Medicare Explained

Health care in Australia is made up of a mixture of both public and private providers. Some of the schemes included in the Federal Government’s funding are:

  • Medicare
  • the Pharmaceutical Benefits Scheme
  • the 30% Private Health Insurance Rebate
  • Australian Childhood Immunisation Register
  • Australian Organ Donor Register
  • Family Assistance Office.

Medicare

The ultimate goal of Medicare Australia is to improve the health of all Australians by making professional medical care available to all, regardless of their financial situation. Medicare offers subsidised medical services and provides free-of-charge services in public hospitals.

Benefits are provided for:

  • consultation fees
  • tests and examinations including X-rays and pathology
  • eye tests performed by optometrists
  • most surgical and other therapeutic procedures
  • some surgical procedures performed by approved dentists
  • specified items under the Cleft Lip and Palate Scheme

In public hospitals, public patients must be treated by doctors and specialists provided by the hospital. Private patients have a choice of doctor. Seventy five per cent of the Medicare Schedule fee for services provided by the chosen doctor will be paid for by Medicare. Outstanding fees must be covered by the patient or their health insurance company.

Making a claim

Claiming the subsidies can be achieved in a number of ways.

  • Bulk billing – this is the process where no charge is made to the patient for medical treatment received. The medical practitioner will bill Medicare themselves for reimbursement of their services.

If a doctor doesn’t offer bulk billing then any charges incurred are paid by the patient, who then claims the benefit from Medicare.

Some doctors will invoice a patient for payment. A claim can be made to Medicare for the benefit cheque, which is given to the doctor along with any balance owing on the account.

Claims for Medicare reimbursement by a patient can be done:

  • online at the Medicare website
  • in person at any Medicare office
  • at participating medical practices
  • by telephone
  • by mail.

Pharmaceuticals Benefits Scheme (PBS)

The PBS subsidises many of the prescription medicines used in Australia. Most medicines available in Australia actually cost substantially more than the general public pay for them. The extra amount is covered by the government.

However, not all medicines are covered by the scheme.

Some unsubsidised medicines can be substituted by a generic brand, which will serve the same purpose. So if your doctor prescribes a medicine not included in the PBS, it can be worth your while to check with your pharmacist in case a generic brand is available.

What’s not covered by Medicare?

  • private patient costs
  • most dental treatment
  • ambulance services
  • home nursing
  • physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology
  • acupuncture
  • glasses / contact lenses
  • hearing aids
  • prostheses
  • overseas medical costs
  • medical costs for which someone else is responsible
  • elective / cosmetic medical services
  • life insurance / superannuation examinations.