Medicare Benefits

Australia's Medicare Benefits is a universal health insurance scheme called Medicare that was first Introduced in 1984, its objectives are: to make health care affordable for all Australians, to give all Australians access to health care services with priority according to clinical need, and to provide a high quality of care.

As of May 2014 Australia's Medicare provides access to free treatment as a public (Medicare) patient in a public hospital free or subsidised treatment by practitioners such as doctors, including specialists, participating optometrists or dentists (specified services only).

Australia's public hospital system is funded jointly by the Commonwealth, State and Territory Governments and is administered by State or Territory health departments.

Contribution to the health care system is made through taxes and the Medicare levy, which is based on taxable income.

Medicare Australia administers the Medicare benefits program, including enrolments and benefit payments.

All practising Doctors must obtain a Medicare Provider number before starting their practice allowing all claims and payments to be made to there nominated Bank.


Q & A about Medicare Benefits

Who is eligible for Medicare benefits ?

People who reside in Australia and hold Australian citizenship or have been issued with a permanent visa or hold New Zealand citizenship, or have applied for a permanent visa (other requirements apply).

The Australian Government has signed Reciprocal Health Care Agreements with some countries. Under these arrangements, residents of these countries are entitled to restricted access to health cover while visiting Australia.

How do I Enrole?

After arriving in the country applications can be made in person at a Medicare Office. If you are unable to visit a Medicare office you can call 132 011 (local Australian call  to request a form. When enrolling, applicants will need to show documentary proof that they are eligible, (eg Visa certificate or passport).

Bulk Billing

In Australia you can visit your local GP or medical practitioner and after showing your Medicare Card the fee's being charged by your doctor are forwarded to Medicare for payment. Alternatively you may be charged up front especially for specialty services.

In 2012 the Department of Human Services changed the way they distribute bulk bill claims forms. They also changed our procedures for processing cheque payments for bulk bill and DVA (Department Veteran Affairs) claims.

Medicare Coverage

Hospital

Under Medicare you can be treated as a public patient in a public hospital, at no charge, by a doctor appointed by the hospital. You can choose to be treated as a public patient, even if you are privately insured.

As a public patient, you cannot choose your own doctor and you may not have a choice about when you are admitted to hospital.

Medicare does not cover:

  • private patient hospital costs (for example, theatre fees or accommodation),
  • medical and hospital costs incurred overseas,
  • medical and hospital services which are not clinically necessary, or surgery solely for cosmetic reasons,
  • ambulance services.

Medical

When you visit a doctor outside a hospital, Medicare will reimburse 100% of the Medicare Benefits Schedule (MBS) fee for a general practitioner and 85% of the MBS fee for a specialist. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.

Medicare provides benefits for:

  • consultation fees for doctors, including specialists,
  • tests and examinations by doctors needed to treat illnesses, such as x-rays and pathology tests,
  • eye tests performed by optometrists,
  • most surgical and other therapeutic procedures performed by doctors,
  • some surgical procedures performed by approved dentists,
  • specific items under the Cleft Lip and Palate Scheme,
  • specific items under the Enhanced Primary Care (EPC) program,
  • specified items for allied health services as part of the Chronic Disease Management Plan.

Medicare does not cover:

  • examinations for life insurance, superannuation or memberships for which someone else is responsible (for example, a compensation insurer, employer or government authority),
  • ambulance services;
  • most dental examinations and treatment,
  • most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services,
  • acupuncture (unless part of a doctor's consultation),
  • glasses and contact lenses,
  • hearing aids and other appliances.
  • home nursing.
Pharmaceutical

Under the Pharmaceutical Benefits Scheme (PBS) you pay only part of the cost of most prescription medicines purchased at pharmacies. The rest of the cost is covered by the PBS. You must present your Medicare card to obtain this benefit.

The amount you pay varies with the medicine, up to a standard maximum. People with concession cards have a lower maximum payment.