Medicare is Australia’s universal health care system, introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care.
Medicare was established on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income taxes and an income-related Medicare levy.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital, and
- free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)
- subsidies for prescribed medicines (with a safety net providing free medicines for the chronically ill).
Some services under Medicare and at public hospitals have long waiting lists - for this and other reasons many Australians have private medical insurance as well as being able to access the benefits of Medicare.
Medicare benefits are paid based on a comprehensive list of services and corresponding benefits; the Medicare Benefit Schedule (MBS). If the medical practitioner provides an eligible service such as a consultation at the MBS recommended fee the patient pays no fee at the point of care and this is often referred to as bulk billing. If the medical practitioner provides a service and elects to charge more than the MBS recommended fee the patient pays the higher fee and then claims back the MBS fee from Medicare.
Doctors in private practice are largely free to determine the number of rebateable services they provide and the fees they charge to patients.
More information about Medicare for health professionals is available using the Medicare eLearning service .
Medicare Provider Numbers
Any medical practitioner working in private practice in Australia must have a Medicare Provider Number. This will allow a doctor to:
- raise referrals for specialist services
- make requests for pathology or Diagnostic Imaging services
- prescribe medications.
Where the doctor satisfies the legislative requirements, their provider number may also be used to attract Medicare rebates for professional services rendered (that is, treatment of private patients).
International Medical Graduates (IMGs) are subject to Medicare Provider Number restrictions if they require the latter type of provider number listed above.
These Medicare Provider Number restrictions affect where an IMG can work in Australia and are determined by both residency status and when the IMG
first registered in Australia.
Medicare Provider Numbers are issued by Medicare Australia, formerly known as the Health Insurance Commission (HIC), after an IMG has been offered a job and has obtained the relevant Medical Board registration.
Pharmaceutical Benefits Scheme
Australians have affordable access to a broad range of quality health services that are either free at the point of delivery or subject to substantial government rebates.
The two major national subsidy schemes, Medicare and the Pharmaceutical Benefits Scheme (PBS), subsidise payments for services provided by doctors and optometrists, and for many prescription medications bought from pharmacies.
Safety nets apply for Medicare and the PBS to protect Australians from high out-of-pocket costs for medical services and pharmaceuticals provided outside of hospitals. These two schemes are further integrated with social welfare arrangements, with larger rebates and/or lower safety net thresholds provided for individuals or families who receive certain income support payments (such as for unemployment or disability).
Additional information about the PBS can be found by accessing The PBS and You. This is a stand alone educational resource, comprising 33 units of education, that allows for individual, self-paced learning in the users own environment.
Are my family and I eligible to access Medicare benefits?
People who reside in Australia - excluding Norfolk Island - are eligible if they:
- hold Australian citizenship
- have been issued with a permanent visa
- hold New Zealand citizenship
- have applied for a permanent visa (excludes an application for a parent visa) — other requirements apply.
Reciprocal Health Care Agreements — the Australian Government has signed Reciprocal Health Care Agreements with some countries. Under these arrangements, residents of these countries are entitled to restricted access to health cover while visiting Australia. For more information go to the visitors travelling to Australia section of the Department of Human Services website.
How do I enrol?
To enrol in Medicare you need to fill out an enrolment form (PDF 193KB). Forms are also available from your local Medicare office.
If you haven’t yet applied for permanent residency in Australia or if you come here on a temporary visa, you should purchase health insurance cover to protect yourself and your family for any unforeseen medical expenses.
Australian private health insurance for overseas visitors is available from Australian registered health organisations, insurance brokers and general insurers.Source: www.heti.nsw.gov.au