Medicare information for health professionals

Important information for accessing Medicare as a health professional.

National health care

The national health care funding system gives eligible Australian residents access to health care at an affordable cost or no cost.

The health care system includes a mixture of public and private sector health services.

The Australian Government's health funding is made up of 3 major national subsidy schemes:

  • Medicare, Australia's key health care program
  • the Pharmaceutical Benefits Scheme (PBS)
  • the Australian Government rebate on private health insurance

Medicare and the PBS cover eligible Australian residents and subsidise their payments for private medical services and most prescription medicine.

The Australian Government rebate on private health insurance helps people to choose and keep private health insurance.

Medicare

Medicare provides access to:

  • free or subsidised treatment by health professionals such as
    • doctors
    • specialists
    • optometrists
    • dentists, and
    • other allied health professionals,
  • free treatment and accommodation as a public Medicare patient in a public hospital

Medicare also provides access to 75% of the Medicare Schedule fee for services and procedures if you’re a private patient in a public or private hospital. This doesn’t include hospital accommodation and items such as theatre fees and medicines.

Federal, state or territory and local government responsibilities

The Australian Government has the primary role of developing national policies, regulations and administer funding.

The Australian Government and state and territory governments mutually fund Australia’s public hospital system.

State, territory, and local governments are responsible for delivering and managing public health services and for maintaining direct relationships with most health care providers. This includes regulating health professionals and private hospitals.

How we work with the Department of Health

We work in partnership with the Department of Health (Health) to achieve the Australian Government's health policy objectives.

We make payments for services provided by eligible health professionals under Medicare, the PBS and other programs, such as the Australian Immunisation Register.

Health is responsible for the policy development of the Medicare program and the Medicare Benefits Schedule (MBS).

We are responsible for administering the Medicare program on behalf of Health. This includes registering details for health professionals eligible to have Medicare benefits paid for their services.

Working as a doctor in Australia

To work as a doctor in Australia, you must have current registration with the Australian Health Practitioner Regulation Agency (AHPRA).

You may also need to have a Medicare provider number so you can claim Medicare benefits for the services you provide.

A Medicare provider number lets you:

  • raise referrals for specialist services
  • make requests for pathology or diagnostic imaging services

If you satisfy the legislative requirements you can use a provider number to accrue Medicare benefits for the professional services you provide, such as treating private patients.

A Medicare provider number doesn’t automatically let you get Medicare benefits for your services.

Eligibility to access Medicare benefits is determined by the Health Insurance Act 1973 (the Act) and related regulations. The requirements of sections 19AA and 19AB of the Act must be satisfied before access to Medicare benefits can be granted. You can read the Act on the Federal Register of Legislation website.

A Medicare provider number uniquely identifies both you and the place you work.

Medicare provider number restrictions

Overseas trained doctors (OTDs) are subject to Medicare provider number restrictions if they want to treat private patients. These restrictions affect where an OTD can work in Australia.

If you work in a District of Workforce Shortage you may get exemption from these restrictions.

We issue a Medicare provider number after an OTD has been offered a medical job in Australia. The Application for an initial Medicare provider number for a medical practitioner form is on our website.

Specialists

If you’re a specialist wanting access to Medicare benefits that attract a higher specialist payment you need to apply for recognition as a specialist for Medicare billing purposes.

Page last updated: 12 September 2017