do not have any out-of-pocket expenses to pay.
If the doctor or specialist does not bulk bill, you need to pay for the consultation and claim part of the cost back from Medicare. The amount you pay is known as the gap fee.
For example, your doctor might charge you $70 for a standard GP visit. Medicare will only pay $38.75. So your gap fee will be $31.25.
If you see a specialist, you can only claim back part of the cost from Medicare if you have a current referral from your doctor (GP).
Learn how to make a claim on the Services Australia website.
If you need to spend a lot of money on out-of-hospital medical visits or tests, you may be eligible for the Medicare Safety Net. This means you will get more money back from Medicare for your out-of-pocket expenses.
If I need to have tests, how do I pay for them?
Your doctor might order tests or scans to find out more about your health. Medicare sometimes covers the costs of these.
- Pathology tests: Tests such as blood, urine or tissue tests are usually covered by Medicare. Many are bulk billed.
- Images and scans: These include x-rays, CT scans, MRI scans, PET scans and ultrasound. Medicare covers some or all of the cost of many of these.
There are also some free screening tests available in Australia, including screening for breast cancer, bowel cancer, eye tests and hearing tests. Read about what help is available with tests on the Services Australia website.
Read more here about paying for diagnostic tests and scans.
How do I pay for medicines?
If you get a prescription from a doctor for a medicine, the Australian Government helps with the cost of some medicines through the Pharmaceutical Benefits Scheme (PBS).
You will still need to pay some of the cost of the medicine. The current maximum you will pay is $41.30 for most people and $6.60 for people with an eligible concession card.
If you spend a lot on PBS medicines, the PBS Safety Net can reduce your costs after you have spent a certain amount each calendar year. Read more about the PBS Safety Net on the Services Australia website
If the medicine is not listed on the PBS, you will need to pay the full amount. You can read more about keeping your medicine costs down on the NPS Medicinewise website.
Does Medicare cover my healthcare if I need to go to hospital?
If you need to go to hospital, you can choose either a public or a private hospital. Read more about the public and private hospital systems.
Everyone who has a Medicare number is entitled to free treatment as a public patient in a public hospital, paid for by Medicare. However, you might have to join a waiting list.
If you are treated in a private hospital, some or all the costs may be covered by your private health insurance.
If you need an ambulance, you will probably go to a public hospital emergency department.
Are ambulance services free in Australia?
There is generally a fee for ambulance services in Australia. The fee varies between states and territories. In some places it is free; in others it is subsidised for some people.
Medicare does not cover the cost of an ambulance. If you have private health insurance, it may cover some or all of the cost.
You can read what ambulance services are available in your state on privatehealth.gov.au.
What is private health insurance, and should I get it?
It is not compulsory to have private health insurance in Australia, but everyone is encouraged to have it through various government surcharges and incentives.
Having private health insurance gives you more choice about your healthcare. For example, you can choose the doctor you want to treat you.
Read more about private health insurance on privatehealth.gov.au.
Last reviewed: June 2021