The Low-down on Medicare in Australia

What is Medicare? 

Medicare helps to provide Australians with affordable health and hospital services. 

It is funded by Australian taxpayers, who contribute 2 percent of their taxable income in order to help cover the costs of running the program.

Who can get Medicare? 

You can enrol in Medicare if you live in Australia and you’re: 

• An Australian citizen
• A New Zealand citizen
• An Australian permanent resident
• Applying for permanent residency
• A temporary resident covered by a ministerial order 

You can also enrol if you’re a citizen or permanent resident of: 

• Norfolk Island
• Cocos (Keeling) Islands
• Christmas Island
• Lord Howe Island

There’s also some good news if you’re on Bridging Visa A, B, C or E – in most cases, you can access some Medicare entitlements too (generally if you are in the application process for permanent residency)!

How do I get a Medicare card? 

It’s a pretty straightforward process. There are detailed instructions on how to enrol in Medicare on the Services Australia website.   

Basically, you’ll need to complete some paperwork and email it along with your  supporting documents to the Medicare Enrolment Services or post it to the address on the form. You can also visit a Services Australia office in person.  

Once your application is approved at the Medicare service centre, you should be given a Medicare number and access to a digital card, which you can start using straight away. But it might take up to a month for your little green card to arrive in the mail.

What age can I get my own Medicare card?  

If you’ve been on your parents’ Medicare card, once you are over the age of 15 you can apply to have your own card. 

How long can I stay on my parents Medicare card?  

There is no limit to how long you can stay on your parents Medicare card, so really it’s up to you whether you’d prefer to get your own card or stay on theirs. If you want to stay on your parent’s card, you can get your own copy of your family’s Medicare card. 

What is bulk billing and how does it work? 

As we mentioned earlier, Australian taxpayers contribute a portion of their income tax towards funding Medicare, and bulk billing allows you to access these medical services from health professionals without paying any out of pocket costs.  Essentially, the Medicare scheme picks up the tab for you. 

Let’s say you visit your local GP. After your visit, your GP’s clinic bills Medicare directly and accepts your Medicare benefit as full payment for their service.  The term ‘bulk billing’ means that the medical practice bills Medicare in a batch of consultations to Medicare all at once. 

The Australian Government Department of Health and Aged Care then pays a benefit towards consultations or health services listed on the Medicare Benefits Schedule (MBS). The amount they pay for these consultations, also known as medical services, is listed on the MBS Online.  You might want to make yourself a cuppa before trying to wrap your head around the MBS. 

Typically, Medicare pays for 85 percent of the schedule fee for any listed procedure, 75 percent for private patients, and 100 percent for GPs. 

Some health professionals may charge more than the schedule fee, which means you may need to pay some out of pocket costs (which is called the “gap”).  If you’re unsure about whether or not you need to make any payments, ask your medical practitioner before you visit them.

Helpful Tip:

It’s definitely worth exploring your telehealth options under Medicare. Telehealth doesn’t just offer some Aussies a convenient way to see their GP, but it’s a lifesaver for people who live in remote areas or those who suffer from mobility issues.

Telehealth services are an excellent and much needed service for patients, however it is worth noting they are meant for GPs or other medical professional consultations with whom you have an existing relationship and who you have seen face-to-face within the last 12 months. Just make sure to speak with your healthcare provider to double-check if the consultation in question is covered by the MBS. Also of note, some GPs or other specialists may charge gap fees for telehealth.

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Coach

What does Medicare cover? 

The Medicare system subsidises a large number of health services and medicines.

Hospital services 

If you’re a public patient in a public hospital, you can access services and treatments covered by Medicare such as: 

• Emergency care
• Most surgeries and procedures (although you may need to wait if it’s not an emergency)
• Medicines provided to you while in hospital
• Follow-up care 

The good news is that if you’re a public patient in a public hospital, your costs for these services are generally fully covered by Medicare! 

Medical services 

A number of medical services are also partially or fully covered by Medicare through the MBS. These include things like: 

• Consultations with GP specialists, non-GP specialists, and other health professionals either in person or via telehealth
• Mental health services such as mental health assessments, treatment plans and medicines
• Health check-ups
• Some dental procedures for children 

While the list of medical services under Medicare is pretty comprehensive, it’s always a good idea to ask your local medical clinic whether they cover the service or treatment you require before you visit them. 

Diagnostic imaging 

Let’s say you’ve visited your local GP for a medical issue, and they’ve advised you to undertake some further tests to figure out exactly what’s going on beneath the surface. 

You may be required to undertake some diagnostic imaging tests or scans. Medicare covers many of these services such as: 

• Magnetic resonance imaging (MRI) – conditions apply
• Nuclear medicine scans such as positron emission tomography (PET) – conditions apply
• Ultrasounds
• Computed tomography (CT) scans
• X-rays 

Keep in mind that not all imaging and scanning providers will bulk bill, so check with your provider to see if you will need to pay any out of pocket costs. 

MRI and PET scans must also fulfil a certain criterion before you can receive a Medicare rebate. This includes things like being listed on the MBS, being referred by a specific health practitioner, be provided by an accredited provider and being conducted on eligible equipment.

Pathology tests 

Your doctor might advise you to get some tests done in order to screen for, diagnose, or monitor any medical issues or diseases. This includes things like blood, urine or tissue tests. 

Some pathology clinics do bulk bill, but some don’t. Generally, Medicare will cover you for pathology tests and screenings. It’s also worth noting that if your GP requests more than 3 tests on the same day, Medicare will only cover the 3 most expensive tests.  

Eye tests 

Whether you’re in your early twenties or approaching your late fifties, it’s always worth getting your eyes checked by an optometrist to make sure everything is in working order and your eyes are in good health. 

Medicare covers eye tests by an optometrist once every three years if you’re under 65, and once a year if you’re over 65. 

Keep in mind that not all optometrists bulk bill, so ask them if they do before you make your appointment.

Medicines 

Many of us need to access different types of medicine at some point throughout our lives. And yes, that could mean more than the occasional Panadol or Nurofen. 

While some prescription medicines can be expensive, many are partially or fully subsidised by Medicare under the Pharmaceutical Benefits Scheme (PBS).

Vaccines 

Remember those vaccinations you got during your primary or secondary school days?  

That’s thanks to the National Immunisation Program, which covers costs of most childhood vaccines and a number of other essential vaccines to help protect eligible Australians from a range of diseases. 

What kinds of treatments aren’t covered by Medicare? 

While your little green card can be a ticket to great savings at the doctor’s clinic, many medical services aren’t accessible via Medicare. 

Medicare doesn’t cover the costs of: 

• ambulance services 

• most dental services 

• glasses and contact lenses 

• hearing devices 

• elective and cosmetic surgery 

• services not on the MBS 

• services provided through the private health system 

This is why many people choose to pair their Medicare card with Private Health Insurance to give them more options – and more potential savings – on healthcare. 

Having private Health Insurance can give you invaluable peace of mind knowing that you’re covered for an even greater range of Hospital services, and Extras such as dental, optical, physio, chiro and much more. 

In some cases, depending on your state or territory, you may also be able to combine Hospital and Extras cover with Ambulance cover. 

Basically, Private Health Insurance may fill the gap and cover some of the costs of medical services and treatments where Medicare doesn’t. Plus, you have greater freedom in choosing your hospital and doctor, too.

Where can I compare Health Insurance policies? 

If you’re ready to boost your healthcare cover (on top of your little green card, of course!) you can compare a range of policies from our range of providers or you could give us a call on 1800 784 772.