Medicare allows us the basic human right to healthcare. Unlike many countries around the world, we are lucky enough in Australia to have access to healthcare no matter what our financial status.
Medicare is the Federal Government’s universal health insurance scheme, guaranteeing all Australians, and some overseas visitors, access to healthcare at either no or very low costs.
If you have a Medicare card, the Federal Government either covers all or most of the costs of a range of health-related expenses such as GP appointment, medical specialist appointments, allied health appointments, public hospital stays and many prescribed medications.
However, Medicare does not cover everything. Medicare generally excludes ambulance services, dental services, glasses, contact lenses, hearing aids and cosmetic surgery.
Am I eligible for Medicare?
To be eligible for a Medicare card, you must meet one of the following criteria:
Be an Australian or New Zealand citizen
Be a permanent Australian resident, or be in the process of applying for Australian residency
Be a temporary resident on a valid visa under a Ministerial Order
Yes. You should enrol your newborn baby into Medicare as soon as possible. A newborn baby is defined as being up to 52 weeks old. You can ask your doctor or midwife about enrolling your baby. This requires you to fill out a Newborn Child Declaration Form and have it signed by your doctor or midwife. Completing this form will automatically enrol your newborn baby into Medicare.
If your child is over 12 months old, you will need their birth certificate to enrol your child into Medicare.
Can children have their own Medicare card?
Yes, once a child is aged 15 years old or over are able to apply for their own Medicare card by completing the online form or filling out the hardcopy form and sending it in the mail. However, children younger than 15 years old will be on their parent’s Medicare card.
If you are 15 years old, you can either transfer or copy to your new card. If you choose to transfer, this means you will no longer be on your parents card. However, if you only choose to copy to your new card, you will stay active on your parent’s card as well.
Once a child is aged 15 years old, they may feel they want greater independence and autonomy from their parents which having their own Medicare card allows. They will be able to access a range of medical services and subsidised prescribed medications.
How does Medicare work?
When you have a healthcare-related cost, such as a doctor’s appointment, you will receive a refund from Medicare known as a benefit. These benefits are based on the Medical Benefits Scheme (MBS) which is a list of all the health services subsided by the Federal Government. You will pay the entire amount of the cost but will receive a refund into your bank account in the next 2-3 business days after paying the fee.
Each service included in the MBS has a specific item number. You are able to search online using the MBS Online search engine to see which services are a part of the scheme by using key words or item numbers.
For an increasing number of prescription medicine, the Federal Government provides these at a subsidised cost based on the Pharmaceutical Benefits Scheme (PBS). This means that when you go to the pharmacy to purchase your medications, if they are listed on the PBS, they will already be at a subsidised cost so you will not be paying the full amount.
Each prescription medicine listed on the PBS can be viewed in an A-Z medicine listing online. You can also use the search engine provided to look up specific medications.
How much can I claim on Medicare?
The amount that can be claimed on Medicare varies depending on the type of service and how much out-of-pocket health expenses that you have.
As part of Medicare, the Federal Government most often will contribute:
100% of the schedule fee for general practitioner services
85% of the schedule fee for specialist services
75% the schedule fee for in-hospital services
If you are someone who has lots of out-of-pocket healthcare costs, you are able to claim a greater amount back from Medicare once you have spent a certain amount within a given calendar year. See APA’s More on Medicare Safety Nets for information.
How do I make a claim?
There are various ways for you to make a Medicare claim. These include:
Claiming directly at your doctor’s office after your appointment
Filling out an online claim form using your online account via myGov
Filling out a claim form using the Express Plus Medicare mobile app
Completing a hard copy Medicare claim form and posting it in the mail
Making a claim at a service centre
Click here for more information about all the different ways to make a claim
Is Telehealth covered by Medicare?
Yes, Telehealth services were initially temporarily covered by Medicare from 13 March 2020 in response to the COVID-19 pandemic. However, on 13 December, 2021, the Federal Government announced it was going to continue funding Telehealth services and has committed $106 million over the next four years to achieve this. You can claim Telehealth appointments with your GP, medical specialist or allied health professional in the same way you would claim for a face-to-face appointment.