Medicare rebates are the amounts the Australian Government contributes toward the cost of medical services listed on the Medicare Benefits Schedule (MBS). This guide explains rebates, how to claim them, and how the Safety Net protects you from high out-of-pocket costs.
What Is a Medicare Rebate?
A Medicare rebate is the portion of a doctor's fee that the Government covers. The MBS sets a schedule fee for each service. Medicare pays 100% of the schedule fee for GP services and 85% for specialist services in most cases.
If your doctor charges more than the schedule fee, you pay the difference (the gap or out-of-pocket cost).
Example
| Item | Doctor's Fee | Schedule Fee | Medicare Rebate (85%) | Out-of-Pocket |
|---|---|---|---|---|
| Specialist consultation | $250.00 | $100.00 | $85.00 | $165.00 |
Bulk Billing
When a doctor bulk bills, they accept the Medicare rebate as full payment for the service. This means you pay nothing out of pocket. Many GPs bulk bill for:
- Standard GP consultations
- Health assessments and care plans
- Pregnancy-related care
- Children under 16 and concession card holders
How to Claim a Medicare Rebate
Option 1: Online Claiming (via myGov)
- Log into myGov and go to Medicare
- Select "Manage claims" then "Make a claim"
- Upload your itemised receipt (must show provider name, item number, date, fee, and the gap amount if applicable)
- Enter your bank details for payment and submit
- Rebate is usually paid within 2–5 business days
Option 2: Express Plus Medicare App
- Download the Express Plus Medicare app
- Use the "Claim a benefit" feature to photograph and submit your receipt
- Track claim status and payment history
Option 3: In-Person
- Visit a Services Australia service centre with your completed claim form (MS014) and original receipts
- Rebate is processed while you wait or deposited within a few days
Medicare Safety Net
The Medicare Safety Net provides extra financial protection once you reach certain out-of-pocket thresholds in a calendar year.
Original Medicare Safety Net (OMSN)
- Threshold: $593.60 (concession card holders) / $2,150.40 (general)
- Benefit: Once reached, Medicare pays 100% of the MBS schedule fee for further services in the same calendar year
Extended Medicare Safety Net (EMSN)
- Threshold: $793.20 (concession card holders) / $2,542.00 (general)
- Benefit: Once reached, Medicare pays 80% of the out-of-pocket cost (up to the EMSN cap) for further services
Note: Thresholds are updated on 1 January each year. Check Services Australia for current figures.
What Services Are Covered by Medicare?
- GP and specialist consultations
- Pathology tests (blood tests, urine tests, etc.)
- Medical imaging (X-rays, CT scans, MRIs, ultrasounds) — outpatient only
- Eye tests (but not glasses or contact lenses)
- Most surgery and hospital treatment (as a public patient)
- Some dental procedures (for children under the Child Dental Benefits Schedule)
What Is NOT Covered?
- Ambulance services (varies by state — check your state's policy)
- Cosmetic surgery
- Physiotherapy, podiatry, and allied health (unless you have a Chronic Disease Management plan or are in hospital)
- Dental care (except CDBS for children)
- Glasses, contact lenses, and hearing aids
Medicare Online Account
Through your Medicare online account in myGov, you can:
- View your Safety Net balances and thresholds
- Track claim history and payment status
- Update bank account details
- Request replacement Medicare card
- View and update your Medicare details
This guide is updated for 2026. Check Services Australia website for latest rates.