Medicare services

We provide payments and services that can help when you, or someone you provide care for, use health care services or buy medicines.

Find out how to get your Medicare benefit tax statement for your tax return.

About Medicare

We administer Medicare on behalf of the Department of Health, who is responsible for developing Medicare policy.

Medicare usually covers:

  • free or subsidised treatment by health professionals such as doctors, specialists, optometrists and in specific circumstances dentists and other allied health practitioners free treatment and accommodation as a public Medicare patient in a public hospital
  • 75% of the Medicare Schedule fee for services and procedures if you are a private patient in a public or private hospital. It does not include hospital accommodation and items such as theatre fees and medicines
  • some health care services in certain countries

We pay Medicare benefits in accordance with legislation governing Medicare and has no discretion to pay benefits outside of this legislation.

The Medicare Benefits Schedule (MBS) is a Department of Health publication listing services that are subsidised by the Australian government under Medicare. You can use MBS Online to check if a service is listed under Medicare.

Once you reach the relevant threshold, the Medicare Safety Net provides an additional benefit for eligible services, in addition to the standard Medicare benefit. This may mean that visits to your doctor or having tests could cost you less for the rest of the calendar year.

Many types of medicine cost much more than the price you pay. The Pharmaceutical Benefits Scheme (PBS) and the PBS Safety Net can reduce the cost of medicine.

If you or your family pay for private health insurance, you may be eligible for the Australian Government Private Health Insurance Rebate on your premiums.

If you aren’t already enrolled, you can complete a Medicare enrolment application form. When you take the form to a service centre, you need to bring your identification and proof of residency documents.

Billing and claiming options

Billing

Your doctor can choose to bulk bill you for the service or issue you with a patient account.

Bulk billing is when your doctor bills us directly for the full payment for their service. You cannot be charged any additional costs such as a booking or administration fee, or a charge for bandages.

A patient account is when your doctor charges you directly. You can claim benefits from us for this cost.

Claiming

Before you start your claim, check if you are eligible for this payment.

You can claim your Medicare benefit:

  • at your doctor's
  • online, or
  • over the phone

You can also submit a Medicare claim form by mail or in a drop box at a Medicare service centre.

You can lodge claims at participating private health funds if they use Medicare two-way.

If your doctor offers electronic claiming, practice staff will lodge your claim with us, either through the practice's EFTPOS terminal using your EFTPOS card, or through a secure internet connection. Your Medicare benefit will usually be paid into your nominated bank account the next working day, sometimes even sooner.

You can lodge some Medicare claims online through Medicare online accounts. You can submit claims for anyone listed on your Medicare card. If you’ve registered your bank account details with us, your benefit will usually be paid into your account the next working day.

You can also claim at a service centre.

You need to register your bank account details with us before you take advantage of the range of claiming options available.

You can register your bank account details:

You will need to:

  • have your Medicare card and bank account details (BSB, account number and account name) with you when you register
  • let us know if your details change in the future

Register for the Medicare Safety Net

If you are an individual, you don’t need to register for the Medicare Safety Net. Couples and families need to register.

You can register in a number of ways:

Pharmaceutical Benefits Scheme

If you have an Australian Government concession card, you will pay even less for your PBS medicines when you show your card.

If your doctor has written a non-PBS or private prescription, you will have to pay the full price for this medicine. These medicines don’t count towards the PBS Safety Net. Also, if you choose a higher priced brand of medicine, or your doctor prescribes one, you may pay more.

Reciprocal Health Care Agreements

Medicare benefits are not available for treatment you receive overseas. However, the Australian Government has signed Reciprocal Health Care Agreements with some countries to cover Australians for the cost of essential medical treatment while they are overseas.

These agreements also provide some health services and subsidised medicines to visitors from these countries when they are in Australia.

Agreements have been signed with:

  • New Zealand
  • the United Kingdom
  • the Republic of Ireland
  • Sweden
  • the Netherlands
  • Belgium
  • Finland
  • Italy
  • Malta
  • Norway
  • Slovenia

Useful Medicare tips

  1. Register your bank account details for a great range of claiming options
  2. Register your family for the Medicare Safety Net
  3. Let us know if you change your address
  4. Destroy your old Medicare card if you receive a new one
  5. Take your Medicare card with you when you visit a doctor or have a prescription filled

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