Medicare: what it covers, eligibility

What is Medicare?

Medicare provides payments and services that can help when you, or someone you provide care for, use health care services or buy medicines.

Who is eligible for Medicare?

Your eligibility for Medicare depends on your residency and other factors. If you live in Australia you are eligible for Medicare benefits if you:

  • are an Australian or New Zealand citizen, or
  • are a permanent resident, or
  • have applied for a permanent visa (excludes an application for a parent visa) and meet certain other criteria, or
  • are covered by a Reciprocal Health Care Agreement with another country

Read more about Medicare eligibility

Medicare card

To access public health services, you need a Medicare card. Cards are issued to people enrolled in Medicare. If you are aged 15 or older, you can get your own card. Children under 15 can be listed on their parents’ card.
You use your Medicare card when:

  • making a Medicare claim for a paid or unpaid doctor's bill
  • visiting a doctor who bulk-bills
  • getting treatment as a public patient in a public hospital
  • filling a Pharmaceutical Benefits Scheme prescription at a pharmacy

Read more about Medicare cards.

What does Medicare cover?

Medicare helps with some of your health care costs for hospital, medical and pharmaceutical. The benefits you receive from Medicare are based on a schedule of fees set by the Australian Government. Health care providers may choose to charge more than the fees in the schedule, and you will have to pay the extra amount, often called a ‘gap’ payment.

Medicare usually pays:

  • the full schedule fee for general practitioner services
  • 85% of the schedule fee for other out-of-hospital services
  • 75% of the schedule fee for in-hospital services as a public patient.

You may receive a higher benefit under the Medicare safety net if you have a lot of medical expenses.

Find out what Medicare covers.

What is not covered by Medicare?

Medicare does not cover a range of costs like:

  • private patient costs in hospital
  • extras services like dental and physiotherapy
  • medical aids like glasses or hearing aids

You may choose to take out private health insurance to help with these costs. Private health insurance may cover some of your costs for things like glasses, or hearing or mobility aids. You may also be eligible for free or low-cost medical aids under the Medical Aids Subsidy Scheme.