min read
· Posted on
February 21, 2024

Talk Medicare to me: your guide to decoding healthcare in Australia

We know Medicare is important, but most of us weren’t taught exactly what’s involved with it. Let's break it down.

What's the key learning?

  • Medicare is Australia's universal healthcare system.
  • It provides free or subsidised healthcare to Australians.
  • You are eligible for Medicare based on your residency status, but there are some exceptions.
  • Bulk-billing is when your medical practitioner bills Medicare for treating you.

When you’ve got a blocked nose, and you feel like there’s a boulder in your throat, the last thing you want to be thinking about is medical bills.

Enter: the only guide you’ll need to understand Medicare.

What’s Medicare?

Medicare is Australia’s universal health care system that provides free or subsidised healthcare to Australians.

That means the government covers most.. or all of the medical bill for you so you don’t have to think twice about seeing the doctor when there’s a weird thing growing on your foot.

The system covers or subsidies you in three ways:

  • Hospital - You’re covered for treatment in public hospitals
  • Medical - Think visits to the GP, specialists, optometrists, and sometimes other healthcare professionals.
  • Pharmaceutical - Medicare chips in for the cost of some medication. 

Everyone covered with Medicare is given a Medicare card, which you present everytime you see a healthcare professional.

Am I eligible for Medicare?

You’re eligible for Medicare if you’re:

  • An Australian or New Zealand citizen
  • An Australian permanent resident or have applied for permanent residency (in most cases)
  • Are visiting from a country covered in Australia’s Reciprocal Health Care Agreements.

There are a couple of other ways you can be eligible, which you can find out more about here.

Quick note: International students aren’t covered by Medicare. They need to take out Overseas Health Cover (OSHC) which gives them access to medical services in Australia.

If you’re eligible, you’ll get a Medicare card with a number (which you can enrol for here). The enrollment can be done as an individual or as a family.

What does Medicare cover?

Medicare will partially or fully cover:

  • Doctors and specialists that bulk bill (more on that later)
  • Blood tests, X-rays, scans
  • Some dental procedures
  • Eye tests
  • Other specific items

If you’re a public hospital patient, Medicare will also subsidise:

  • Emergency care
  • Most surgeries and procedures (there can be a long wait time for non-emergency procedures)
  • Medicines provided in hospital
  • Follow up care

There’s a document called the Medicare Benefits Schedule which lists every medical service covered under medicare, and the fee that Medicare subsidises for the service.

So if you’re tossing up between treatment options and you want to understand how much they’ll cost under Medicare, that Schedule is the place to go.

I keep hearing the word ‘bulk-billing’. What is that?

Bulk billing essentially means that you don’t need to pay a cent for your medical services. How good!

The health professional who’s treated you will bill Medicare directly for their fees to get paid.

Practitioners bill Medicare for their fees in ‘bulk’, hence the name.

Bulk billing covers services like:

  • GP visits
  • Some specialist visits
  • Tests and scans like x-rays, pathology tests, eye tests

And what doesn’t Medicare cover?

  • Ambulance services
  • Most dental services
  • Glasses/contacts
  • Elective and cosmetic surgeries
  • Physiotherapy
  • Healthcare costs overseas (some costs might be covered in a country that Australia has a Reciprocal Health Care Agreement with)

Put simply, any services that aren’t in the Medicare Benefits Schedule won’t be covered by medicare.

So if you want to get covered for some of those other costs, you might want to look at private health insurance. You can learn more about health insurance in our Academy here.

Understanding Medicare, and how the system works can help you make informed decisions when it comes to you and your health.

What else do you want to understand about Medicare? Let us know in the comments.

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