Australian Healthcare Glossary

Medicare covers all or part of the cost of a wide range of health services for Australian residents — GP visits, specialist consultations, most tests and scans, and treatment in a public hospital as a public patient. It's paid for out of general tax revenue plus the Medicare levy on personal income.

Medicare doesn't cover everything: it generally doesn't cover most dental, allied health outside of specific programs, private hospital fees, ambulance in most states, or things like optical, glasses, and cosmetic procedures.

Every eligible Australian resident (and some visitors from countries with a Reciprocal Health Care Agreement) has a Medicare number. The card has your name, a 10-digit number, an individual reference number (IRN), and an expiry date. You need to show it — or provide the numbers — to claim a Medicare rebate.

You can carry it in the Express Plus Medicare app on your phone (a "digital Medicare card") or in the Apple/Google Wallet. It's valid at every bulk-billing GP and pharmacy.

The MBS is a numbered list of every medical, pathology, imaging, allied health, and specialist service that Medicare subsidises — each with a unique item number, a description of what the service involves, and a schedule fee. The rebate a patient receives is a percentage of the schedule fee (usually 100% for a GP consult, 85% for a specialist out-of-hospital consult, or 75% for in-hospital).

The MBS is updated multiple times a year and is indexed on 1 July. Individual items are added, changed, or ceased periodically.

Every service Medicare rebates has an item number — e.g. 23 is a standard GP consult less than 20 minutes; 36 is a longer GP consult (20–40 min); 44 is the longest (40+ min). Specialist, allied health, pathology, imaging, and procedural services each have their own item ranges.

The item on your bill or claim receipt tells you exactly what Medicare thinks was done. If you don't recognise it, look it up.

If a GP, specialist, or pathology practice bulk-bills you, they send the bill straight to Medicare, accept the Medicare rebate as complete payment, and you pay $0 out of pocket. You sign a form or an on-screen "assignment of benefit" and that's it.

Not every practice bulk-bills, and many that do only bulk-bill certain patients (children, concession card holders, pensioners). You can search for clinics that bulk-bill in your area.

If a GP charges $90 for a Level B consult and the Medicare rebate is $45.05, the gap is $44.95 — that's the out-of-pocket cost to you. Gap fees are set by the provider, not by Medicare, and different clinics charge different amounts for the same service.

Some patients (children under 16, concession card holders at bulk-billing clinics) may have their gap waived, and once a patient hits their Medicare Safety Net threshold, the government pays back a bigger share of future out-of-pocket costs.

Everyone with a Medicare card is on the OMSN by default. Once your gap between Medicare rebate and MBS schedule fee across the year hits the threshold (currently $594.40, indexed 1 January), Medicare pays back 100% of the schedule fee for out-of-hospital services for the rest of that calendar year (instead of 85%).

Most families never notice the OMSN because it's a small change and the gap counted here is only the schedule-fee gap, not the full charged amount. The much larger help is the Extended Medicare Safety Net.

Once your actual out-of-pocket costs for out-of-hospital Medicare services hit the annual EMSN threshold, Medicare pays back 80% of any further out-of-pocket costs for the rest of the calendar year.

Thresholds for 2026: $2,699.10 for the general public, $861.20 for concession card holders and FTB-A families. Both are per family (you have to register your family with Medicare).

The PBS lists medicines that the Australian government subsidises so that patients pay a capped price at the pharmacy instead of the full commercial cost. In 2026 the maximum a general patient pays for a PBS-listed script is $25.00; a concession card holder pays $7.70.

Not every medicine is on the PBS. Ones that aren't (or that a doctor prescribes off-label) are called "private" scripts and you pay the full price.

Once you spend a set amount on PBS medicines in a calendar year, further scripts drop to a reduced price (general) or are free (concession). 2026 thresholds: $1,748.20 for the general public (drops to concession co-payment for the rest of the year), $277.20 for concession card holders (drops to $0).

Your pharmacist tracks this automatically on your Medicare number. If you use multiple pharmacies, ask for a Prescription Record Form and take it to each.

The GPCCMP (MBS items 965 for the initial plan, 967 for review) is what your GP prepares if you have a chronic (long-term) condition — things like diabetes, asthma, heart disease. It sets out your care goals and links you to up to 5 subsidised allied-health visits per calendar year (physio, dietitian, psychology, podiatry, EP, OT, speech).

The GPCCMP replaced the older GPMP (item 721) and Team Care Arrangement (item 723) on 1 July 2025.

An MHTP is a written plan your GP prepares if you have a mental-health condition. It gives you access to up to 10 subsidised sessions with a psychologist or mental-health social worker each calendar year, in two batches of six and then four (with a GP review in between).

The initial plan is MBS item 2715 (or 2717 for a longer plan); the review is 2712 or 2713 (until Nov 2025, then 2715/2717 again). Sessions themselves are billed by the psychologist under items in the 80000 range.

If you're taking multiple medicines or your GP is worried about interactions, adherence, or side effects, they can refer you for an HMR (MBS item 900). An accredited pharmacist visits you at home, reviews every prescription and over-the-counter medicine you take, and sends a report back to your GP. Your GP then completes the plan (item 903).

You pay nothing for an HMR. Item 245 covers a Residential Medication Management Review (RMMR) if you live in aged care.

The K10 is a widely-used self-report screener — ten questions about how often you've felt tired, nervous, hopeless, restless, and so on in the last four weeks. Each answer scores 1–5 for a total of 10–50. GPs, psychologists, and EAP providers often use it as a self-screen before or after an appointment.

The K10 is a screening tool, not a diagnosis. It's designed to prompt a conversation with your GP or a mental-health professional — not to replace one.

"CDM" is what people used to call the old care-plan items (721 for GP Management Plan, 723 for Team Care Arrangement, 732 for review) that were combined and replaced by the GPCCMP on 1 July 2025. You'll still hear the term used to mean chronic-condition care in general, and many older documents refer to CDM items.

"Concession card" is a general term covering the Pensioner Concession Card (PCC), Health Care Card (HCC), and Commonwealth Seniors Health Card (CSHC). Holders pay the concession-rate PBS co-payment ($7.70 in 2026 instead of $25.00), and hit the PBS Safety Net at a much lower spend ($277.20 instead of $1,748.20).

Many bulk-billing GP practices bulk-bill concession card holders even when they don't bulk-bill the general public.

If you receive certain Centrelink payments (JobSeeker, Youth Allowance, Parenting Payment, Family Tax Benefit A at maximum rate, and others), you may qualify for a Health Care Card. It gives you concession-rate PBS scripts, cheaper prescriptions at bulk-billing pharmacies, and often reduced fees at public transport, utilities, and council services (state-dependent).

The CSHC is for Australians who are of Age Pension age but don't get the Age Pension — usually because their income is above the pension threshold. It gives you concession-rate PBS scripts, the concession EMSN threshold, and sometimes discounted state services.

There's an income test but no assets test. Your income for the test includes deemed income on financial assets like super in account-based pensions.

DVA administers three colour-coded cards. Gold Card: covers all clinically-required health care in Australia. White Card: covers care for accepted service-related conditions only. Orange Card: covers PBS scripts at the concession rate for certain veterans, widows, and dependants.

DVA cardholders present their DVA card at the GP or pharmacy instead of (or as well as) their Medicare card. Many services that Medicare charges a gap for are fully covered under DVA.

MyMedicare is a free voluntary registration you make with a specific general practice. Once registered, that practice becomes your "home" practice for Medicare purposes: you're eligible for longer bulk-billed telehealth consults, better access to funded chronic-disease programs, and priority for after-hours care through your registered practice.

You can only be registered with one practice at a time. You can change registration anytime by asking the new practice.

The NIP is the list of vaccines the federal government funds for eligible Australians — most childhood vaccinations, annual flu vaccine for at-risk groups, shingles for over-65s, RSV for over-75s and pregnant women, pneumococcal for over-65s, HPV vaccination for adolescents, and COVID-19 vaccines.

NIP-funded means the vaccine itself is free. You may still pay a consultation fee to the GP or pharmacist for administering it, unless they bulk-bill.

ATAGI is the expert clinical body that advises the federal Health Minister on immunisation. When you see "ATAGI recommends" in a news article or a Handbook chapter, it means this committee has reviewed the evidence and set the official Australian recommendation.

ATAGI recommendations often go beyond what's actually funded on the NIP — e.g. flu vaccine is recommended for everyone 6 months and older, but only free for certain groups.

The AIR records every vaccination given — NIP or private — from infancy through adulthood. Providers must upload records; individuals can view their own history through their Medicare online account, the Express Plus Medicare app, or myGov.

Employers, schools, and childcare centres may ask for an AIR Immunisation History Statement to confirm vaccinations. It's free to download.

Capvaxive (21vPCV) is a pneumococcal conjugate vaccine that replaces the older two-dose Prevenar 13 + Pneumovax 23 sequence for adults on the NIP from 1 July 2026. It's a single dose that protects against 21 pneumococcal serotypes.

Funded eligibility: adults 65 and over (non-Indigenous), 25 and over (Aboriginal and Torres Strait Islander), and 18 and over with a risk condition. If you've had a previous pneumococcal vaccine, you can have Capvaxive at least 12 months later.

Everyone with a cervix aged 25–74 is invited to screen every 5 years under the NCSP. The test itself is a Cervical Screening Test (CST) — a swab that looks for HPV rather than the older Pap smear approach. Self-collection is available as an option.

The test is free of any Medicare-provider bulk-billing fee at bulk-billing GPs and dedicated screening clinics; you may pay a gap fee at a non-bulk-billing GP.

The NBCSP mails a free faecal immunochemical test (FIT) kit to eligible Australians every 2 years. Age 50–74 is invited automatically; adults 45–49 can request their first kit through the program.

The kit and postage are free. If the result is positive, your GP will refer you for a colonoscopy — which may attract private fees or waitlist depending on the pathway.

BreastScreen Australia offers free screening mammograms every 2 years for women aged 50–74 (women 40–49 and 75+ can also access the service). No GP referral is needed; you book directly.

The mammogram and reporting are free. If they find something on screening, you're referred back through a GP for further work-up — which may or may not be bulk-billed.

Private hospital cover pays part or all of the cost of a private hospital admission — your accommodation, theatre fees, and (usually) the doctor's fees on top of what Medicare rebates. It doesn't cover outpatient GP or specialist visits (that's Medicare).

Different policies have different waiting periods, excesses, and gap arrangements. Reading the Private Health Information Statement (PHIS) for any policy is the fastest way to compare.

Extras cover (also called "general treatment" or "ancillary") is separate from hospital cover. It pays a percentage of your dental, optical, physio, chiropractic, remedial massage, and similar out-of-hospital costs, usually up to an annual limit.

You don't need extras to satisfy the Medicare Levy Surcharge or Lifetime Health Cover rules — those only require hospital cover.

The MLS is an additional 1–1.5% levied on your income at tax time if your income is above the threshold and you don't have appropriate private hospital cover for the full financial year. Thresholds for 2026–27 (from 1 July 2026): singles $105,000, families $210,000 (plus $1,500 per child after the first).

The surcharge often costs more than a basic hospital policy would — which is largely the point of the policy.

If you don't hold hospital cover by the 1 July after you turn 31, and then take out cover later, you pay a 2% loading on the base premium for every year you were without cover — up to a maximum 70%. The loading is removed once you've had continuous cover for 10 years.

People who move to Australia have a year from becoming a resident to take out cover without a loading.

The RACGP sets the standards, curriculum, and continuing-professional-development requirements for Australian GPs. Fellowship of the RACGP (FRACGP) is one of the two specialist qualifications recognised for general practice; the other is FACRRM (Australian College of Rural and Remote Medicine).

The RACGP is also the publisher of the Red Book (preventive health guidelines) and the Standards for General Practices.

AHPRA manages the national registration of every doctor, nurse, dentist, pharmacist, psychologist, physiotherapist, and 10 other regulated professions in Australia — through their respective National Boards. Every registered practitioner has a unique AHPRA number that patients can look up.

If you have a serious concern about a practitioner's conduct or safety, AHPRA is where you make a notification.

The TGA is the Australian regulator for medicines, medical devices, blood products, and other therapeutic goods. Before a prescription drug can be marketed here, it has to be evaluated and approved by the TGA and listed on the Australian Register of Therapeutic Goods (ARTG).

The TGA also runs safety monitoring after approval, issues recalls, and publishes medicine shortage notices.