What is Medicare?

Medicare is the insurance scheme that gives Australian citizens and permanent residents access to healthcare, including a wide range of health and hospital services at no cost or low cost.

Medicare is funded by Australian taxpayers who pay 2% of their taxable income to help cover costs. Depending on your financial circumstances, you may be eligible for a reduction or exemption from the Medicare levy.

How does Medicare work?

To access Medicare, you need to enrol.

If you are eligible, you will get a Medicare number and card. If you’re a parent or guardian, your Medicare card will show family members’ names and individual reference numbers, under a single Medicare number.

You can use this card to receive a wide range of medical services. However, not all services are paid for by Medicare.

Medicare cards are issued to people enrolled in Medicare. You can also get a digital copy of your Medicare card. Download the Express Plus mobile app to access your Medicare card. You will first need to download and sign in to your myGov account, and make sure it’s linked to your Medicare online account.

You can find registration information at the front of the Medicare enrolment form at Services Australia. You use your Medicare card when:

• making a Medicare claim for a paid or unpaid doctor’s account
• visiting a doctor who bulk bills
• receiving treatment as a public patient in a public hospital
• filling a Pharmaceutical Benefits Scheme (PBS) prescription at a pharmacy

Who is eligible for Medicare?

You are eligible for Medicare benefits if you:

• are an Australian or New Zealand citizen
• are an Australian permanent resident
• have applied for permanent residency (some conditions apply)
• are a temporary resident covered by a Ministerial Order
• are a citizen or permanent resident of Norfolk Island, Cocos Islands, Christmas Island or Lord Howe Island
• are covered by a Reciprocal Health Care Agreement with another country

How do I register for Medicare?

You can find registration information on how to enrol at Services Australia. If you are aged 15 years or older, you can apply for your own Medicare card, while children under 15 can be listed on their parents’ card. Babies born in Australia are automatically enrolled in Medicare.

What does Medicare cover?

If you have a Medicare card, you can get free or lower cost:

• medical services by doctors, specialists and other health professionals (if your doctor bulk bills, you won’t have to pay for anything)
• hospital treatment
• many prescription medicines (available for many medicines)
• mental health care

The benefits (refunds) you receive from Medicare are based on a schedule of fees set by the Australian Government, known as the Medical Benefit Schedule (MBS). Your doctor can choose to charge more than the set schedule fee. If an out of hospital service is on the MBS, Medicare will pay:

• the full schedule fee for general practitioner services
• 85% of the schedule fee for a specialist
• 75% of the schedule fee for in hospital services (but if you have private hospital insurance cover for the medical service, your insurer may pay the gap of 25% of the MBS fee.)

If you need to spend a lot of money on out-of-hospital medical appointments or tests, you may be eligible for the Medicare Safety Net. This means once you have spent up to a certain amount then you will get more money back from the government for your out-of-pocket expenses.

What is MyMedicare?

MyMedicare is a voluntary patient registration system that allows people to register with their regular general practice, preferred GP and primary care team.

This means that other health professionals will be able to easily find details of your regular practice and preferred GP, enabling better continuity of care. MyMedicare will not hold clinical health information about you.

Once registered, you will have:

• longer MBS-funded telephone calls (levels C and D) with your usual general practice
• a triple bulk billing incentive for longer MBS telehealth consultations (Levels C, D and E) for children under 16, pensioners and concession card holders
• from August 2024, more regular visits from your GP and better care planning if you live in a residential aged care home
• from the 2024-25 financial year, connections to more appropriate care in general practice if you have been visiting hospital frequently

To register for MyMedicare, people must have either:

• a Medicare card, or
• a Department of Veterans’ Affairs (DVA) Veteran Card

You will need to have had 2 face-to-face visits recorded with the same practice in the previous 24 months to be eligible to register with that practice.

Parents/guardians and children can be registered at the same practice if one of them is eligible and registered at the practice. You can only be registered with one practice at a time.

People in remote locations, or people experiencing hardship such as family, violence or homelessness, may be exempt from eligibility criteria.