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What is Medicare?

Medicare is a government insurance scheme that helps Australians pay for healthcare. Find out how to enrol for Medicare on the Services Australia website.

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 healthcare services for free or at a lower cost, including:

• Seeing a doctor or specialist — for all out-of-hospital health services that are on the Medicare Benefits Schedule (MBS), Medicare will pay:
• 85% of the schedule fee for a specialist consultation
• 100% of the MBS fee for a GP consultation

If your doctor does not bulk bill, you will need 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 getting 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 pays for 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 by optometrists. If you are under 65 years, you can claim an eye test once every three years. People over 65 years 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 healthcare plan and referral from your doctor.
• Other support: Medicare covers the costs for some long-term conditions, allied health services and prescription medicines. Services are covered based on your health needs, so speak with your GP if you have a chronic or complex health condition that means you have additional health costs. You may be eligible for a Team Care Arrangement to help with these costs.

Medicare does not generally pay a benefit for out-of-hospital services that are not on the MBS, such as physiotherapy and podiatry.

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. Around 1 in every 3 people are eligible for public dental care, but the waiting list to get treatment can be very long. Generally, you must pay yourself. Many people use private health insurance to help them pay for dental costs.

Medicare covers some of the costs of dental care for some children under a scheme called the Child Dental Benefits Schedule. Find out if 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?

Your out-of-pocket costs for services provided outside of hospital that are on the MBS will be the difference between what your doctor charges and any Medicare benefit paid by the government.

If your doctor bulk bills, Medicare covers the full cost of the visit. This means you do not have any out-of-pocket expenses to pay. If the doctor does not bulk bill, you will 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 GP might charge you $70 for a standard visit. Medicare will pay $38.75. Your gap fee will be $31.25.

If you see a medical specialist, you can only claim part of the cost from Medicare if you have a current referral from your 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 biopsy tests are usually covered by Medicare. Many are bulk billed.
• Images and scans: These include x-rays, CT scans, MRI scans, PET scans and ultrasounds. Medicare covers some or all of the costs 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. Get help to manage the costs of 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 $42.50 for most people and $6.80 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?

Anyone with a Medicare number can get free treatment as a public patient in a public hospital, paid for by Medicare. However, you might need to join a waiting list before you get treatment in a public hospital. If you need an ambulance, you will probably go to a public hospital emergency department.

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.

If you receive treatment in a private hospital, some or all the costs may be covered by your private health insurance.

Are ambulance services free in Australia?

The fee for ambulance services in Australia varies between states and territories. In some places it is free; in others it is subsidised for some people. If you have private health insurance, it may cover some or all of the cost.

Medicare does not cover the cost of an ambulance.

For more information about ambulance cover arrangements in your state or territory, see privatehealth.gov.au.

What is private health insurance, and should I get it?

Depending on your policy, private health insurance pays some or all of the costs of:

• treatment in a public hospital as a private patient or treatment in a private hospital, with the doctor of your choice
• health services not covered under Medicare such as physiotherapy, dental and optical

Private health insurance also helps to get some hospital services more quickly.

Read more about private health insurance on privatehealth.gov.au.