How Medicare works

All Australians can enrol in Medicare. Find out how to enrol on the Services Australia website.

When you enrol in Medicare, some or all of the costs of your necessary health care are paid for by Medicare.

The costs will depend on who your doctor is.

  • If your admission is unplanned and you choose to see a hospital doctor, your insurance and Medicare will cover your private hospital costs.
  • If you've planned to see your private doctor you'll have to pay any costs not covered by your insurance before you go to hospital.

If your injury or illness is due to a worker's compensation or motor vehicle accident, you may be able to claim for your hospital charges.

Medicare Benefits Scheme

The Medicare Benefits Schedule (MBS) lists the services Medicare will pay for. The Department of Health manages the MBS.

Read more about what’s covered on the Services Australia website.

Medicare can also help make some medicines more affordable through the Pharmaceutical Benefits Scheme (PBS).

Read more about Medicare on the Services Australia website.


If you're eligible for Medicare, you won't pay for any medications you have while you're in hospital.

You might have to pay for medication you get when you're discharged or as an outpatient. These are usually the same price as the Pharmaceutical Benefits Scheme co-payment for each item.

If you’re not eligible for Medicare, you'll be charged the full price for all medications dispensed through the pharmacy. Health insurance may help to cover some of these costs.

Specialist fees

Fees can vary and will depend on whether you see a specialist in a bulk billing public hospital or at a private clinic or hospital.

The fee structure of each specialist may also vary.

When considering costs, you may want to ask if the specialist:

  • works in the public or private healthcare system
  • bulk bills using the Medical Benefits Scheme (MBS)
  • requires gap payments
  • has a payment plan
  • accepts your private health cover.

Ask your doctor and specialist how much it will cost upfront and if there are likely to be any further costs.

Last updated: December 2022