Medicare provides access to a range of medical services, lower cost prescriptions and free care as a public patient in a public hospital. All eligible Australian residents and certain categories of visitors to Australia can enrol in Medicare and access these services. We administer Medicare and pay Medicare benefits on behalf of the Department of Health, which is responsible for developing Medicare policy.
If you are eligible, 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 for public Medicare patients 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 are not able to pay benefits outside of this legislation.
The Medicare Benefits Schedule (MBS) lists services that are subsidised by the Australian Government under Medicare. Check if a service is listed under Medicare on the Department of Health MBS Online website.
Medicare Safety Net
For high out of hospital medical expenses the Medicare Safety Net provides higher benefits to individuals, couples and families. Eligible out of pocket expenses are added up and when you reach a Medicare Safety Net threshold you will receive a higher benefit on eligible services for the rest of the calendar year.
Pharmaceutical Benefits Scheme
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 have an Australian Government concession card, you will pay even less for your PBS medicines when you show your card.
Private health insurance
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.
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.
If you aren’t already enrolled in Medicare, you can complete a Medicare enrolment application form and submit the form along with identity and proof of residency documents to a service centre.