Important Health Disclaimer
This article provides general information only about Australia's Medicare system and is not medical, legal, or financial advice. Information is sourced from official Australian Government websites including Services Australia, Department of Health, and PBS. Information was accurate as of March 2026 but policies, fees, and thresholds may change โ always verify with Services Australia or your healthcare provider. If you need urgent medical help, call 000. For 24/7 non-emergency health advice, call healthdirect on 1800 022 222.
Medicare is the backbone of healthcare in Australia. It gives every citizen and permanent resident access to free or subsidised medical services โ from GP visits to public hospital treatment to prescription medications. But understanding exactly what Medicare covers, what it doesn't, and how to make the most of it can be surprisingly confusing.
2026 has brought some significant changes to the system, including lower prescription costs, expanded urgent care clinics, and new bulk billing incentives. This guide breaks it all down in plain language, with every dollar figure sourced directly from official government websites.
What Medicare Covers
Medicare is funded through a 2% levy on taxable income (with higher earners paying an additional surcharge if they don't hold private hospital cover). Here's what it pays for:
| Service | What Medicare Pays | Your Cost |
|---|---|---|
| GP visit (bulk billed) | 100% of the schedule fee | $0 |
| GP visit (not bulk billed) | 100% of the schedule fee | Gap fee varies โ typically $30โ$60 |
| Specialist (out of hospital) | 85% of the schedule fee | 15% + any fee above schedule |
| Public hospital (as public patient) | 100% โ free treatment | $0 |
| Blood tests & pathology | 85โ100% of the schedule fee | Usually $0 (most bulk bill) |
| X-rays & imaging | 85โ100% of the schedule fee | Some gap possible |
| Eye tests | Covered every 3 years (annual if clinical need) | Usually $0 |
| Mental health (via GP Mental Health Care Plan) | Up to 10 sessions per year with psychologist | Gap fee varies by provider |
The โschedule feeโ is the dollar amount the Australian Government sets for each medical service via the Medicare Benefits Schedule (MBS). Source: Services Australia, updated January 2026.
What Medicare Does NOT Cover
This is where many people get caught out. Medicare has significant gaps, and understanding them can save you from unexpected bills:
Not Covered by Medicare
Dental (adults)
No coverage for adult dental. Children may get some cover under the Child Dental Benefits Schedule.
Glasses & contact lenses
Eye tests are covered, but corrective eyewear is not.
Ambulance
Not covered in most states. QLD and TAS residents are covered by state schemes. All others need ambulance cover or risk bills of $1,000+.
Private hospital treatment
Medicare only covers you as a public patient in a public hospital. Private hospital = private health insurance.
Physiotherapy, chiro, podiatry
Not covered unless your GP sets up a Chronic Disease Management Plan (max 5 sessions/year).
Cosmetic procedures
No coverage for elective cosmetic surgery or treatments.
Prescription Medicines: The PBS and What Changed in 2026
The Pharmaceutical Benefits Scheme (PBS) is the government program that subsidises prescription medications. Without the PBS, many common medicines would cost hundreds of dollars. With it, there's a maximum you'll pay per script.
PBS Costs โ 2026 Update
General patients
Maximum co-payment per PBS prescription
Concession card holders
Pensioners, healthcare card holders
Frozen until 2029 โ no increases
Safety Net โ general patients
Once you/your family spend this much per year, co-payment drops to $7.70
Safety Net โ concession holders
Once reached, PBS medicines are free for the rest of the year
Source: PBS.gov.au and Department of Health, effective 1 January 2026. The general co-payment dropped from $31.60 to $25.00 under the National Health Amendment (Cheaper Medicines) Act 2025 โ the lowest price since 2004.
What This Means in Practice
If you fill one PBS prescription per month, you'll save about $6.60 per script compared to 2025 โ that's roughly $80 per year. For a family managing two regular prescriptions, the annual saving is close to $160. The savings are automatic โ just fill your script as usual at any pharmacy.
Medicare Urgent Care Clinics: The Free Alternative to Emergency
One of the biggest additions to Medicare in recent years is the Medicare Urgent Care Clinic (UCC) network. These clinics are designed for health issues that are urgent but not life-threatening โ the kind of thing where you'd normally think about going to a hospital emergency department but don't actually need emergency-level care.
Medicare Urgent Care Clinics โ Key Facts
100% bulk billed โ no out-of-pocket cost
Walk in โ no appointment or referral needed
Extended hours โ open 7 days, including evenings and weekends
Over 2.5 million visits since the first clinics opened in June 2023
The government is investing $1.4 billion over seven years to build this network. Currently there are 87 clinics operating, with plans to expand to 137 nationwide โ with the goal that 4 out of 5 Australians will live within a 20-minute drive of a Medicare UCC.
UCCs can treat: minor fractures, cuts needing stitches, burns, sprains, urinary tract infections, gastro, ear infections, coughs and colds, minor skin infections, and other conditions that need same-day attention but aren't emergencies.
UCCs are NOT for: chest pain, difficulty breathing, serious injuries, suspected stroke, severe allergic reactions, or any condition that may be life-threatening. For these, always call 000.
How to Find Your Nearest Medicare UCC
Visit the Department of Health's Medicare UCC finder or use the healthdirect Service Finder. UCC information is also available in Simplified Chinese (็ฎไฝไธญๆ), Traditional Chinese (็น้ซไธญๆ), Arabic, Vietnamese, Korean, and other community languages.
MyMedicare: Should You Register?
MyMedicare is a voluntary registration system introduced in 2023 that links you to a specific GP practice. Think of it as formally establishing a โhome baseโ for your healthcare. You can register through your GP practice or via your myGov account linked to Medicare.
Benefits of registering with MyMedicare:
Longer telehealth consultations
Access to additional bulk-billed telehealth items, including longer phone and video consultations with your registered GP โ particularly useful for chronic condition management and mental health follow-ups.
Better continuity of care
Your GP practice maintains a complete record of your health history. If you visit a Medicare Urgent Care Clinic, your visit details are shared back to your registered practice.
Additional support for frequent hospital visitors
If you frequently attend hospital emergency departments, your registered practice may receive additional Medicare-funded services to better manage your care in the community.
Chronic condition management
From 1 July 2025, GP chronic condition management services require access through your MyMedicare-registered practice if you're registered.
Registration is free and voluntary. You can change your registered practice at any time. It doesn't lock you into seeing only that GP โ you can still visit any doctor you choose. To register, ask at your regular GP clinic or log in via myGov.
Medicare Safety Nets: Extra Support for High Medical Costs
If you or your family have high out-of-pocket medical costs during the year, the Medicare Safety Net provides higher rebates once you pass certain spending thresholds:
| Safety Net | How It Works | 2026 Threshold |
|---|---|---|
| Original Medicare Safety Net (OMSN) | Once your gap expenses reach the threshold, Medicare reimburses 100% of the schedule fee (instead of 85%) for out-of-hospital services | Varies โ set annually by Services Australia |
| Extended Medicare Safety Net (EMSN) | Once your out-of-pocket costs exceed the threshold, Medicare pays 80% of future out-of-pocket costs (subject to caps on some services) | Varies by concession status |
| PBS Safety Net โ general | Once you spend $1,748.20 on PBS medicines in a year, you pay the concession rate ($7.70) for the rest of the year | $1,748.20 |
| PBS Safety Net โ concession | Once you spend $277.20, PBS medicines are free for the rest of the year | $277.20 |
Source: Services Australia and PBS.gov.au, effective 1 January 2026. Thresholds reset every 1 January. Families can combine their spending to reach thresholds sooner โ register as a family with Services Australia.
Tip: Keep Your Prescription Record Form
Your pharmacy tracks your PBS spending towards the Safety Net, but only for scripts filled at that pharmacy. If you use multiple pharmacies, ask for a PBS Prescription Record Form and keep it updated. You can also check your Safety Net balance through myGov (linked to Medicare).
Who Is Eligible for Medicare?
RHCA visitors are covered for medically necessary treatment only โ it's not a substitute for travel insurance. Coverage duration and scope vary by country.
Not eligible for Medicare: Most temporary visa holders (including student visas and working holiday visas from non-RHCA countries). These visa holders typically need Overseas Visitor Health Cover (OVHC) or Overseas Student Health Cover (OSHC) as a visa condition.
How to Enrol in Medicare
If you're newly eligible (just arrived in Australia or just became a permanent resident), here's how to get your Medicare card:
Gather your documents
Passport with valid visa, proof of Australian address (lease, utility bill, or bank statement), visa grant letter or ImmiCard, and travel documents if enrolling under RHCA.
Enrol โ three options
In person at a Services Australia (Medicare) centre (fastest โ bring originals). Online via myGov (if you already have a myGov account). By post โ download form MS004 from the Services Australia website.
Receive your Medicare card
Your physical card arrives by mail in about 2โ3 weeks. In the meantime, you can access a digital Medicare card through the Medicare app or myGov โ most clinics accept the digital card.
Link Medicare to myGov
This lets you claim rebates online, track your Safety Net spending, view your immunisation history, and access your digital Medicare card. It's also required for MyMedicare registration.
For help in languages other than English, call the Translating and Interpreting Service (TIS National) on 131 450 โ they can connect you with Services Australia in your language.
Do You Need Private Health Insurance Too?
Medicare is comprehensive for essential medical care, but it has gaps. Here's a quick comparison:
| Need | Medicare | Private Insurance |
|---|---|---|
| GP visits | Covered | Not usually needed |
| Public hospital | Free as public patient | Not needed |
| Private hospital / choose your doctor | Not covered | Hospital cover |
| Dental | Not covered (adults) | Extras cover |
| Optical / glasses | Not covered | Extras cover |
| Physio, chiro, podiatry | Limited (5/year via GP plan) | Extras cover |
| Ambulance | Not covered (except QLD/TAS) | Usually included |
| Shorter wait times for elective surgery | Public waitlist | Hospital cover |
Medicare Levy Surcharge โ Worth Knowing
If you earn above $101,000 (singles) or $202,000 (families) and don't hold private hospital cover, you'll pay an additional Medicare Levy Surcharge of 1โ1.5% on your taxable income. For many higher earners, taking out basic hospital cover is actually cheaper than paying the surcharge. This is a tax consideration โ consult the ATO website or a tax professional for your specific situation.
Key Contacts and Resources
Emergency
Life-threatening situations
healthdirect
24/7 nurse-on-call health advice
Medicare (Services Australia)
Enrolment, claims, general enquiries
Translating & Interpreting Service
Help in languages other than English
Find a Medicare UCC
Urgent care clinics near you
healthdirect Service Finder
Find GPs, pharmacies, hospitals, allied health
PBS Medicine Information
Check if a medicine is subsidised
Related Guide
Looking for a bulk billing GP in your area? Read our companion guide: How to Find a Bulk Billing GP Near You in Australia
Navigating life in Australia?
From Medicare to Centrelink to school enrolment โ we break down Australian public services in plain language, no jargon.
Browse Health GuidesDisclaimer: This article is for general informational purposes only. It is not medical, legal, or financial advice. While we have sourced all information from official Australian Government websites, policies and figures may change without notice. Always check with Services Australia (servicesaustralia.gov.au) or consult a qualified professional for advice specific to your situation. Mubboo Pty Ltd is not affiliated with the Australian Government, Services Australia, or any health insurance provider.
Sources:
Services Australia โ Medicare overview and enrolment (servicesaustralia.gov.au) โข Department of Health, Disability and Ageing โ Medicare Urgent Care Clinics (health.gov.au) โข Pharmaceutical Benefits Scheme โ PBS fees and Safety Net thresholds (pbs.gov.au) โข MBS Online โ Medicare Safety Net Arrangements 2026 (mbsonline.gov.au) โข healthdirect โ Medicare Safety Net (healthdirect.gov.au) โข All figures effective as of 1 January 2026 unless otherwise stated.
Last verified: March 2026