What is Medicare ??

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 card showing family names and individual reference numbers, under a single Medicare number

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.

Sources:  Services Australia (Medicare card), Services Australia (Medicare Safety Net), Services Australia (How to enroll), Department of Health (Out of Pocket Costs), Australian Taxation Office (Medicare and Private health Insurance