Medicare is the cornerstone of Australia’s public healthcare system, providing essential medical services to citizens, permanent residents, and eligible visa holders. Understanding what Medicare covers—and what it doesn’t—can help you plan your healthcare needs and avoid unexpected costs. This guide explores the services included under Medicare, ensuring you can make the most of the system during your time in Australia.

What Is Medicare?

Medicare is a government-funded system offering free or subsidised healthcare services. It ensures universal access to necessary medical care, including doctor visits, public hospital treatment, and subsidised medications. Medicare is funded through a 2% tax on income, known as the Medicare Levy, and provides a safety net for high out-of-pocket costs.

Services Covered by Medicare

Medicare covers a broad range of healthcare services, ensuring essential medical care is accessible to all eligible residents.

1. Doctor Visits (General Practitioners)
   Medicare subsidises or fully covers consultations with GPs. Some clinics bulk bill, meaning Medicare pays the doctor directly, so you pay nothing out-of-pocket. Other clinics charge a fee, and you’ll need to claim a partial rebate from Medicare.
2. Specialist Services
   Visits to specialists, such as dermatologists or cardiologists, are partially covered by Medicare if referred by a GP. The rebate typically covers 85% of the Medicare Benefits Schedule (MBS) fee, leaving you to pay any gap between the specialist’s charge and the MBS fee.
3. Hospital Care
   • Public Patients: Medicare covers the full cost of treatment in a public hospital, including consultations, surgeries, and nursing care.
   • Private Patients in Public Hospitals: Medicare pays 75% of the MBS fee for doctor services, but additional costs like private room fees are not covered.
4. Diagnostic Tests
   Medicare provides subsidies for essential diagnostic tests, such as X-rays, ultrasounds, and blood tests, when ordered by a doctor.
5. Prescription Medications
   Subsidies are available for medicines listed under the Pharmaceutical Benefits Scheme (PBS). Patients pay a capped amount, with concessional rates available for eligible individuals.
6. Mental Health Services
   Medicare covers part of the cost for psychological services under a GP-approved mental health care plan. Up to 10 subsidised sessions with a psychologist are available per calendar year.
7. Eye Tests
   Eye tests conducted by optometrists are covered, though Medicare does not subsidise glasses or contact lenses.
8. Chronic Disease Management Plans
   Patients with chronic illnesses may be eligible for Medicare-funded allied health services, such as physiotherapy or podiatry, when referred under a GP care plan.

Services Not Covered by Medicare

While Medicare offers comprehensive coverage, some services are excluded, requiring private health insurance or out-of-pocket payments:

• Ambulance Services: Not covered by Medicare. Separate ambulance insurance is necessary in most states.
• Dental and Orthodontic Care: Excluded, except for specific treatments under certain public schemes.
• Optical Products: Glasses and contact lenses are not subsidised.
• Physiotherapy and Chiropractic Care: Excluded unless covered under a chronic disease management plan.
• Cosmetic Procedures: Not covered unless deemed medically necessary.
• Overseas Medical Costs: Medicare does not provide coverage for medical expenses incurred outside Australia.

Understanding Medicare Safety Nets

The Medicare Safety Net helps reduce out-of-pocket costs for individuals and families who incur high medical expenses in a calendar year. Once you reach the annual threshold, Medicare provides higher rebates for subsequent medical services.

Thresholds for 2023:

• General Safety Net: AUD $524.80.
• Extended Safety Net (concession cardholders and families): AUD $717.90.

How to Access Medicare Services

1. Register for Medicare
   Eligible residents must enrol in Medicare at a local service centre or online. You’ll receive a Medicare card, which is required for accessing subsidised services.
2. Choose Bulk Billing Clinics
   Look for bulk billing GPs and specialists to minimise out-of-pocket costs. Clinics advertise this service on their websites or signage.
3. Keep Your Medicare Card Handy
   Present your card when visiting a doctor, undergoing diagnostic tests, or purchasing PBS-listed medications.
4. Claiming Rebates
   Rebates can be claimed immediately at most clinics or via the MyGov website or Medicare app.

Tips for Managing Health Costs

• Combine Medicare with Private Insurance: Supplement Medicare with private health insurance to cover services not included, such as dental or private hospital stays.
• Use Preventive Services: Take advantage of free health checks and screenings offered by Medicare to stay healthy and avoid costly treatments.
• Understand Your Coverage: Familiarise yourself with the MBS and PBS to know which services and medications are subsidised.

Medicare is an essential part of Australia’s healthcare system, offering accessible and affordable care for a wide range of medical needs. By understanding what Medicare covers—and where private insurance may be necessary—you can manage your health costs effectively and ensure you receive the care you need.