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How do I pay for healthcare in Australia?

The Australian health system helps to provide Australians with safe and affordable health care. Medicare and the public hospital system allow eligible people to access public hospitals, health services and some prescription medicines for free or at a low cost. Private health insurance policies can provide extra coverage outside of the public system.

What is Medicare?

Medicare is a government insurance scheme that helps Australians pay for healthcare. Find out how you can enrol for Medicare on the Services Australia website.

Medicare is available to:

• Australian citizens
• New Zealand citizens
• Australian permanent residents
• people who are applying for permanent residency (some conditions apply)
• a temporary resident covered by a ministerial order
• citizens or permanent residents of Norfolk Island, Cocos (Keeling) Islands, Christmas Island or Lord Howe Island

If you are visiting Australia, you may be eligible for Medicare benefits if you come from a country that has a reciprocal healthcare agreement with Australia.

If you are a visitor from a country that does not have a healthcare agreement with Australia, you should consider buying private health insurance to cover the costs of medical treatment in Australia.

You can check whether you are eligible for Medicare on the Services Australia website.

What services does Medicare cover?

Medicare covers a range of healthcare services for free or at a lower cost, including:

• Seeing a doctor or specialist: If your doctor bulk bills, Medicare will pay for your appointment (including telehealth appointments). If your doctor does not bulk bill, you will need to pay for the appointment and then claim part of the cost (called a rebate) back from Medicare.
• Going to hospital: If you are a public patient accessing care in a public hospital, Medicare will cover your costs. If you go to the emergency department of a public hospital, Medicare will pay for everything. If you are a private patient in hospital, Medicare may cover some of your costs.
• Tests and scans: Medicare pays for a range of tests, including x-rays and pathology tests, if your doctor or pathology collection centre bulk bills.
• Eye tests: Medicare pays for eye tests, if the optometrist chooses to bulk bill. Not all optometrists bulk bill. If you are under 65 years of age, you can claim an eye test once every 3 years. People over 65 years of age can claim once a year.
• Mental health services: You can claim a Medicare rebate for up to 10 individual sessions and 10 group sessions each calendar year with a mental health professional. To do this, you need a mental health treatment plan and referral from your doctor. Medicare may only cover part of the cost, as health professionals set their own fees.
• Other support: Medicare covers the costs for some long-term conditions, allied health services and prescription medicines. Services are covered based on your health needs. If you have a chronic or complex health condition that results in extra health costs, talk to your doctor for more information. You may be eligible for a Team Care Arrangement or a GP Management Plan to help with these costs.

Medicare does not generally pay for out-of-hospital services that are not on the Medicare Benefit Scheme (MBS), such as physiotherapy and podiatry.

Read more about what's covered by Medicare on the Services Australia website.

Are dental services covered by Medicare?

Medicare only pays for dental procedures if you are eligible for care at a public dental clinic. Generally, you must pay yourself. Many people use private health insurance to help them pay for dental services.

Medicare covers some of the costs of dental care for some children under a scheme called the Child Dental Benefits Schedule. Find out if your child is eligible.

Read more here about how to pay for dental costs.

How much of my doctor's fee is covered by Medicare?

Medicare will cover some or all of the fee that you are charged by your doctor - this is called a ‘Medicare benefit’.

Some doctors bulk bill. This is when your doctor charges the same fee as the benefit. If your doctor bulk bills, Medicare covers the full cost of the visit, which is paid directly to your doctor. This means you do not have to pay your doctor a fee for the visit.

If the doctor does not bulk bill, you will need to pay for the consultation yourself, and claim part of the cost back from Medicare. The amount covered by Medicare is the ‘benefit’, and extra amount you need to cover yourself is known as the ‘gap fee’.

At some doctor’s offices, they can submit an electronic claim for your Medicare benefit automatically when you pay for the visit. After processing, the Medicare benefit is then paid into your bank account. Ask your doctor if they provide this service.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

If you see a medical specialist, you can only claim a Medicare benefit if you have a current referral from your GP.

Learn how to make a claim on the Services Australia website.

If you spend a lot of money on out-of-hospital medical visits or tests, you may be eligible for the Medicare Safety Net. This means you will receive a higher Medicare benefit.

How do I pay for tests or scans?

Your doctor might refer you for tests or scans to find out more about your health. Medicare sometimes covers the costs of these if you have a referral.

• Pathology tests: Tests such as blood, urine or biopsy tests are usually covered by Medicare. Many are bulk billed.
• Images and scans: These include x-rays, CT scans, MRI scans, PET scans and ultrasounds. For many of these tests, Medicare covers part or all of the cost.

There are also some free screening tests available in Australia, including screening for breast cancer, bowel cancer, eye tests and hearing tests. Get help to manage the costs of tests on the Services Australia website.

Not all tests are covered by the MBS. Read more here about paying for diagnostic tests and scans.

How do I pay for medicines?

The Australian Government helps with the cost of some prescription medicines through the Pharmaceutical Benefits Scheme (PBS).

Most of the cost of PBS medicines is covered by Medicare but you will still need to pay part of the cost (known as the co-payment). The amount of the co-payment changes on 1 January each year, in line with the Consumer Price Index (CPI). You can check the current fees on pbs.gov.au.

If you spend a lot of money on PBS medicines, the PBS Safety Net can reduce your costs after you have spent a certain amount on medicines each calendar year. Read more about the PBS Safety Net on the Services Australia website.

If your prescription medicine is not listed on the PBS, you will need to pay the full cost. You can read more about keeping your medicine costs down on the NPS MedicineWise website.

Does Medicare cover my healthcare if I need to go to hospital?

If you treatment in hospital, you can choose to receive care in a public or a private hospital. Read more about the public and private hospital systems.

Anyone with a Medicare number can get free treatment as a public patient in a public hospital. However, you might need to join a waiting list before receiving some treatments or procedures in a public hospital.

If you call an ambulance, it’s likely you will be taken to a public hospital emergency department.

Are ambulance services free in Australia?

Medicare does not cover the cost of ambulance services.

The fee for ambulance services in Australia varies between states and territories. Queensland and Tasmania provide free ambulance trips. People in other parts of Australia must pay, unless they have ambulance cover through their private health insurance or pay for an ambulance subscription. If you have private health insurance, it may cover some or all of the cost.

For more information about ambulance cover arrangements in your state or territory, see privatehealth.gov.au.

What is private health insurance, and should I buy it?

Private health insurance can help to pay for some of the costs that are not covered by Medicare. Depending on your policy, private health insurance covers some or all of the costs of:

• treatment in a public hospital as a private patient
• treatment in a private hospital, with the doctor of your choice
• some health services not covered by Medicare such as physiotherapy, dental and optical

Private health insurance also helps you access some hospital services more quickly.

If you can, you should take out private health insurance to help cover more services and out-of-pocket costs. Read more about private health insurance on privatehealth.gov.au.

Resources and Support

Looking for information for Aboriginal and/or Torres Islander people?

• Read more about available health services and Medicare benefits as part of the Indigenous Access Program
• Call the Indigenous Access Line on 1800 556 955 for help with a Medicare services or payment.

Looking for information for rural and remote Australians?

• Check how you can access Medicare and bulk billed appointments in your location on the Services Australia website.

Looking for information about Medicare, pregnancy and birth?

• Find out what fertility treatments, routine ultrasounds and tests, and hospital fees surrounding the birth of your baby are be covered by Medicare on the Services Australia website.
• You can find helpful information about the costs involved and those covered by public and private health insurance on the Pregnancy, Birth and Baby