Medicare

What is Medicare

Medicare is Australia’s publicly funded health insurance scheme supporting access to certain health services.  It aims to provide government-funded rebates for eligible services delivered by participating providers.

 

Medicare does not operate hospitals nor does it employ most healthcare professionals; it is an insurance type funding system to reduce cost of specific services.

 

How Medicare is funded

In general, Medicare is funded through:

• Australian Government revenue, such as taxation

• The Medicare levy (paid by most taxpayers, according to individual factors such as income thresholds and exemptions)

• Additional government budget allocations

 

Medicare funding arrangements are determined by the Australian Government. Public hospitals are primarily funded and operated by state and territory governments, with shared funding arrangements between governments.

 

What Medicare generally covers

In general, Medicare may provide rebates for:

• General practitioner consultations

• Specialist consultations (often requires a valid referral)

• Some diagnostic services (e.g. some blood tests and/or some imaging)

• Certain procedures performed in community or hospital settings

 

A 'rebate' refers to the government payment towards the cost of the service.  It does not necessarily cover the full fee charged by a provider.

 

"Bulk billing" commonly refers to when a provider accepts the Medicare benefit as the full payment for the service provided.

 

"Gap" commonly refers to the difference between the cost of the service and the Medicare rebate (if there is an appropriate Medicare rebate).

 

Medicare rules are established by the Australian Government and are subject to review and change.  Medicare does not cover all health services.

 

Medicare:

• Does not guarantee that a service will be free

• Does not guarantee immediate access to a service

• Does not determine clinical decisions

• Does not replace private health insurance

• Does not cover every health-related expense

 

Fees are set by individual providers. Access to services may vary depending on location, workforce availability, and local service capacity.

 

Who decides what is covered

The Australian Government determines which services are eligible for Medicare rebates and under what general conditions. These decisions are informed by clinical, economic, and policy considerations.

 

Healthcare professionals make clinical decisions about diagnosis, investigations, and treatment based on individual circumstances.

 

Medicare is about rebates and hence typically does not direct clinical care.

 

However because of this separation of roles, Medicare does not guarantee that a service will be free and/or partially covered.

 

Private health insurers operate separately from Medicare and may provide cover for additional services, depending on the policy held.

 

How people typically use Medicare

In general, people access Medicare-supported services by:

• Seeing a GP or other eligible health professional

• Receiving a referral to a specialist if required

• Attending public hospitals as a public patient

• Claiming a rebate after paying for an eligible service

 

Eligibility for Medicare and for specific rebates depends on individual circumstances and applicable legislation. This website does not determine eligibility or entitlement.

 

Variation and change

Health system arrangements, rebate amounts, and eligibility rules may change over time. Access to services can vary across metropolitan, regional, and remote areas. Workforce availability, local service models, and state-based arrangements may influence how care is delivered.

For current and authoritative information, refer to official government sources.

 

For up to date information please refer to the Australian Government Services Australia Medicare website (https://www.servicesaustralia.gov.au/medicare)

 

 

 

Important Information

This page provides general educational information about Medicare in Australia. It is not medical, legal, financial, or eligibility advice. Health system rules, funding arrangements, and eligibility criteria can change. Official government sources prevail.  This page provides general educational information only. It does not provide personalised advice and does not create a professional, advisory, or clinical relationship. Clinical decisions are made by healthcare professionals. For emergency medical situations, contact emergency services or seek urgent medical care.

 

Last reviewed: February 2026