Medicare FAQ

Medicare is Australia's universal public health insurance system. It's funded by taxpayers (including the Medicare levy on your tax return) and provides free or subsidised access to a range of health services.

Medicare covers: GP visits, specialist consultations (with a referral), most blood tests and pathology, most imaging (X-rays, ultrasounds, CT, MRI), and public hospital treatment as a public patient. It also subsidises prescription medications through the PBS (Pharmaceutical Benefits Scheme).

Medicare does not cover: dental, most optical, ambulance, physiotherapy, psychology (unless via a Mental Health Care Plan), cosmetic procedures, or private hospital costs.

You're eligible for Medicare if you are: an Australian citizen, a permanent resident, a New Zealand citizen living in Australia, or a citizen of a country with a Reciprocal Health Care Agreement (RHCA) — including the UK, Ireland, NZ, Sweden, Netherlands, Finland, Italy, Belgium, Malta, Slovenia, and Norway.

If you're on a temporary visa (e.g. student, working holiday), you are generally not eligible for Medicare unless your country has an RHCA. You should have private health insurance or travel insurance.

Your Medicare card is a green card with your name and Medicare number. You need to show it when you visit a doctor, hospital, or have a blood test. You can also use the myGov app on your phone as a digital card.

If you've lost your card, you can order a replacement through myGov or by calling Medicare on 132 011.

Here's how it works: the doctor sends the bill straight to Medicare, and you walk out paying nothing. Simple. But not all doctors bulk bill — some charge a gap fee on top of the rebate, and it's entirely their choice whether they bulk bill everyone, just some patients (like concession card holders or children), or nobody at all.

Bulk billing rates have dropped in recent years, but the government introduced triple bulk billing incentives in 2023 to encourage more GPs to bulk bill children under 16 and concession card holders.

You can ask when booking: "Do you bulk bill?" If not, ask what the fee is so there are no surprises.

If you are not bulk billed, a standard GP consultation typically costs $60–$110 depending on the practice and location. Medicare rebates approximately $45.05 for a standard consult (Level B, item 23), so your out-of-pocket "gap" is usually $15–$65.

Longer appointments cost more. A long consult (Level C, 20+ minutes) might cost $100–$160, with a Medicare rebate of around $80.10. Always ask about fees when booking.

For a detailed breakdown, try our MedCost Finder.

Most of the time you don't need to do anything. If your practice lodges the claim electronically (most do), Medicare pays the rebate straight into your bank account, usually within a day or two of your visit.

If you paid the full fee upfront and the claim wasn't lodged for you — which can happen with some specialists — you can claim the rebate yourself through your Medicare online account via myGov, or in the Medicare app. You'll need the service details, how much you paid, and a photo or scan of your itemised invoice and receipt. The rebate is paid into the bank account recorded in your Medicare account, so check those details are up to date.

You can also claim at the doctor's, by mail, or at a Medicare Service Centre. Step-by-step on the official myGov — Claim your Medicare benefit page.

The Medicare Safety Net reduces your out-of-pocket costs once you (or your family) spend a certain amount on out-of-pocket medical costs in a calendar year.

Original Medicare Safety Net (2026): Once your gap costs exceed $594.40, Medicare pays 80% of the out-of-pocket for most out-of-hospital services for the rest of the year.

Extended Medicare Safety Net (2026): Once out-of-pocket costs exceed $2,699.10 (general) or $861.20 (concession/FTB-A), Medicare pays an additional 80% of future out-of-pocket costs (capped per service).

Track your spending via myGov (Medicare online) or ask your doctor's receptionist. Try our Medicare Safety Net Calculator.

Concession cards give you access to cheaper PBS prescriptions ($7.70 instead of $25.00) and many GPs bulk bill concession card holders. Types include:

Pensioner Concession Card: For Age Pension, DSP, and Carer Payment recipients.

Health Care Card: For low-income earners, some Centrelink payment recipients, and foster carers.

Commonwealth Seniors Health Card: For self-funded retirees who don't qualify for the Age Pension but meet income thresholds.

Low Income Health Care Card: You can apply through Centrelink if your income is below the threshold (approximately $681/week for a single person in 2025).

Apply through Services Australia (Centrelink).

Yes. GP refers you → you get a Medicare rebate for the specialist visit. No referral → you pay the full fee, no rebate. Simple as that.

GP referrals to specialists are valid for 12 months. Some specialists (e.g. psychiatrists, geriatricians) accept referrals valid for 3 months. Referrals to surgeons for a specific procedure don't expire until the procedure is done.

Exception: You do not need a referral for optometrists or for emergency department visits — but for anything else, assume you'll need one.

Book a long appointment with your GP and let reception know it's for a mental health assessment. Your GP will assess your mental health (often using the K10 questionnaire), discuss your goals, and create a Mental Health Care Plan.

This gives you access to up to 10 Medicare-subsidised sessions per calendar year with a psychologist, social worker, or occupational therapist. The GP will provide a referral to a specific provider or you can choose your own.

Medicare rebate for psychology sessions is approximately $116 (registered psychologist) or $171 (clinical psychologist) from Mar 2026. Many psychologists charge $180–$280, so there may be a gap. Some offer reduced-gap or bulk-billed sessions — ask when booking.

PBS-listed medications cost up to $25.00 for general patients or $7.70 for concession card holders (2026 rates). Many common medications are now available in 60-day supplies for a single co-payment.

If a medication is not on the PBS, you pay the full private price. This varies by pharmacy — it's worth shopping around. Try our PBS Cost Calculator.

An eScript (electronic prescription) is a digital prescription sent to your phone via SMS or email as a QR code/token. You show it at any pharmacy to get your medication dispensed — no paper needed.

eScripts work across all pharmacies Australia-wide. You can also store them in compatible apps like the Medicare app. For a full guide, see our eScripts Explained page.