Costs and Medicare

Medicare helps cover the cost of many health services in Australia, but how much you actually pay depends on the provider, the service and how it's billed. Bulk billing, out-of-pocket costs, rebates, referrals and telehealth rules can all be confusing. The guides in this section explain how it works in plain language, using official information from Services Australia and the Department of Health, Disability and Ageing.

We don't publish fees or rebate amounts, because they change and differ between practices. Instead, we explain how billing works and what to ask.

The guides in this section

• Bulk billing explained: what it means, who decides and how to check before you book.
• Asking about fees: the questions to ask GPs and specialists, and your right to information about costs.
• Referrals and specialists: how referrals work and how long they generally last.
• Telehealth appointments: when phone and video visits suit, Medicare eligibility basics and how to prepare.

The key ideas

Bulk billing

According to Services Australia, bulk billing means the provider accepts the Medicare benefit as full payment for the service, so you pay nothing for that service. The doctor or practice decides whether to bulk bill. Some bulk bill everyone, some bulk bill certain patients or services, and some charge a fee. Always ask.

Out-of-pocket costs

If a service isn't bulk billed, you pay the provider's fee and get a Medicare benefit back. The difference is your out-of-pocket cost, sometimes called the gap. For high costs over a year, the Medicare Safety Net may help; check Services Australia for details.

Referrals

To claim Medicare benefits for specialist services, you generally need a valid referral. Services Australia says GP referrals are generally valid for 12 months from the first specialist service, unless the GP specifies a different period, and referrals from one specialist to another are generally valid for 3 months.

Telehealth

Many GP telehealth services are covered by Medicare, but most require an established relationship with the GP or practice, generally a face-to-face service in the previous 12 months, with exceptions. MyMedicare registration provides another pathway for some services.

Questions worth asking every time

• Will this be bulk billed?
• If not, what's the fee, and how much will Medicare pay back?
• Are there any extra costs, such as tests, procedures or forms?
• For specialists and surgery: what are all the likely costs, and can I have a written estimate?

Your right to information about costs

The Australian Charter of Healthcare Rights includes a right to clear information about services, treatment options and costs. Asking about money is normal and reasonable, and good providers expect it. If you receive a bill you didn't expect, talk to the provider first. If you can't resolve it, see our guide to health complaints.

When cost is a barrier

If cost is stopping you from getting care, tell your GP or the practice. Ask whether it bulk bills certain patients, such as children or concession card holders. For urgent, non-life-threatening problems, Medicare Urgent Care Clinics are bulk billed and don't need an appointment or referral; see our urgent care section. Public hospital outpatient clinics may also be an option for specialist care.

Plan your visit

Our visit planner always includes a question about billing, so you remember to ask before the appointment starts.

Keep track of what you spend

Your Medicare online account, accessed through myGov, shows the Medicare claims made for you. Checking it from time to time helps you understand what you've paid and spot any errors. Keep receipts for out-of-pocket costs. If your family has significant costs for Medicare services, registering as a family for the Medicare Safety Net means your costs are combined towards the threshold. For medicines, the PBS Safety Net works in a similar way; your pharmacy can keep a record of your prescriptions. Services Australia explains current arrangements.

Concession cards and DVA

If you hold a concession card, mention it when you book, because some practices bulk bill concession card holders. If you hold a DVA card, tell the practice, as DVA arrangements differ from standard Medicare billing.

How we keep these guides current

We review each guide against official sources and show the date it was last checked. Medicare rules and government programs change, so before relying on any detail, follow the source links on each guide or ask your practice or Services Australia. If you notice something out of date, please tell us through our contact page, and we'll check and correct it.

Five habits for smoother appointments

1. Ask about billing when you book: whether it will be bulk billed and, if not, the fee and the Medicare rebate.
2. Keep an up-to-date list of every medicine you take, including vitamins, supplements and over-the-counter products.
3. Write your questions down and put the most important one first.
4. Confirm the plan before you leave: tests, referrals, prescriptions, follow-up and warning signs.
5. Know your options for urgent care, including healthdirect on 1800 022 222, Medicare Urgent Care Clinics and 000 for emergencies.

About these guides

Patient Appointments is an independent information site. We aren't a medical practice, booking platform, government agency or health insurer, we don't give medical advice, and no practice pays to appear in our guides. We don't publish fees or rebate amounts. We write every guide in our own words and list the official sources we used, such as Services Australia, the Department of Health, Disability and Ageing, healthdirect, Ahpra and the Australian Commission on Safety and Quality in Health Care. Rules and programs change, so check current details with your practice and the relevant agency. In an emergency, call Triple Zero (000).