Medicare gives Australian residents access to health care. It is partly funded by taxpayers who pay a Medicare levy of 2% of their taxable income.
Your Medicare levy is reduced if your taxable income is below a certain threshold. In some cases you may not have to pay the levy at all.
If you don't have private hospital health insurance, you may have to pay the Medicare levy surcharge (MLS) in addition to the Medicare levy. This depends on your income for MLS purposes.
If you do have an appropriate level of private hospital health insurance, you won't have to pay the MLS, and depending on your income you may be eligible for the private health insurance rebate. This rebate is an amount the government contributes towards the cost of your private hospital health insurance premiums.
The Medicare levy and MLS and any reductions are calculated from information provided in your tax return.
Medicare provides access to a range of medical services; lower cost prescriptions and free care as a public patient in a public hospital. All eligible Australian residents and certain categories of visitors to Australia can enroll in Medicare and access these services. We administer Medicare and pay Medicare benefits on behalf of the Department of Health, which is responsible for developing Medicare policy.
If you are eligible, Medicare covers:
- Free or subsidised treatment by health professionals such as doctors, specialists, optometrists, and in specific circumstances, dentists, and other allied health practitioners
- Free treatment and accommodation for public Medicare patients in a public hospital
- 75% of the Medicare Schedule fee for services and procedures if you are a private patient in a public or private hospital - this does not include hospital accommodation and items such as theatre fees and medicines
- Healthcare professional consultations
- Blood tests
- CT scans
- Pap smears
- Tissue biopsies
We pay Medicare benefits in accordance with the legislation governing Medicare and we are not able to pay benefits outside of this legislation.
The Medicare Benefits Schedule (MBS) lists services that are subsidised by the Australian Government under Medicare. Check if a service is listed under Medicare on the Department of Health MBS Online website.
Medicare Safety Net
For high out of hospital medical expenses the Medicare Safety Net provides higher benefits to individuals, couples and families. Eligible out of pocket expenses are added up and when you reach a Medicare Safety Net threshold you will receive a higher benefit on eligible services for the rest of the calendar year.
If you see a doctor often, or have tests regularly, your medical costs could be high. Visiting a doctor or having tests may cost you less once you reach a Medicare Safety Net threshold.
Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year. This may mean that visits to your doctor or having tests could cost you less. For example, once you reach the relevant threshold, you still pay the same amount upfront to your doctor, however you may receive a higher Medicare benefit, making your out of pocket expenses much less.
Confirming who is in your family
If your family is close to reaching a Medicare Safety Net threshold, we will ask you to confirm the members of your Medicare Safety Net family for that year. Confirming your details allows us to check your family's eligibility for higher Medicare benefits.
The Medicare Safety Net covers a range of out of hospital doctor visits and tests covered by the Medicare Benefits Schedule.
If a service is not in the Medicare Benefits Schedule it does not count towards the Medicare Safety Net. If you have surgery, see a doctor or have tests while you are in hospital, these services don't count towards the Medicare Safety Net.
Keeping a tally of medical expenses
If you pay your doctor before claiming your Medicare benefit, we'll automatically keep a tally of your out of pocket medical expenses.
If you claim from us before paying your doctor:
- We will send you a cheque made payable to the doctor, which you take or send to your doctor with any outstanding balance you owe
- Bring us the doctor's receipt and the Medicare statement you received with our cheque and we will add your out of pocket amount to your Medicare Safety Net balance
- We will contact you when you are nearing a Medicare Safety Net threshold and may ask you to verify any unpaid claims
If you only pay the gap amount to the doctor we usually add your out of pocket amount to your Medicare Safety Net threshold for you.
Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year.
Medicare Safety Net for families
Couples and families need to register as a Medicare Safety Net family, even if you are all on the same Medicare card, in order for us to keep a total of the medical expenses you have as a family.
For Medicare Safety Net purposes, a family consists of:
- A couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children
- A single person with dependent children
A dependant is someone who the family contact or spouse supports financially and is either a:
- Child dependant aged under 16 years, or
- Student dependant aged between 16 and 25 who is in full time education
Dependants who are members of 2 families
Dependants may be a member of 2 Medicare Safety Net families, for example because of separation or divorce. The out of pocket medical expenses will count towards the Medicare Safety Net of the family whose Medicare card is used to claim the Medicare benefit. Only the family that pays the cost of the medical service receives the Medicare benefit.
Extended benefit cap
An Extended Medicare Safety Net benefit cap is the maximum amount you can get back under the Medicare Safety Net for some out of hospital Medicare services. Not all Medicare items have a benefit cap.
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