How Medicare works
Medicare is Australia's universal public health insurance. It pays a rebate towards services listed in the MBS, provides free treatment as a public patient in public hospitals, and works alongside the Pharmaceutical Benefits Scheme (PBS) for medicines.
| Term | Meaning |
|---|---|
| MBS item | A numbered service with a set Medicare fee and rules, such as a standard GP consultation |
| Rebate | The amount Medicare pays the patient, usually 100% of the schedule fee for GP services and 85% for most other out-of-hospital services |
| Bulk billing | The doctor accepts the rebate as full payment, so the patient pays nothing |
| Gap | The difference between the doctor's fee and the rebate, paid by the patient |
| Provider number | Identifies the doctor and location for Medicare claims |
| Safety nets | Higher rebates once a family's out-of-pocket costs pass annual thresholds |
GP consultation items
| Item | Level | Typical use |
|---|---|---|
| 3 | Level A | Straightforward problem, such as a repeat prescription |
| 23 | Level B | Standard consultation, under 20 minutes |
| 36 | Level C | At least 20 minutes |
| 44 | Level D | At least 40 minutes |
| 123 | Level E | At least 60 minutes |
Time-based levels require the documented clinical time to meet the threshold. Telehealth equivalents exist with separate item numbers, and many GP telehealth services require an established clinical relationship, usually a face-to-face visit in the past 12 months, with listed exceptions.
Item numbers and fees change. Always check MBS Online for current descriptors, fees and rules.
Health assessments and chronic condition plans
| Service | Items | Key point |
|---|---|---|
| Health assessments (by length) | 701, 703, 705, 707 | For eligible groups, such as people aged 45 to 49 at risk of chronic disease, people aged 75 and over, and people with intellectual disability |
| Aboriginal and Torres Strait Islander health assessment | 715 | Any age, once every 9 months |
| GP chronic condition management plan: prepare | 965 (face to face), 92029 (video) | Replaced the GP management plan and team care arrangement items from 1 July 2025 |
| GP chronic condition management plan: review | 967 (face to face), 92030 (video) | Can be reviewed every 3 months |
A chronic condition management plan allows referral for Medicare-subsidised allied health services. A mental health treatment plan allows subsidised psychological therapy sessions.
Chronic condition item changes from the 1 July 2025 MBS framework update, with transition arrangements for existing patients.
Bulk billing incentives
From 1 November 2025, bulk billing incentive payments were extended to all Medicare card holders, not just children under 16 and concession card holders. Practices that bulk bill every eligible patient can also join the Bulk Billing Practice Incentive Program for an additional 12.5% payment, shared between the practice and the GP.
For exams, the key ideas are who pays what, when a patient faces a gap, and how cost affects access to care, especially for referrals and tests.
Rules that apply to IMGs
Two sections of the Health Insurance Act 1973 affect whether an overseas-trained doctor can provide services that attract Medicare rebates.
| Rule | What it means |
|---|---|
| Section 19AB (the 10-year moratorium) | Overseas-trained doctors and foreign graduates must generally work in a Distribution Priority Area (DPA) or District of Workforce Shortage for 10 years from first medical registration to access Medicare rebates |
| Scaling | Working in regional and remote areas reduces the time spent in the moratorium, down to 9 years in inner regional through to 5 years in very remote areas |
| Section 19AA | Doctors first registered after 1996 need to hold specialist or GP fellowship, or be on an approved training or workforce program, to access Medicare rebates |
| Provider number | Applied for through Services Australia for each practice location, with any required exemptions |
From the Department of Health 19AB moratorium and scaling page and Services Australia guidance at the date above. Rules and exemptions are complex; check your situation with Services Australia before accepting a position.
How Medicare appears in exams
- Choosing a plan that the patient can afford, such as a bulk-billed service or public hospital option.
- Knowing that a chronic condition plan is the route to subsidised allied health.
- Recognising the 715 health check and the 45 to 49 and 75+ health assessments as preventive opportunities.
- In GP exams, documenting care in a way that supports the item claimed.
Medicines funding is covered in PBS and Australian prescribing.
Common questions
What is the difference between Medicare and the MBS?
Medicare is the public insurance scheme. The MBS is the list of services Medicare subsidises, each with an item number, fee and rules.
What is a Level B consultation?
MBS item 23, a standard GP consultation of less than 20 minutes.
What replaced GP management plans in 2025?
From 1 July 2025, GP chronic condition management plans (items 965 and 967, with video equivalents) replaced the GP management plan and team care arrangement items.
What is the 10-year moratorium?
Under section 19AB, overseas-trained doctors generally need to work in a Distribution Priority Area for 10 years from first registration to access Medicare rebates, reduced by scaling for regional and remote work.