Health care and Medicare

How you can get affordable health care and access our services.

Medicare is Australia's universal health care system. We help all Australians access a wide range of health services. Learn more about Medicare and how it works.

Accessing Medicare

You’ll need to enrol in Medicare to access our services. Find out if you’re eligible to enrol. When you enrol, you’ll get a Medicare card.

It’s best to bring your valid Medicare card or number with you when you visit a GP or specialist.

You’ll also have a My Health Record that helps securely store all your health data in 1 place. Read more on the My Health Record website.

Medicare covers

We help to cover the costs for part or all of the following services:

  • seeing a GP or specialist
  • tests and scans, like x-rays
  • most surgery and procedures performed by doctors
  • eye tests by optometrists.

Medicare doesn’t cover

We don’t pay for things like:

  • ambulance services
  • most dental services
  • glasses, contact lenses and hearing aids
  • cosmetic surgery.

Seeing a doctor

When you’re enrolled in Medicare, we can help pay some or all of the costs of seeing a doctor. If your doctor chooses to bulk bill, we’ll cover the costs and you won’t need to pay at all.

If your doctor doesn’t bulk bill, you’ll need to pay either:

  • the full cost
  • the difference between what they charge and what we cover.

If you pay the full cost, you can make a claim for the amount we cover. Your doctor can also make a claim on your behalf.

When you make your appointment, you should ask if they bulk bill. If they don’t, you should ask:

  • what they charge
  • what you may get back from us.

To find a doctor who bulk bills, use the find a health service tool on the healthdirect website.

It’s best to bring your valid Medicare card or number with you when you see your doctor.

If you download the Express Plus Medicare mobile app, you’ll always have a digital copy of your card with you.

Going to hospital

You may need to go to a hospital emergency department if you’re badly hurt or sick. Hospital emergency departments are open 24 hours a day.

You may also need to go when your GP refers you to a specialist and they suggest you go to hospital. When this happens, you usually have to wait to go into hospital. This is a booked admission.

Your costs are covered if you’re a public patient in a public hospital.

You’ll need to take your valid Medicare card or number with you when you go to hospital.

To find a hospital near you, you can use the find a health service tool on the healthdirect website.

Costs

You can choose to be a public or private patient when you go to hospital. As a public patient at a public hospital, your costs will be covered. This includes the costs of going to an emergency department.

Private health insurance can help you cover costs as a private patient in hospital. We can cover some of your costs for services and procedures in a hospital. We don’t cover accommodation costs, medicines, and theatre fees if you’re a private patient.

Learn more about private health insurance and Medicare.

Ambulances

We don’t cover the cost of emergency transport or ambulance services to hospital. Ambulance costs are different in each state and territory. Private health insurance can help you with ambulance costs.

Read more about ambulance cover on the PrivateHealth.gov.au website.

Getting help with health care costs

We can help if you and your family have high health care costs. There are also things you can do to keep your costs down. Find out how to get help with medical costs.

Medicare Safety Net

If you have a lot of out of hospital costs, the Medicare Safety Net can help keep them under control. If your costs for the year reach a threshold amount, we’ll pay more of your costs. If you’re enrolled in Medicare, you’re automatically registered for the safety net.

You can combine your out of hospital costs with your partner and children to reach the threshold sooner. To combine your out of hospital costs, you need to register as a family.

Read more about the thresholds for the Medicare Safety Net.

Medicines and Medicare

The Pharmaceutical Benefits Scheme (PBS) helps you get PBS medicines at a cheaper price. You may get further discounts if you have a concession or health care card.

If you spend a lot on PBS medicines, you can apply to the PBS Safety Net to get them even cheaper. Read more about the thresholds and the PBS Safety Net.

Accessing other services and payments

Depending on your needs, we have a range of other programs and schemes to support your health care:

Using My Health Record

You can keep track of your health information in 1 place with My Health Record. It’s an online summary of your key health information. It brings together information from you, your health care providers, and Medicare.

It records details of your:

  • medical conditions
  • medical treatments
  • medicines
  • allergies
  • test or scan results.

Find out more about My Health Record on the My Health Record website.

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Page last updated: 29 August 2019