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Medicare and private health insurance

Australia has two health insurance regimes: Medicare, and private health insurance.

Medicare is a taxpayer-funded health cover scheme that gives all permanent residents a basic level of health insurance. It provides:

  • access to free treatment as a public patient in a public hospital
  • a rebate on the medical costs of being a private patient in a public or private hospital (75% of the recommended schedule fee)
  • a rebate on fees charged by GPs, specialists and optometrists (85% of the schedule fee)
  • subsidised prescription medications purchased from pharmacies.

Bulk-billing

If a doctor bulk-bills the government, there is no charge to the patient. If the doctor does not bulk-bill, the patient is responsible for the shortfall between what the doctor charges and what Medicare pays (this is often referred to as ‘the gap’).

Medicare and private health insurance  :  Last Revised: Fri Jul 18th 2014
The content of the Law Handbook is made available as a public service for information purposes only and should not be relied upon as a substitute for legal advice. See Disclaimer for details. For free and confidential legal advice in South Australia call 1300 366 424.