What Medicare covers
What does Medicare cover?
The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee. The Medicare Benefits Schedule (MBS)
lists all the Medicare item numbers.
Better Access to Mental Health Services
New Medicare items available from November 2006 will provide families, schools and health professionals with more support in recognising and addressing mental illness.
The items, part of the Australian Government's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative will cost $538 million over five years.
Further information about this initiative is available from the Department of Health and Ageing website.
Out-of-hospital services
Medicare provides benefits for:
- consultation fees for doctors, including specialists
- tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests
- eye tests performed by optometrists
- most surgical and other therapeutic procedures performed by doctors
- some surgical procedures performed by approved dentists
- specified items under the Cleft Lip and Palate Scheme
- specified items for allied health services as part of the Enhanced Primary Care (EPC) program—contact Medicare on 132 011 for more information
You can choose the doctor who treats you for out-of-hospital services.
In-hospital services
Public Patient
If you choose to be admitted as a public (Medicare) patient in a public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not be charged for care and treatment, or after-care by the treating doctor.
Private Patient
If you are a private patient in a public or private hospital, you will have a choice of doctor to treat you. Medicare will pay 75 per cent of the Medicare Schedule fee for services and procedures provided by the treating doctor. If you have private health insurance some or all of the outstanding balance can be covered.
You will be charged for hospital accommodation and items such as theatre fees and medicines. These costs can also be covered by private health insurance.
What's not covered by Medicare?
Medicare does not cover such things as:
- private patient hospital costs (for example, theatre fees or accommodation)
- dental examinations and treatment (except specified items introduced for allied health services as part of the Enhanced Primary Care (EPC) program)—contact Medicare for more information
- ambulance services
- home nursing
- physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology (except specified items introduced for allied health services as part of the Enhanced Primary Care (EPC) program)—contact Medicare for more information)
- acupuncture (unless part of a doctor's consultation)
- glasses and contact lenses
- hearing aids and other appliances
- the cost of prostheses (except External Breast Prostheses covered by the External Breast Prostheses Reimbursement Program)
- medicines (except for the subsidy on medicines covered by the Pharmaceutical Benefits Scheme)
- medical and hospital costs incurred overseas
- medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
- medical services which are not clinically necessary
- surgery solely for cosmetic reasons
- examinations for life insurance, superannuation or membership of a friendly society
- eye therapy
You can arrange private health insurance to cover many of these services.
Last updated: 18 March, 2010
