Budget 2014-15: Medicare Benefits Schedule – introducing patient contributions for general practitioner, pathology and diagnostic imaging services

Important Update: This measure is subject to the passage of legislation.

Description of the measure

From 1 July 2015 the Medicare benefit will be reduced by $5 for all patients for:

  • non-referred general practitioner (GP) consultations
  • out-of-hospital pathology episodes
  • out-of-hospital diagnostic imaging services.

A patient contribution of $7 will be introduced and this may be charged by the provider. A maximum of 10 patient contributions per calendar year across these services would be payable by concessional patients (including children under 16), where the provider charges a patient contribution. After 10 patient contributions have been paid, the Medicare benefit for concessional patients for these services will revert to the full amount. All patient contribution amounts charged will be excluded from the Medicare Safety Net.

Where patients assign their Medicare benefit directly to a provider, changes will be made to legislation to allow providers to charge the patient a $7 patient contribution.

A Low Gap Incentive will also be introduced and paid to providers that accept a concessional patient’s (including children under 16) assignment of Medicare benefit, and charge a patient contribution of $7 only.

The bulk bill incentive will stop for:

  • non-referred GP consultations in groups A1, A2, A11, A22 and A23
  • pathology and diagnostic imaging services for general and concessional patients.

The bulk bill incentive will continue to be paid for other GP services (not in groups A1, A2, A11, A22, and A23) that do not attract a patient contribution.

Questions and answers

Who will be affected by this measure?

This measure will affect GPs, pathology and diagnostic imaging providers and all patients entitled to Medicare benefits.

Am I eligible for this measure?

All patients entitled to Medicare will still be eligible. This Budget measure will not change the way people qualify for Medicare benefits, but will change the amount of the Medicare benefit payable for these services.

Patients may also experience higher out-of-pocket costs for these services where providers charge a patient contribution, including services where they assign their Medicare benefit to the provider.

When will this measure start and finish?

This measure will start on 1 July 2015 and will be ongoing.