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

Medicare provides access to medical and hospital services for all Australian residents and certain categories of visitors to Australia. We administer Medicare, including the payment of Medicare benefits on behalf of the Department of Health, who is responsible for developing Medicare policy.

Medicare 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. This does not include hospital accommodation and items such as theatre fees and medicines

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

The Department of Health Medicare Benefits Schedule (MBS) lists services that are subsidised by the Australian Government under Medicare. Use the Department of Health MBS Online website 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 medicines 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 in Medicare, you can complete a Medicare enrolment application form and submit the form along with identification and proof of residency documents to your local service centre.

Billing and claiming options

Billing

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

Bulk billing is when your health professional accepts the Medicare benefit as full payment for a service. You cannot be charged any additional costs such as a booking, administration fee or record-keeping fees, or a charge for consumables such as bandages.

A patient account is when a health professional charges you directly. You can claim benefits from us for this cost.

Claiming

You can submit claims for anyone listed on your Medicare card. You can also submit a claim for someone who is not listed on your Medicare card if you have paid for the service.

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

Claiming when you receive the service is the most convenient choice for customers because you are naturally connected. If your health professional offers electronic claiming, they will submit your claim to us, either through a secure internet connection or through the practice's EFTPOS terminal using your EFTPOS card. Your Medicare benefit will be paid into your nominated bank account - usually on the next working day but sometimes even sooner.

If your health professional does not offer electronic claiming, you can claim your Medicare benefit:

Registering for the Medicare Safety Net

The Medicare Safety Net provides families and individuals with financial assistance for out-of-pocket costs for Medicare Benefits Schedule services. Once you reach a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for the rest of that calendar year. If you are an individual, you don’t need to register for the Medicare Safety Net. Only couples and families need to register.

Read more about registering for the Medicare Safety Net.

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 visiting those countries.

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

Useful Medicare tips

  1. Register your bank account details
  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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This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.