What Is Medicare?

Medicare is Australia's publicly funded universal health insurance scheme, administered by Services Australia. It provides eligible Australians with access to a wide range of medical services either free of charge or at a subsidised cost. Medicare is funded through general taxation and the Medicare Levy, which most taxpayers pay as part of their annual tax obligations.

Who Is Eligible for Medicare?

To be eligible for Medicare, you must be:

  • An Australian citizen
  • An Australian permanent resident
  • A New Zealand citizen living in Australia
  • A person from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia (such as the UK, Ireland, Sweden, and several others) — with some limitations

Temporary visa holders (other than RHCA countries) are generally not eligible for Medicare. If you are enrolling for the first time, visit a Services Australia service centre with your identity documents.

What Does Medicare Cover?

Medical Services (MBS)

The Medicare Benefits Schedule (MBS) is a list of medical services that Medicare subsidises. Key coverages include:

  • Consultations with GPs (general practitioners)
  • Specialist consultations (with a GP referral)
  • Diagnostic imaging and pathology tests (X-rays, blood tests)
  • Some surgical procedures performed in hospital
  • Mental health services through a Mental Health Treatment Plan (up to 10 sessions with a psychologist per year)
  • Optometry (eye tests)

Hospital Cover (as a Public Patient)

If you are admitted to a public hospital as a public patient, Medicare covers the full cost of treatment — including accommodation, nursing care, and medical services. You do not choose your own doctor in this arrangement.

What Medicare Does NOT Cover

  • Most dental services
  • Ambulance services (covered separately by state ambulance services or private insurance)
  • Physiotherapy, occupational therapy, and most allied health (except under specific chronic disease plans)
  • Glasses, contact lenses, and hearing aids
  • Cosmetic surgery
  • Overseas medical costs

Bulk Billing vs. Gap Payments

When you see a doctor, they may choose to bulk bill, meaning they accept the Medicare benefit as full payment and you pay nothing out of pocket. Alternatively, they may charge a fee higher than the Medicare benefit, and you pay the gap — the difference between the doctor's fee and the Medicare rebate.

Always ask your doctor before an appointment whether they bulk bill, so you know what to expect.

The Pharmaceutical Benefits Scheme (PBS)

The PBS subsidises the cost of a wide range of prescription medicines, making many medications significantly cheaper than their full price. When a doctor prescribes a PBS-listed medicine, you pay a government-set co-payment rather than the full cost. Concession card holders pay a reduced co-payment. If you reach the PBS Safety Net threshold in a calendar year, further prescriptions become free or further reduced.

Your Medicare Card

Your Medicare card lists all family members covered under your Medicare enrolment. You'll need to show it when accessing medical services. You can also access a digital Medicare card through the Medicare app or via myGov. If your card is lost or damaged, you can order a replacement through myGov or by calling Services Australia.

Useful Contacts

  • Services Australia: 132 011 (Medicare general enquiries)
  • Online: servicesaustralia.gov.au/medicare
  • myGov: Link your Medicare account to manage claims and details online