GUIDES & RESOURCES

What Is A Medicare Claim?

Australians have access to free and subsidised healthcare through the taxpayer-funded federal Medicare scheme. A Medicare claim is an application for reimbursement from the Australian Government Department of Human Services.
Woman With Child Claiming At Medicare

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Medicare covers General Practitioner (GP), specialist and hospital services. In 2016-17, patients accessed 148.8 million GP services, at a cost in Medicare benefits of $7.5 billion. At the same time, the volume of total Medicare services in 2016-17 was 394.3 million services, at a cost of $22.0 billion in Medicare benefits.^

Medicare service claims and cost infographic

How can I make a Medicare claim?

There are several ways to claim on Medicare. We’ll start with the quickest and easiest.

Ways to make a medicare claim infographic

At the doctor

If a GP bulk bills, you won’t have to pay anything at all as they only require the $37.05 fee for a 10-minute consult covered by Medicare. However, most doctors set their fees higher than the amount covered by Medicare.

In these scenarios, often you pay the higher fee and then claim back the $37.05 portion of your doctor’s fee immediately while still at their office, via an EFTPOS machine or other secure connection. The Medicare benefit payment will then be made either to your EFTPOS card or nominated bank account.

If your doctor doesn’t offer electronic claiming, there are three other ways to claim: mobile, online, and by mail.

Express plus Medicare mobile app

The newest payment option is to use the express plus Medicare mobile app, available on iOS and Android phones. To download the app, first check that you have a myGov account linked to Medicare, creating a Medicare online account. Then go ahead and download the app from your app store.

Through the app you can submit claims for most services, view your Medicare safety net balance, change your bank details, or order a replacement Medicare card.

Medicare online account

Some Medicare claims can be made online. A list of the items that can be claimed this way is found here. In order to claim online, you must register a Medicare online account in myGov.

By mail

If for some reason you’re unable to use the mobile app or an online account, there’s always submitting a Medicare claim by post. Fill out this form and mail it to Medicare at the address on the form. However, it’ll take longer for Medicare to process your claim this way compared to online or in the app.

At a Medicare Service Centre

You can still make a claim at a Medicare Service Centre. The Service Centre will provide you with a claim form to fill out, and leave in their on-site dropbox. Forms are then transferred off-site for processing. Claiming this way will take longer for your claim to process than other methods.

Does Medicare cover any dental expenses?

While a limited amount of dental treatment is provided to children of families receiving certain government benefits, and some adult concession card holders, you can’t submit a Medicare claim for most dental examinations and treatments.

It’s a good idea to maintain private health insurance so that you can claim for dental treatments. These include, but aren’t limited to: check-ups, cleanings, x-rays, fillings, extractions, crowns, bridges, dentures, orthodontics, root canals, and treatment of gum disease. The range of benefits offered and paid, and the number of times you can claim, will typically vary widely between health funds.

Gap cover

The difference between what is covered by the Medicare Benefit Scheme (MBS) and what you pay at a doctor or specialist is called the ‘gap.’ Private health insurance assists you in paying this difference through the medical gap scheme.

You may be able to avoid paying the gap if you have private health insurance, and your doctor participates in the fund’s ‘No Gap’ scheme. Speak to your doctor or specialist before receiving treatment, to check that they participate in the medical gap scheme with your private health insurer.

Find out more about how you can be completely covered with private health insurance by calling iSelect on 13 19 20.

Sources:
^Department of Heath and Ageing, 2016-17 Financial Year Bulk Billing Rates: http://www.health.gov.au/internet/main/publishing.nsf/content/annual-medicare-statistics

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