The Young Australian's Guide to Health & the Medicare System

Medicare is Australia's universal health insurance scheme, funded by the Medicare levy (2% of taxable income for most residents). It covers a broad range of medical services — but not everything, and the gap between what Medicare pays and what doctors charge is something every Australian encounters eventually.

The Medicare Benefits Schedule (MBS) sets the scheduled fee for each medical service. For GP consultations, Medicare pays 100% of the MBS fee when you bulk bill. For specialist consultations, Medicare pays 85% of the MBS fee. If the doctor charges above the schedule fee, the difference — the gap — comes out of your pocket.

Bulk billing means the doctor charges the MBS fee exactly and bills Medicare directly — you pay nothing. Bulk billing rates vary significantly: higher in outer suburbs and regional areas, lower in inner-city practices and specialist clinics. Bulk billing for GP visits has declined in recent years as the Medicare rebate has not kept pace with practice costs. In major cities, it's increasingly common to pay a gap even for a standard GP visit.

• Medicare card: If you're an Australian citizen or permanent resident, you're eligible for Medicare. Get your own Medicare card through myGov when you turn 15 — don't rely on your parents' card indefinitely.
• Medicare Safety Net: Once your out-of-pocket costs exceed the annual threshold — $770.30 for concession card holders, $2,249.80 for others in 2024–25 — Medicare covers a higher percentage of your costs for the rest of that calendar year. Costs must be for out-of-hospital MBS services. Families can pool their costs toward the threshold.
• What Medicare doesn't cover: Dental (except the Child Dental Benefit Schedule), most ambulance services (except QLD and TAS), standalone physiotherapy, psychology and allied health without a referral plan, and optical.

A regular GP — a general practitioner you see consistently rather than whoever is available at a walk-in clinic — is one of the most valuable health assets you can have. They know your history, track preventive care, coordinate referrals, and catch things that one-off consultations miss. Finding one you trust is worth the effort.

To find a bulk billing GP in your area, use the healthdirect.gov.au service finder or ask at your local pharmacy. Be aware that even practices advertising bulk billing may not bulk bill all appointment types or all patients — a longer appointment or a complex consultation may attract a gap fee.

What to know before your appointment:

• Bring your Medicare card — and your healthcare card if you have one. Concession card holders are more likely to be bulk billed at practices that don't bulk bill everyone.
• Referrals: To see a specialist and receive a Medicare rebate, you need a GP referral. GP referrals last 12 months for most specialists (3 months for specialist clinics). Without a referral, you can still see a specialist but the Medicare rebate is lower.
• After-hours care: For non-emergency medical issues after hours, National Home Doctor Service (13SICK) provides bulk-billed home visits in most cities. This is an alternative to expensive emergency department visits for non-urgent conditions.
• Telehealth: GP telehealth consultations attract Medicare rebates when conducted with your regular GP (or a practice you've attended in the last 12 months). Convenient for follow-ups, referrals and prescription renewals.