What does the Australian Medicare cover?

Medicare is Australia’s universal health care system, and most residents of Australia are eligible for coverage. An individual has the choice of being covered by Medicare exclusively or opting to be covered by both Medicare and private health insurance. The program covers most health care costs and is divided into three sections: hospital, pharmaceutical, and medical.

Most health care costs are covered, some are excluded. The Medicare Benefits Schedule (see below) lists 5,700 items covered under the program. Things not covered include, but are not limited to:

  • private patient hospital costs
  • costs incurred overseas
  • unnecessary services (e.g. cosmetic surgery)
  • ambulance services
  • dental services
  • psychology services
  • most therapy other than physical therapy
  • glasses and contact lenses
  • hearing aids and similar devices
  • home nursing

How does Australian Medicare work?

If you reside in Australia and meet certain criteria, you can enrol and will be given a Medicare Card. Your eligible costs are then paid directly by Medicare to your health care provider. If your practitioner does not bulk bill, however, this is not the case; instead, you must pay the full bill and then you will be reimbursed by Medicare. Also, in the absence of bulk billing, you must pay for the appointment, but if certain criteria are met you may be reimbursed for that cost.

Australia’s Medicare is a publicly funded program, paid for by the Medicare levy, an income tax on working Australians. Low-income earners are exempt from the tax, and there is a Medicare levy surcharge for high-income individuals to encourage them to enrol in private insurance and reduce the financial strain on the program.

What is the Medicare Benefits Schedule?

The Medicare Benefits Schedule (MBS) is a listing of more than 5,700 items covered by the Australian Medicare program.

What are the benefits of MBS Review?

The Medicare Benefits Schedule Review Taskforce was established in 2015. Its mission is to research and provide recommendations for how the over 5,700 items on the MBS can be updated to better reflect current evidence and practices. This includes identifying services or practices that are obsolete and unsafe for patients in today’s healthcare environment. The ultimate goal is to improve outcomes for patients. Over 70 committees have been formed by the Taskforce to provide advice regarding each subset of practice that the MBS supports. This review is crucial to keeping Australia’s health care system up to date in order to provide the best service possible to patients.

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