What Does Medicare Cover in Australia? A Full Guide
If you've ever opened a hospital bill, scanned a specialist quote, or stared at the cost of a dental appointment and asked "wait, what does Medicare actually cover?", you are not alone. Medicare is one of the most quietly important institutions in Australian life and one of the most misunderstood. Most of us know it pays for "the doctor", but the precise edges (what's rebated, what's a gap, what's excluded entirely) are genuinely confusing. This guide walks through what does Medicare cover in 2026: GP visits, telehealth, specialist appointments, pathology and imaging, mental health, and the gaps that catch people out. If this is a medical emergency, call 000 immediately.
Medicare is Australia's universal health-care scheme. It was established in 1984 and is funded primarily through general taxation and the Medicare levy (2% of taxable income for most earners). It is administered by Services Australia on behalf of the Department of Health and Aged Care.
In practice, Medicare pays for healthcare in three main ways.
The first is the Medicare Benefits Schedule (MBS): a long list of clinical services (GP consultations, specialist visits, pathology, imaging, certain procedures) each tied to an item number and a rebate. When a clinician provides one of these services, they (or you) submit a claim against the relevant item number, and Medicare pays the rebate. The full list is published at MBS Online.
The second is the Pharmaceutical Benefits Scheme (PBS), which subsidises a wide range of prescription medicines so most Australians pay a capped contribution at the pharmacy rather than the full cost. PBS thresholds and safety nets reduce annual costs further for high users.
The third is public hospital care (emergency departments, public hospital admissions, public hospital outpatient clinics), which is delivered through state and territory health systems but funded jointly by the Commonwealth and states under National Health Reform Agreements.
Two important things to keep in mind. First, Medicare pays a defined rebate, not a defined fee. Clinicians choose whether to charge above the rebate (a gap fee) or accept the rebate as full payment (bulk billing). Bulk billed for eligible patients with a valid Medicare card. Strict eligibility criteria apply. Our companion guide on what is bulk billing in Australia walks through this in detail.
Second, Medicare is not the only public scheme. Private health insurance, Department of Veterans' Affairs cover, workers' compensation and motor accident schemes all sit alongside or interact with Medicare. This guide focuses on Medicare itself.
GP visits are the most-used part of Medicare. Each year, Australians make more than 170 million GP attendances, according to AIHW data.
A standard GP visit attracts a Medicare rebate based on the consultation length:
- Level A (under 6 minutes): short, simple consult.
- Level B (6-20 minutes): the most common consult type, e.g. a sore throat, a script renewal.
- Level C (20-40 minutes): longer consult, e.g. multiple problems, a chronic condition review.
- Level D (40+ minutes): complex, multi-issue consult.
If the clinic bulk bills your visit, you pay nothing on the day and Medicare pays the rebate to the clinic. If the clinic privately bills, you pay the clinic's fee, Medicare deposits the rebate into your account, and the difference is your gap.
Telehealth GP visits have been a permanent part of Medicare since 2022. Most standard GP consult items are now available as telehealth equivalents (phone or video), with rebates close to the in-person amounts. The key eligibility rule is the established relationship requirement: in most cases, a telehealth GP consult is only Medicare-rebatable if you've had a face-to-face visit with that GP or practice within the last 12 months. There are exceptions for residents of MMM 6-7 remote areas, certain mental health items, and emergency situations.
This is why online-first clinics matter: continuity is not just a nice-to-have, it's how telehealth bulk billing works. See our explainer on bulk-billed online doctor consults for how this plays out in practice.
Medicare also covers visits to specialists (cardiologists, dermatologists, paediatricians, psychiatrists, gynaecologists, and so on), but with a critical condition: you generally need a GP referral to receive a Medicare rebate.
The rebate covers a portion of the specialist's fee, almost never the whole amount. Specialist fees are unregulated, and gap fees of $100-$300 per appointment are common in major cities. The first appointment with a new specialist attracts a higher rebate (an "initial consult" item) than follow-up appointments.
Three things to know.
First, the referral usually lasts 12 months from the date of the first specialist visit, not from the date of issue. After 12 months, your specialist will request a new referral if ongoing care is needed. For some chronic conditions, specialists may request an indefinite referral, which doesn't expire. See our guide on online referrals in Australia for how this works in practice.
Second, a referral from your usual GP is preferred. The Medicare rebate is the same regardless of who issues the referral, but referrals from someone who knows your full history tend to be more useful clinically.
Third, public hospital outpatient clinics are an alternative for many specialties. They have longer waits but no out-of-pocket cost for most patients. Your GP can refer to either a private specialist or a public outpatient clinic.
For mental-health specialist care (psychiatry) Medicare rebates apply with a referral. Psychology is partly covered, but only under a Mental Health Care Plan (covered below).
Pathology (blood tests, urine tests, swabs, cervical screening) and diagnostic imaging (X-ray, ultrasound, CT, MRI, mammography) are funded by Medicare under separate MBS sections.
For pathology, the most common arrangement is bulk billing. Most pathology providers (Australian Clinical Labs, 4Cyte, Dorevitch, Healius, Sonic Healthcare practices) bulk bill standard tests when ordered by a Medicare-recognised request form. You pay nothing if your GP requests the test. See our pathology service page for what an Abby GP can request.
For imaging, the picture is more varied. X-rays and ultrasounds are commonly bulk billed. CT and MRI services often charge gap fees, particularly in private centres. Mammography for breast cancer screening is free through BreastScreen Australia for eligible women aged 40-74.
Two practical points. The pathology or imaging request form has to come from a Medicare-recognised practitioner (GP, specialist, or in some cases nurse practitioner), and the request is generally valid for 6 months for pathology and longer for imaging. If you misplace it, your GP can re-issue it.
Medicare-funded mental health care has expanded significantly since the introduction of the Better Access initiative. Three pathways are most commonly used.
The Mental Health Care Plan (also called a GP Mental Health Treatment Plan) is prepared by your GP and entitles you to up to 10 Medicare-rebated psychology sessions per calendar year (with a possible additional 10 in certain circumstances). It includes a goal-setting conversation, a referral to a psychologist or accredited mental health social worker, and a review by your GP after a few sessions. See our explainer on Mental Health Care Plans in Australia for the step-by-step.
Psychiatry sessions are Medicare-rebated with a GP referral. Psychiatry is the medical specialty for mental health and is appropriate when medication assessment, complex diagnosis, or hospital-level care is in scope.
GP mental health consultations themselves are Medicare-rebated under specific items, with longer consult durations recognised. A GP can manage anxiety, depression, sleep, and stress in many cases without a specialist referral, and arrange a Mental Health Care Plan if more support is needed.
For a closely related guide, see our piece on stress leave and sick leave in Australia.
Book a Medicare-rebated online consult
Knowing what Medicare doesn't cover is just as useful as knowing what it does. Some of the most common gaps:
- Most adult dental care. Public dental schemes exist for concession card holders and children (the Child Dental Benefits Schedule), but routine adult dental check-ups, fillings, crowns and orthodontics are not covered by Medicare. Most people pay privately or through extras-level private health insurance.
- Optometry frames and lenses. Medicare covers eye tests with an optometrist, but not the cost of glasses or contact lenses.
- Most allied health. Physiotherapy, podiatry, dietetics, occupational therapy and exercise physiology are not generally Medicare-rebated, except under a Chronic Disease Management plan or a Mental Health Care Plan, both of which are time-limited.
- Ambulance services. Coverage varies by state. In Queensland and Tasmania, ambulance is free for residents. In NSW, Victoria, SA, WA, ACT and NT, ambulance is generally a user-pays service unless you are a concession card holder or have ambulance cover through private health insurance or a state ambulance subscription.
- Cosmetic procedures. Procedures classified as cosmetic (not medically necessary) are not covered.
- Most non-PBS medicines. Medicines outside the PBS are paid for at full cost.
- Hospital costs as a private patient. If you choose to be admitted as a private patient (whether in a public or private hospital), Medicare covers a portion but private health insurance usually covers the rest.
A useful rule of thumb: Medicare covers what is medically necessary and clinically recognised. Anything labelled "cosmetic", "elective" or "lifestyle" is more likely to fall outside the schedule.
Abby Health is an online-first clinic that operates fully inside the Medicare system. When you see an Abby GP, the consultation is billed against a standard MBS GP item number, the same item your local in-person clinic would use. Bulk billed for eligible patients with a valid Medicare card. Strict eligibility criteria apply.
That means everything we've covered above applies to an Abby consultation: standard GP rebate, pathology and imaging requests through Medicare-recognised forms, specialist referrals through the standard system, Mental Health Care Plans, prescriptions on PBS where applicable. Australia's largest online-first clinic (Abby Health internal data, Q1 2026), with 300+ clinicians available seven days a week (Abby Health internal data, Q1 2026), and a 71% rebook rate (Abby Health internal data, Q1 2026) that supports the established-relationship requirement for telehealth.
If you're not sure what Medicare will cover in your specific situation, the most useful first step is usually a consult with a GP. They can confirm what's rebatable, what to expect in gap fees, and what alternative pathways exist. To book, see our appointment booking page, or read our broader explainer on online doctor consultations. If this is a medical emergency, call 000.
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