Medicare Explained — What's Covered and What Isn't

Australia's public health system covers GP visits, hospital treatment, and some specialist care. But not everything.

Last updated April 2026 · Source: Services Australia — Medicare · Financial year: 2025–26 Current 2025–26
The Answer
Free or subsidised
Medicare covers GP visits (bulk billed = free), public hospital treatment, and some specialist/diagnostic services. It doesn't cover dental, optical, ambulance, or most allied health.

What Medicare Covers

ServiceCoverage
GP visits (bulk billed)Free
GP visits (non-bulk billed)Medicare rebate covers part — you pay the gap
Public hospital (as public patient)Free — treatment, accommodation, medicines
Specialist consultationsMedicare rebate (usually 85% of schedule fee)
Pathology and diagnostic imagingMedicare rebate (often bulk billed)
Some allied health (via GP referral)Medicare rebate for up to 5 sessions/year via care plan
PBS prescription medicinesSubsidised — max $25 general, $7.70 concession

What Medicare Doesn't Cover

ServiceYou Pay
DentalFull cost (unless public dental or child benefit)
Optical (glasses, contacts)Full cost
AmbulanceFull cost in most states (covered in QLD & TAS)
Private hospitalNeed private health insurance
Most physiotherapy, chiro, podiatryFull cost (unless via GP care plan — limited)
Cosmetic surgeryFull cost
Travel vaccinationsFull cost

Who's Eligible

All Australian citizens and permanent residents. New Zealand citizens living in Australia. Visitors from countries with reciprocal healthcare agreements (UK, Ireland, NZ, and several others) get limited cover.

How to Get a Medicare Card

Apply online through myGov or in person at a Services Australia office. You'll need proof of identity and citizenship/residency status. Processing typically takes 1–2 weeks.

Frequently Asked Questions

Is Medicare free?

Medicare itself is free to use — you don't pay a premium. It's funded through the Medicare levy (2% of taxable income for most taxpayers). Some services under Medicare are free (bulk billed), while others have a gap payment.

What's the difference between Medicare and private health insurance?

Medicare covers essential public healthcare. Private health insurance gives you choice of doctor, private hospital rooms, and covers things Medicare doesn't — like dental, optical, and physiotherapy.

Do I need a Medicare card to see a doctor?

No, but without one you'll pay full price. With a Medicare card, bulk-billed visits are free, and non-bulk-billed visits are partly covered by the Medicare rebate.

What Changed

Jan 2026 PBS general co-payment reduced to $25 (from $31.60)
Jul 2025 Medicare levy thresholds updated for 2025–26
Last updated: April 2026 · Source: Services Australia — Medicare · Financial year: 2025–26