This section describes the different ways that medical treatment can be accessed in Australia. It includes information on:
Medicare is designed to provide universal health care for Australians. Universal health care means that those people who are eligible for Medicare can always access health care that is free or provided at a low cost. This section on Medicare has information on:
People who live in Australia (excluding Norfolk Island) are eligible for Medicare if they:
Medicare pays all or part of the costs of a range of health care services including:
You can choose who provides you with health care services outside hospitals.
Medicare pays the cost of most consultations and procedures with your General Practitioner (GP). The doctor can usually tell you whether or not the consultation or treatment you need will be paid for by Medicare. If you are in doubt, you should ask before the consultation with the doctor begins.
For more information call Medicare on 132 011*.
The Medicare general enquiries line has changed. Now when you call, an automated voice will ask what your call is about. All you need to do is answer and say what you want to do or what you need help with. You will then be directed to the next step.
*Remember, mobile phone calls to freecall numbers (numbers starting with 1800) and to Local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.
Medicare does not cover the costs of such things as:
For more information, call Medicare on 132 011*.
* Remember, mobile phone calls to freecall numbers (numbers starting with 1800) and to Local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.
Medicare either pays the cost of a health care service up front through what is called ‘bulk billing’ (see below) or they will pay you back for all or part of the amount you have paid for health care services.
You need to have a Medicare card to get the benefit of Medicare paying for the eligible medical treatments . If for some reason you do not have a Medicare card, contact a Medicare office (phone 132 011). Medicare will replace lost or misplaced cards. Your Medicare card number is written on the card. Dependent children are usually listed on their parents’ card.
Some health care professionals (including GPs, specialists and others) ‘bulk bill’ Medicare for the costs of health care. This means that you won’t have to pay anything when you get the health service or treatment. If the health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More doesn’t bulk bill, then you will have to pay at the time you get the health service or treatment or pay on account, and then make a claim to Medicare for some or all of the amount you paid. Health care providers don’t have to bulk bill. Some health care providers only bulk bill pensioners and other Health Care Card holders. Most medical specialists do not bulk bill.
If a health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More bulk bills, the providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More or a staff member will take an imprint or the details of your Medicare card and ask you to sign a form with these details and the details of the health care service or treatment you received.
If a health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More does not bulk bill, after you have paid the bill, you can take or send the receipt to a Medicare office with the completed claim form and you will be paid back an amount of the bill. This is called a ‘Medicare rebate’ and is based on what the Government has agreed to pay for each treatment; these are called the ‘scheduled fees’. The health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More should tell you how much of the bill you should get back from Medicare. This will almost certainly be less than you pay the providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More.
Medicare no longer provide rebates in cash. You can be paid electronically and in several ways through the post.
You will need to advise Medicare of your bank details and the amount you paid, and the rebate is usually refunded within 3 working days.
To find a Medicare office, click here.
Some of Medicare’s 242 branches across Australia currently offer Credit EFTPOS as a payment option.
Some providers can organise to have the Medicare rebate paid directly into your bank account. The process for doing this involves registering your health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More, so you should ask about this when you see the providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More.
Another option is for you to pay only the difference between the health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More‘s fee and the Medicare rebate amount. This is done through the health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More asking you to sign a claims form assigning your Medicare rebate to them.
For more information on Medicare claims and rebate payment options, click here
Note: Health care providers can charge what they choose over and above the Medicare rebate amount (and the scheduled fee). Like any other service you get, you should ask how much you will be charged before you get the service.
For more information, call Medicare on 132 011*.
* Remember, mobile phone calls to freecall numbers (numbers starting with 1800) and to Local call numbers (numbers starting with 13 or 1300) are charged to the caller at the usual mobile rate.
Access to Medicare to cover the cost of health care is granted to three groups of non-citizens in Australia:
Tourists and people with student visas from countries without mutual care agreements have to pay the costs of any medical treatment they get, including stays in public hospitals.
Access to an ambulance and emergency medical treatment at a hospital emergency department is not denied to anyone in NSW. However, after any stay in hospital, a person who is not eligible for Medicare will generally be given a bill for the costs of their hospitalisation, emergency transport and medical treatment. Many tourists get health insurance before they travel to Australia to cover these costs.
There are two schemes that will help cover the cost of getting psychological and allied services,
Access to both of these schemes begins with a visit to a GP.
The Better Access program under Medicare will cover the cost of people with most mental health conditions and provide subsidised access to 10 individual allied mental health services and 10 group therapy sessions each calendar year.
In order to access this benefit, you must be referred for the allied mental health treatment by a GP under a GP Mental Health Care Plan, through a psychiatric assessment and management plan, or by a psychiatrist or paediatrician.
The services that can be accessed under this scheme include psychological therapy services provided by eligible clinical psychologists and focused psychological strategy services provided by eligible psychologists, social workers and occupational therapists.
Like other Medicare-funded services, the costs may be bulk billed by the health care providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More but a providerIn the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services. More may also charge you a fee and you will only get a percentage back as a rebate from Medicare.
If you cannot afford to pay the fee for the service up-front, tell your GP or referring health care professional that you only want to be referred to someone who will bulk bill. (This may make it more difficult to access this scheme, as health care professionals who bulk bill may be limited in your area.) Your GP or referring health care professional could also refer you through the Better Outcomes – ATAPS scheme that only bulk bills for services.
GPs can refer people with diagnosed mental disorders to allied mental health care providers through the ATAPS Scheme which is delivered generally through the Primary Health Networks. This scheme is targeted at low-income earners and all the available services are bulk billed through Medicare.
The ATAPS triage service liaises with GPs and referral sources to review client eligibility and allocate referrals to ATAPS providers. ATAPS programs usually provide up to 12 free sessions individual or groups therapy with a psychologist, a psychiatrist or a GP over a period of one year.
Allied health care professionals include psychologists, social workers, mental health nurses, occupational therapists and Aboriginal and Torres Strait Islander health workers with specific mental health qualifications.
There are now 10 Primary Health Networks in NSW. They have been designed to meet local needs and vary in their referral processes and eligibility criteria.
For further information about a program in your area, contact the Primary Health Network in your area.
headspace centres act as a one-stop shop for young people who need help with mental health, physical health (including sexual health), alcohol and other drugs or work and study support. They provide free access to the following services for young people (12 to 25 years old):
You may not need a Medicare card to see a doctor or get other services at headspace. You are likely to be asked for a Medicare card to get psychological services. The low-cost service ensures young people get high quality mental health care, while continuing their treatment within their local community.
National Telehealth Service
In regional and rural areas, getting access to expert psychiatrists is difficult. The National Telehealth Service addresses this by providing 12-25 year olds access to psychiatrists via video consultations.
eheadspace
eheadspace is the national online and phone support service, staffed by experienced youth mental health professionals. It provides young people and carers with a safe, secure and anonymous place to talk to a professional – wherever they are.
eheadspace was established to reach regional and remote young people who were unable to access a headspace centre. It has since grown in popularity with all young people – many of whom simply feel more comfortable accessing these services online.
The Pharmaceutical Benefits Scheme (PBS) provides for prescription medications at a subsidised (reduced) cost in Australia. However, not all prescription medications are on the PBS list of subsidised drugs.
The eligibility is the same as for Medicare and you may be required by a pharmacist to produce a Medicare card to get subsidised medicine under the PBS.
Some people are eligible for a concessional benefit, to be eligible for a concessional benefit, you must have one of the following concession cards:
Some medicines are sold under more than one name, although they are the same medication for the same conditions. Some of these are called ‘generic medicines’ and often are less expensive than the other medication with a more familiar brand name, even on the PBS. You may want to ask either your doctor or the pharmacist when you are prescribed medication whether there is a cheaper generic equivalent.
For more information on the PBS, click here to go to its website or call the Department of Health and Ageing PBS Information Line on 1800 020 613*. The PBS Information Line is open Monday to Friday from 8.30 am to 5.00 pm.
*Remember, mobile phone calls to freecall numbers (numbers starting with 1800) are charged to the caller at the usual mobile rate.
One of the exceptions to universal access to health care in Australia is dental care.
Private dentists and dental technicians provide most dental care in Australia on a fee-for-service basis. There are limited circumstances in which a person can get free or subsidised dental treatment. These are described below.
As with other private health services, there is no regulation of what a dentist may charge you for their services.
Always make sure when you see a private dentist that you know what they are going to charge you. If you are seeing a dentist for complex work with a large fee, it is strongly recommended that you ask for a written quote before the treatment is started. Some private dentists offer the first consultation (not treatment) for free.
Under the Child Dental Benefits Scheme, children and young people between the ages of 2 and 17 are entitled to free public dental care if they are eligible for Medicare. You can also obtain free public dental care if you have a Pensioner Concession or Health Care Card. No one else can access free public dental care, even if you are working but have little spare money and no assets. Free public dental care is only provided for essential dental care, and not usually for cosmetic dentistry.
Click here to read about the Child Dental Benefits Scheme
Public dental clinics are usually located in or near large public hospitals.
There are long waiting lists, even for some urgent dental procedures, at the public clinics. If your situation becomes more urgent, and you are on a waiting list, you should tell the dental clinic of the change in your condition. Public dental clinics only do some dental treatments. If you need other treatments, your only option may be private treatment.
Schedule 8 drugs are addictive drugs. The ‘schedule‘ is in the NSW Poisons List and it refers to the Commonwealth Standard for the Uniform Scheduling of Drugs and Poisons (the Poisons Standard). Click here to find out more about the Poisons Standard.
Examples of Schedule 8 drugs labelled ‘Controlled Drug’ are medicines with strict legislative controls, including opioid analgesics – for example, pethidine, fentanyl, morphine, oxycodone, methadone and buprenorphine. Two benzodiazepines (flunitrazepam and alprazolam) are also classified as Schedule 8 poisons, as is ketamine (which some nurse practitioners may be authorised to prescribe). They are usually prescribed for severe pain relief. These drugs can be prescribed by medical practitioners (and, in restricted circumstances, by dentists).
Drugs in other schedules of the Poisons Standard can also have special conditions on their dispensing and prescription. This information can be obtained from doctors and pharmacists.
There are restrictions on the prescription of Schedule 8 drugs that people with mental illness should be aware of.
If you are a person known to be a ‘drug-dependent person’, then the doctor must have an authority from the Pharmaceutical Services Branch of NSW Health to prescribe a Schedule 8 drug. These authorities are reviewed and renewed regularly.
If you are not a drug-dependent person, your doctor does not need to get an authority to prescribe you a Schedule 8 drug unless the drug is packaged for the purpose of injection or is:
A doctor cannot prescribe any of these four drugs for more than two months without getting an authority from the Pharmaceutical Services Branch.
It is important to remember that there is no legal obligation on any doctor to treat you (except when they are confronted with extreme life-threatening emergencies), and a doctor does not have to prescribe you any medication, despite the fact that another doctor or doctors may have said it is necessary for your medical condition or pain relief.
Updated October 29, 2019
