What's covered by Medicare

Medicare helps with the costs of seeing a doctor, getting medicines and accessing various healthcare.

Accessing Medicare

Enrolling

You’ll need to enrol in Medicare to access Medicare services. Find out if you’re eligible to enrol. When you enrol, you’ll get a Medicare card.

It’s best to bring your valid Medicare card or number with you when you visit your health Provider.

 

My Health Record

You’ll also have a My Health Record that helps securely store all your health data in one place. Read more on the My Health Record website.

 

Medicare covers

Medicare helps to cover the costs for part or all of the following services:

  • seeing a GP or specialist

  • tests and scans, like x-rays

  • most surgery and procedures performed by doctors

  • eye tests by optometrists.

 

Medicare doesn’t cover

  • ambulance services

  • most dental services

  • glasses, contact lenses and hearing aids

  • cosmetic surgery.

Seeing a doctor

If your doctor chooses to bulk bill, Medicare will cover the costs and you won’t need to pay at all.

If your doctor doesn’t bulk bill, you’ll need to pay either:

  • the full cost

  • the difference between what they charge and what Medicare covers.

 

If you pay the full cost, you can make a claim for the amount Medicare covers. Your doctor can also make a claim on your behalf.

 

It’s best to bring your valid Medicare card or number with you when you see your doctor.

 

If you download the Express Plus Medicare mobile app, you’ll always have a digital copy of your card with you.

Questions we are frequently asked

Bulk billing means you don’t have to pay for your medical service from a health professional. They bill Medicare instead and they accept the Medicare benefit as full payment for the service.

You assign the benefit to them by either:

  • signing a form
  • pressing OK on the EFTPOS terminal after your appointment.

 

Read more

Private health insurance doesn’t cover:

  • GP visits
  • some specialist visits
  • visits to a public or private hospital emergency department.

Unless you’re a patient in hospital, it also doesn’t cover:

  • any x-rays or other scans
  • any blood tests or other pathology tests.

Medicare normally covers these things. Read more about what Medicare covers.

The type of concession or health care card you can get depends on your situation.

You can use your concession or health care card to get cheaper medicines under the Pharmaceutical Benefits Scheme. You may also use your concession card if your doctor bulk bills for visits.

 

Read more

You can see a health professional by videoconference or telephone if you can’t go to their office.

 

This includes appointments with one of the following health professionals:

  • GP
  • Specialist
  • Allied health professional
  • Nurse Practitioner
  • Obstetrician
  • Registered Midwife.

 

Your appointment may be bulk billed. Contact your health professional to check if they’ll bulk bill and organise an appointment.

 

Read more about telehealth and attendance services on the Department of Health website.

Some prescription medicines can cost a lot of money. To make these medicines more affordable, the Pharmaceutical Benefits Scheme (PBS) can lower the cost.

 

The PBS offers reduced cost for PBS prescription medicines to Australian residents, some visitors, and concession card holders.

 

You’ll need to enrol in Medicare to access it. You’ll need your Medicare number to access PBS medicines. Your number may already be on your prescription. If it’s not, you may be asked for it when you submit your prescription.

 

Read more

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