What Medicare covers

Medicare provides for free treatment at public hospitals, and covers some of the costs of GPs, specialists, medical testing and diagnosis for Australian residents (except Norfolk Islanders). It also subsidises a lot of prescription medications.

Hospital benefits
As a public patient at a public hospital, you’ll be treated for free. But you’ll have no say about which doctors treat you, and you’ll have little say about when you’re admitted to hospital, and which hospital you’re treated at. It can mean long waiting periods for non-urgent surgery.

GP and specialist benefits
Medicare pays an amount towards your treatment based on the medical benefits schedule (MBS) – which sets fees for all medical services. However, many GPs and specialists charge rates higher than set MBS fees – meaning you often out of pocket even after receiving Medicare benefits.

Medicare pays 100 per cent of MBS fees for GPs, and 85 per cent of MBS fees for specialists, if you’ve been referred for treatment, diagnostics, testing – or even minor surgery (like mole removal or a dental procedure). In general, however, dentistry is not covered by Medicare. And neither are many other specialist services like physiotherapy, osteopathy, natural therapies, eye and ear services, and podiatry, among others.

Ambulance and medication benefits
Medicare doesn’t cover ambulance, but some state governments provide free ambulance, so you’ll need to check before adding ambulance to your private insurance policy (see our ambulance cover section).

Medications are heavily subsidised by Medicare, under it pharmaceutical benefits scheme (PBS). It means many of the scripts you have filled at the pharmacy are actually much cheaper because they’re list on the PBS.