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Australia's public healthcare system, Medicare, provides healthcare for Australian residents for free or at a reduced cost. Medicare is funded by the Australian government and covers essential treatments like medically necessary hospital procedures in public hospitals, visits to the doctor, and some medicines. However, it does not cover treatments in private hospitals, ambulance services, or extra services like glasses, dental treatment, and natural therapies. While Medicare helps cover the costs of seeing a doctor, there may still be out-of-pocket expenses for patients, depending on whether their doctor chooses to bulk bill or not.
| Characteristics | Values |
|---|---|
| Who funds healthcare services in Australia? | The Australian Government and private health insurance |
| What is the public healthcare system in Australia called? | Medicare |
| What does Medicare cover? | Healthcare for Australian residents for free or at a reduced cost, medically necessary hospital procedures in public hospitals, visits to the doctor, and some medicines |
| What does Medicare not cover? | Treatments in private hospitals, ambulance services, dental treatment, glasses, natural therapies, and accommodation costs, medicines, and theatre fees for private patients |
| What is the Medicare Benefits Schedule (MBS) fee? | A fee set by the Australian Government for most services |
| Can doctors charge more than the MBS fee? | Yes |
| What are 'gaps' or 'out-of-pocket costs'? | The difference between what you're charged and what Medicare and your insurer will pay for your treatment |
| What is My Health Record? | A way to keep track of your health information in one place online |
| What is MyMedicare? | A voluntary patient registration model that helps patients and their general practitioner (GP) manage healthcare needs |
| What is Overseas Student Health Cover (OSHC)? | A mandatory health insurance for international students in Australia |
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What You'll Learn
Medicare covers doctor's visits
Medicare covers some or all of the costs of seeing a doctor in Australia. If your doctor chooses to bulk bill, Medicare will cover the costs, and you won't need to pay at all. If your doctor doesn’t bulk bill, you’ll need to pay some upfront costs, and Medicare will cover the rest. You can make a claim for the amount covered by Medicare after your appointment.
Medicare Part B covers 80% of the cost of doctors' visits for preventive care and medically necessary services. Preventive care helps prevent illnesses or stop early-stage conditions from progressing. Medically necessary services are used to diagnose and treat a patient's medical condition according to their symptoms. Medicare Advantage (Part C) also covers the costs of doctor visits.
Medicare Supplement insurance plans can help pay for some of the out-of-pocket costs associated with Medicare Parts B and C. These plans come with a monthly premium, but they can help cover the 20% coinsurance amount that you would otherwise pay after meeting your Part B deductible.
Medicare does not cover certain medical services, including podiatry, optometry, naturopathic medicine, dental services, and most chiropractic services. It is important to check with Medicare or your insurance provider to understand what is and isn't covered by your plan.
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Bulk billing
In Australia, Medicare is a universal health insurance system funded by the Australian government. Australians contribute to Medicare through their income tax, with the amount of tax depending on their income.
Under Medicare, bulk billing is a payment option that allows eligible Australians to access healthcare services at no cost. The term 'bulk billing' comes from the fact that medical practices bill Medicare in 'bulk', meaning a range of visits and services are billed to Medicare simultaneously. When a doctor bulk bills, they accept the Medicare benefit as full payment for their service and bill Medicare directly, so the patient doesn't pay anything out-of-pocket. The Medicare benefit is the sum that Medicare will cover for a particular health service, and it may be less than the full fee charged by the doctor or health service. The difference between the amount the doctor charges and the Medicare benefit is known as a 'gap payment' or 'out-of-pocket' cost.
If a doctor does not bulk bill, the patient must pay upfront and later submit a claim to Medicare to receive their Medicare benefit, if applicable. It is important to note that not all health professionals bulk bill, so it is recommended to check when making an appointment. To find a doctor who bulk bills, individuals can use the find a health service tool on the healthdirect website.
Medicare Urgent Care Clinics (UCCs) are examples of bulk-billed services. These clinics are open for extended business hours, and patients do not need an appointment or referral. Additionally, Medicare covers the costs of being a public patient in a public hospital, including emergency department visits.
As of January 2023, only about 42.7% of general practitioners offered bulk billing, and this number was even lower outside of Sydney and Melbourne. To address the decline in bulk billing, the Australian Medical Association has called on the federal government to revise indexation to ensure rebates better reflect the rising costs of providing medical care.
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Out-of-pocket expenses
In Australia, 15% of all expenditure on healthcare comes directly from individuals in the form of out-of-pocket fees. Out-of-pocket costs are the difference between the amount a doctor charges for a medical service and what Medicare and any private health insurer pays.
If you are a public patient at a public hospital, you do not pay anything for your medical treatments. Costs for many private treatments are also fully covered by Medicare and private health insurers. However, you may have to pay out-of-pocket costs if you have medical treatment as a private patient in a public or private hospital. This can include costs for doctors and other health providers such as anaesthetists, assistant surgeons, radiology, and pathology tests. Doctors set their own fees for private medical services and can charge more than the Medicare Benefits Schedule (MBS) fee set by the Australian Government. When a doctor’s fee for hospital treatment is higher than the MBS fee, the difference is called the gap, which you pay.
If your doctor chooses to bulk bill, Medicare will cover the costs and you won’t need to pay at all. If your doctor doesn’t bulk bill, you’ll need to pay either the full cost upfront and then claim the Medicare benefit back, or the difference between the Medicare benefit and the total fee. Only 44% of private hospital admissions had no out-of-pocket fees in the 2020–21 financial year, and in the same period, only 34% of specialist attendances were bulk-billed.
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of medicines for Australians. Private health insurance can cover some medicines, for example, medicines not on the PBS. Private health insurance can also help with ambulance costs, which are not covered by Medicare.
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Ambulance costs
While Medicare helps cover the costs of seeing a doctor in Australia, it does not cover emergency transport or ambulance services to the hospital. Ambulance costs vary across states and territories in Australia.
In New South Wales (NSW), there is a call-out fee of $445 for an emergency ambulance, plus an additional charge of $4.02 per kilometre from the ambulance station to the pick-up address, to the destination, and back to the ambulance station. The maximum amount payable is $7,299. NSW government provides a 49% subsidy for these costs. There is an insurance scheme in NSW that provides coverage for emergency ambulance services to state and independent school students attending approved, fully supervised school activities within the state.
In Western Australia, the cost for a life-threatening (emergency) ambulance is $1,133 for residents and $1,355 for non-residents. Western Australian aged pensioners may be exempt from these charges.
In South Australia, the SA Ambulance Service operates a user-pays system, where treatment and transport costs are charged to the patient receiving care. The fees vary based on the services provided, with emergency ambulance call-outs including transport to the hospital costing more than a call-out where no transportation is necessary. All patient transport is billed inclusive of the incident response type call-out fee, combined with the total distance travelled by ambulance. SA Ambulance Cover members or those with other health cover with ambulance benefits are exempt from these charges.
In Victoria, a road-based ambulance trip in the city costs $1,396, while in regional or rural areas it costs $2,059. However, Ambulance Victoria membership or concession entitlements may cover these costs.
In Queensland, ambulance services are covered by the state government. If you are an interstate visitor to Queensland, you will need to cover the costs yourself or through your private health insurance.
In Tasmania, ambulance services are covered by the state government, with a few exceptions.
Private health insurance can help cover ambulance costs.
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Overseas Student Health Cover (OSHC)
In Australia, Medicare helps to cover the costs of seeing a doctor. If your doctor chooses to bulk bill, Medicare will cover the costs, and you won't have to pay anything. If your doctor doesn't bulk bill, you'll need to pay the full cost upfront and then make a claim for the amount covered by Medicare.
If you are an international student in Australia, you may be eligible for Overseas Student Health Cover (OSHC). OSHC is designed to help international students afford and manage their health and medical needs while studying in Australia. It gives students the same base level of medical cover as Australian residents, with the option to increase coverage and add extras.
OSHC is a requirement for almost all student visa applicants to Australia. It is provided by Australian insurers that have an agreement with the Australian government, and there are currently six insurance companies that offer OSHC. The length of your OSHC coverage must cover your entire stay in Australia as a student, as well as any additional time you spend in the country after your studies.
It's important to note that there are wait times for pre-existing conditions. If you have a health condition before applying for OSHC, there will be a waiting period before you can claim insurance for that condition. Therefore, it's essential to check the waiting periods and ensure they align with your travel plans.
While OSHC provides essential healthcare access, it may not cover all your health needs. For example, ambulance costs are not covered by Medicare or OSHC, and private health insurance can help with these expenses. Additionally, OSHC may not be needed if you are from a country with a Reciprocal Health Care Agreement with Australia.
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Frequently asked questions
Doctors in Australia are not free. However, Medicare provides healthcare for Australian residents for free or at a reduced cost.
Medicare is Australia's public healthcare system. It is funded by the Australian government and covers things like medically necessary hospital procedures in public hospitals, visits to the doctor, and some medicines.
If you are an Australian resident, you are likely eligible for Medicare. You can register for Medicare online using your Medicare online account and your myGov account.
If you are an international student, you are required to have Overseas Student Health Cover (OSHC) to ensure you have access to medical care during your stay.
Medicare does not cover treatments in private hospitals, ambulance services, dental treatment, glasses, and natural therapies.
