How Medicare works

When you enrol in Medicare, some or all of the costs of any health care you need gets paid for by Medicare.

The Medicare Benefits Schedule (MBS) lists the services Medicare will pay for. The Australian Department of Health manages the MBS.

Read more about what Medicare covers on the Services Australia website.

If your doctor bulk bills, Medicare will pay for you to see the doctor. The cost of your appointment gets paid by Medicare to the doctor straight away. This means you don't pay anything.

You'll need to pay for your appointment if your GP doesn't bulk bill. You may be able to claim some of this money back from Medicare.

Medicare can also help to bring down the cost of some medicines through the Pharmaceutical Benefits Scheme (PBS).

Read more about Medicare on the Services Australia website.

If you're visiting from overseas, you may be able to use Medicare. Find out more about how to access healthcare if you're visiting from overseas.

You may need to pay for your care if you don't have a valid Medicare card or reference number.

Medications and equipment

If you're eligible for Medicare, you won't pay for any medications you have while you're admitted to hospital.

After you're discharged, you might need to pay for the medication that you're prescribed in hospital for your recovery. These are usually the same price as the PBS co-payment for each item (personal concessions may apply e.g. if you hold a Pensioner Concession Card).

If you can't use Medicare, you'll pay the full price for all medications that you get through the pharmacy. Health insurance may help to cover some of these costs.

Some equipment or garments (such as mobility aids or compression stockings) may not be free-of-charge. Please discuss as required with your clinician.

Specialist fees

These fees can vary. They'll depend on whether you're eligible for Medicare and whether you see a specialist in a bulk billing public hospital or at a private clinic or hospital.

The fee structure of different specialists may also vary.

When you're thinking about the costs, ask if the specialist:

  • works in the public or private healthcare system
  • bulk bills using the MBS
  • requires gap payments
  • has a payment plan
  • accepts your private health cover.

Ask your doctor and specialist how much it will cost upfront and if there are going to be any more costs.

Last updated: December 2022