Medicare

Medicare is the scheme that gives Australian residents access to healthcare.

 

Overview

Medicare is the scheme that gives Australian residents access to healthcare. Most taxpayers pay a Medicare Levy of 1.5% of their taxable income to help fund it.

Medicare gives you access to:

  • free
     or subsidised treatment by health professionals such as doctors, 
    specialists, optometrists, dentists and other allied health 
    practitioners (in special circumstances only)
  • 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 (not including hospital 
    accommodation and items such as theatre fees and medicines).

Who's eligible?

You are eligible for Medicare benefits if you:

  • are an Australian or New Zealand citizen
  • are a permanent resident
  • have applied for permanent residency (excludes an application for a parent visa) and meet certain other criteria
  • are covered by a Reciprocal Health Care Agreement with another country.

Medicare cards are issued to people enrolled in Medicare.  You can find registration information at the front of the Medicare enrolment form at www.humanservices.gov.au. If you are aged 15 years or older, you can apply for your own Medicare card, while children under 15 can be listed on their parents’ card.

When to use the Medicare card

You use your Medicare card when:

  • making a Medicare claim for a paid or unpaid doctor's account
  • visiting a doctor who bulk bills
  • receiving treatment as a public patient in a public hospital
  • filling a Pharmaceutical Benefits Scheme (PBS) prescription at a pharmacy.

The benefits (refunds) you receive from Medicare are based on a schedule of fees set by the Australian Government, although doctors can choose to charge more than the set schedule fee. Medicare usually pays:

  • the full schedule fee for general practitioner services
  • 85% of the schedule fee for other out-of-hospital services
  • 75% of the schedule fee for in-hospital services.

Bulk billing

When you access medical services, you can be bulk billed or given a patient account for those services. Bulk billing is when your doctor bills Medicare directly and accepts the Medicare benefit as full payment for their service. This means you do not have any out-of-pocket expenses. A patient account is when your doctor charges you a fee and you claim the appropriate portion of the schedule fee back through Medicare. The difference between the total account and your Medicare refund is called a 'gap payment' . If you need to see a doctor, you can ask if they bulk bill, and if they don’t you can ask about the expected gap payment.

More information on bulk billing and patient accounts can be found at www.humanservices.gov.au.

Medicare also covers a range of out-of-hospital and in-hospital services. These are explained at www.humanservices.gov.au.

You can claim your Medicare benefit in a number of ways such as:

  • at your doctor’s office
  • through Medicare Online Services
  • at your local Department of Human Services (DHS) Centre.

These options are explained at www.humanservices.gov.au.

It is important to note that from 1 July 2012, Medicare Service Centres started going cashless, and benefits will be paid straight into your bank account. For more information go to www.humanservices.gov.au.

There are other services that come under the Medicare umbrella such as the Australian Childhood Immunisation Register and the Australian Organ Donor Register. A list of all Medicare services can be viewed at: www.humanservices.gov.au.

For all Medicare general enquiries phone 132 011 (24hrs a day, 7 days a week). For further contact information go to www.humanservices.gov.au/customer/contact-us/.

Sources: Australian Taxation Office (Guide to Medicare levy), Department of Human Services (Medicare service changes, Contact us, Medicare website, Medicare Card)