Medicare – What is it? Can I get it? What does it do?
What is it?
Medicare is Australia’s health scheme. It guarantees Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost.
In order to use the Medicare system – you need to register and have a card.
Medicare can help pay for visits to the doctor and you can access a whole range of services such as hospital treatment and prescription medicines.
This link contains the up-to-date listing of Medicare services subsidised by the Australian Government http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home
We do not list the services on our page as they are subject to change.
Can I get Medicare?
Australian Citizens and New Zealand Citizens are eligible to enrol for Medicare. You will need proof of citizenship and proof that you are living in Australia to complete the Medicare enrolment form.
You can also enrol if you are a Permanent Resident but there are certain conditions that must be met.
Temporary residents covered by a ministerial order can also apply to enrol.
The conditions under which you are eligible or not may change so in order to keep up to date and give you accurate advice we recommend you check this page to make sure you have the most up to date advice at all times: https://www.servicesaustralia.gov.au/individuals/subjects/how-enrol-and-get-started-medicare
What does it cover?
Medicare allows you to get a free or lower cost on certain services. Medical services by doctors, specialists and other health professionals. If your doctor bulk bills (see bulk billing section for more details) you won’t have to pay for anything. Some hospital treatments and many prescription medicines are covered under the Medicare arrangement.
He benefits (refunds) you receive through Medicare are based on a set schedule of fees set by the Australian Government, although doctors can choose to charge more than the set schedule fee.
Medicare will usually cover the full schedule fee for most GP services
85% for a specialist and 75% for in-hospital services.
So, what does that mean to me? Well, you need to check with your GP or medical professional before any treatment is carried out. If you call your GP surgery to book an appointment, ask first if they bulk bill. If so, your appointment cost is covered by Medicare. If not then find out how much their fee is and they will tell you how much “out of pocket” expenses will be for your service.
What is ‘Bulk Billing’
Bulk billing means you don’t have to pay for your medical service when you visit a health professional such as your GP. They bill instead and they accept the Medicare benefit as full payment for the service. You assign the benefit to them by either:
- signing a form
- pressing OK on the EFTPOS terminal after your appointment.
If you have more than 1 service in a visit, you may not be bulk billed for everything.
Not all health professionals bulk bill. You should check if yours does when you make an appointment. To find a health professional who bulk bills, use the find a health service tool on the health direct website.
You’ll need to pay for your appointment if your health professional doesn’t bulk bill. You may be able to claim some of this money back though.
You can be bulk billed for a medical service if both:
- you’re enrolled in Medicare
- your health professional chooses to bulk bill.
It’s easiest if you bring your Medicare card or number with you when you go to the doctor or call them beforehand to check what is covered and what is not. They will explain what your “out of pocket” expenses will be, as in what the service will actually cost you.
For example, if the doctor charges $75 for an appointment and Medicare covers $35 for a GP visit then you will be charged $75 in total, Medicare will immediately refund you $35 therefore you only pay $40. This is your out-of-pocket expenses.
Your GP may bulk bill for certain services and not others, so always check before any service is carried out so that you are aware in advance what is covered.