BOOKING TRAVEL / HOW TO RECEIVE AUSTRALIAN MEDICARE
Claim Medicare benefits at your doctor's office
The fastest and easiest way to request is at the doctor's office as soon as you pay.
To do this, you need both:
-Enrolled in Medicare
-Show your Medicare card.
If your doctor pays in bulk, you don't need to pay.
When you pay at a doctor's office, ask if they can claim electronically for you. If they can, they will do it on the spot. We will process your complaint as soon as possible and pay your Medicare benefits on:
-The account for EFTPOS card you used to pay
-The bank account you have registered with us.
If we pay to your bank account, we need your exact details. Find out how to update your Medicare details.
If you pay with cash, we will pay your electronic money to the bank account you have registered with us.
Claim Medicare benefits online
If you cannot make a claim at your doctor's office, you can submit your Medicare claim online using:
-Your Medicare account online through myGov
-The Express Plus Medicare mobile app.
We cannot accept online requests for services older than 2 years.
Use your Medicare online account
If you do not have a myGov account linked to your Medicare online account, you will need to set them up.
We will pay your benefits to the bank account you have registered with us. You can register your bank details through your Medicare online account or Express Plus Medicare mobile app.
When you submit your request online, you will usually receive your benefits within 7 days.
You can read our online guide on how to update your bank details with your Medicare online account.
Use the Express Plus Medicare application
You can make a request with the Express Plus Medicare app on your mobile phone. Do not send a request if your doctor has done it for you.
To use the app, you need to have a myGov account linked to Medicare. If you do not already have these accounts, you will need to set them up.
Before you start your request, make sure you have both:
-Your account and receipt
-Details about the service you want to request.
Upon your request, we will ask you to provide us or confirm your bank account details.
When you make a request through the application, you will usually receive your benefits within 7 days. We pay electronically to the bank account you have registered with us.
Learn how to download the Express Plus Medicare mobile app.
Request Medicare benefits by mail
If you cannot ask for it at a doctor's office or online, you can ask by mail. To do this, fill out the Medicare claim form and send it to us. The address is on the form.
When you send your request in the mail, you will receive your benefits within 28 days. We pay electronically to the bank account you have registered with us.
Request Medicare benefits at the service center
You can also claim at a service center. When you do, we will pay you directly to your bank account. Therefore, it is important to ensure your bank details are correct. We will confirm your bank details when you make your request.
If you make a request at a service center, you will receive your benefits within 28 days. We pay electronically to the bank account you have registered with us.
Claim Medicare benefits for others
You can ask others if:
-Your name on your Medicare card
-You are managing their Medicare account.
When you ask someone to use your Medicare card, you can request one of the following:
- At the doctor's office
-Online
- By mail
-At a service center
If they are not on your card, you will need to register to manage someone else's Medicare account. You can then request by mail or at a service center. You cannot request online.
Repel
If we deny your request, we will let you know. Reasons why we may deny requests include:
-You or your doctor asked for it
-We need more details to evaluate your request
-There is a mistake with your request.
We may also deny a request if you have received the maximum allowable benefits for that service.
What is bulk invoice
Bulk payment means you don't have to pay for your medical services from a health professional. Instead, they bill us and they accept Medicare benefits as a full payment for the service. You assign benefits to them by:
-Sign the form
-Press OK on terminal c
Refuse EFTPOS after your appointment.
If you have more than 1 service at a time, you may not be billed in large quantities for everything.
Not all medical professionals bulk bill. You should check if you do when you have an appointment. To find a medical professional with a large bill, use the health services finder on the Healthdirect website.
You will need to pay for your appointment if your medical professional does not pay the bulk bill. You can claim this money back from us.
You may be billed in large quantities for a medical service if both:
-You have enrolled in Medicare
-Your health professional chooses the bill in bulk.
It's easy if you take your Medicare card or your number with you when you go to the doctor. Read how to replace a lost, stolen or damaged Medicare card.
What does the bulk invoice include
Bulk payments may include:
-Visit GP and bulk invoice expert
-Screen and scan as x-ray and pathology
-The eye exam is done by an ophthalmologist.
If you have a concession or health care card, you can get bulk payment services.
Example
Maya went to her GP to discuss some health concerns. While she was there, the GP advised her to get a flu shot and a blood test to check for iron levels.
Maya's GP has billed her. This means she did not have to pay for her appointment.
Maya had to pay for her flu vaccine. This is because we do not cover flu vaccines for most adults. Maya paid a total of $ 20 to pay for the flu vaccine.
Maya asked her family doctor, how much a blood test would cost. Maya did not have to pay for this test because the pathology lab tested the sample that selected the bulk invoice.
How to find GP bulk payment
Use the health services finder on the Healthdirect website to find a GP or bulk payment specialist near you.
Australians help pay for Medicare through 2 types of income taxes:
- Medicare taxes
- Medicare tax surcharge.
You can pay these amounts each year as part of your income tax.
medical care costs
The tax amount is about 2% of your taxable income. You pay taxes on top of the tax you pay on your taxable income.
Your Medicare tax amount may decrease if your taxable income is below a certain amount. In some cases, you may not have to pay this amount.
Read about Medicare tax payments on the Australian Taxation Office (ATO) website.
Who does not pay taxes
You may not pay taxes if you meet any of the following criteria:
-You are a temporary foreigner working in Australia
-You are not eligible for Medicare
-You have certain medical requirements
How to get a Medicare tax exemption
If you are not eligible for Medicare for all or part of the year, you can apply for a waiver. You do this as part of your tax return. An exemption means you do not have to pay Medicare taxes for all or part of the year.
You need a Medicare Benefits Statement to request a waiver. You need a statement for each year you want to be exempt.
You will need to tell the ATO that you have a statement when you file your income tax return. You need your statement before you can get started. Keep a statement for your records.
Medicare tax surcharge
You may incur additional charges if you:
- Earn on a certain income
-No appropriate private hospital insurance rates.
Read more about surcharges on the ATO website.
Discount on private health insurance
To make it easier to buy private health insurance, you may be able to get discounts on private health insurance.
The amount of your discount depends on your income and directly reduces your premium.
Most people claim a discount as a pre-discount on their health insurance premiums. If you do not do this, you can claim it as a tax offset on your annual income tax return.
Check if you can get discounts on private health insurance.
Medicare benefit tax report
We will no longer issue you a Medicare benefit tax statement.
You can read more about medical expenses on the ATO website.
See a doctor
If the doctor pays in bulk, we will pay for the cost and you will not need to pay it all.
If they do not pay in bulk, you will need to pay.
If your doctor does not pay the bulk bill, you will need to pay either:
-Total cost
-The difference between what they charge and what we include.
If you pay the full cost, you can make a claim for the amount we pay. Your doctor may also make a request on your behalf.
When you make an appointment, ask if they have a large bill. If they don't, you can ask them what they charge. You can also ask i them what you can get back from us.
Learn more about seeing a doctor.
Medicare safety net
If you have a lot of hospital expenses, the Medicare Safety Net can help control them. If your costs for the year reach a threshold, we will pay more than your costs. You can check what is your threshold.
If you are single and have no children, you do not need to register for a safety net. If you are a couple or have children, you need to register as a family.
You need to be enrolled in Medicare before you can use the safety net.
Take medicines
Some drugs can cost a lot of money. Benefits Scheme Pharmacy (PBS) subsidizes the cost of the drug for most medical conditions.
We have a concession card that can help you get health care and drugs for less. If you have a concession or health care card, you can get an extra discount for PBS medicines.
If you need a variety of medications, the PBS safety net can help reduce your costs. When you reach the yearly threshold, you pay less for the drugs you need. You can check what is your threshold. It is best to discuss the PBS Safety Net with your pharmacist so they can track your spending.
Go to the hospital
You can choose to be a public or private patient when you go to the hospital. As a public patient at a public hospital, you will not have to pay.
You will need to bring a valid Medicare card or number when you go to the hospital.
Find out more about going to the hospital.
Emergency examination
If you are going to an emergency as a public patient in a public hospital, your costs will be paid.
We do not include ambulance costs. Ambulance costs vary by state and territory. Some states and territories offer discounts for some or may cover costs for everyone. It is best to check. You can check the cost of an ambulance for the place you live on PrivateHealth.gov.au.
If your ambulance costs are not covered where you live, private health insurance may cover these costs. Read more about ambulance insurance on PrivateHealth.gov.au.
Surgery
If you are a public patient in a public hospital, you will not lose anything.
You may have costs if you are a private patient in a public or private hospital. You need to pay the difference between what we pay and your surgery costs.
Request a quote from your specialist before surgery. Your private health insurance may cover the costs. Talk to your insurance company before surgery to make sure you know what they cover.
Read more about private health insurance and Medicare to see what coverage is covered.
If there is an amount that your insurance company does not cover, talk to your specialist about payment options.
After care
Any aftercare needs are part of your surgery expenses. When you have surgery, the specialist will talk to you about your care needs.
Access to income support
If you are ill, injured or disabled and can only work for a limited number of hours, Centrelink can help. Use our payment finder and services to see if you can get Centrelink help.
What does insurance cover?
There are 2 types of private health insurance:
- Hospital insurance for things like accommodation and theater fees
-Including general treatment for services like dentistry and physiotherapy.
Many insurance companies offer a combination of hospital and general insurance. Most private health insurance allows you to:
-Choose your own surgeon or other specialist
-Handling in private hospital or private patient in public hospital.
Insurance companies can tell you what they will pay and how much they will pay. This will help you choose a level that suits your needs and budget.
You can read more about:
-What is private health insurance on the Ministry of Health website
-What insurance covers on the PrivateHealth.gov.au website.
You can still use our services even if you have private health insurance. For example, you might choose to go to a public hospital as a public patient.
Learn more about health care and Medicare.
What insurance does not cover
Private health insurance does not cover:
-Family doctor
-Some expert visits
-Visit a public or private hospital emergency department.
Unless you are a patient in a hospital, it does not include:
-Any X-ray or other scan
-Any blood test or other pathological test.
Medicare usually covers these. Read more about what Medicare pays.
How to save money with private health insurance
Discount on private health insurance
You may be reimbursed for what you pay for private health insurance if you:
-Make less than income threshold
-Have a high enough hospital coverage.
Your income must be within the threshold to receive a discount. It can:
-Reduce your premiums
-A tax offset on your income tax return.
Find out more about the Australian government's discount on private health insurance.
Use the private health insurance discount calculator to find out your discount amount on the Australian Tax Office website.
Private health insurance and taxes
You may also have to pay an additional fee compared to regular Medicare taxes if you:
-No private hospital insurance
- Rare to exceed income threshold.
You must pay this Medicare tax surcharge as part of your income tax.
Learn more about Medicare and taxes.
Lifetime health insurance
Australia's lifelong health insurance system can save you money if you:
-Get private hospital insurance before you turn 31
-Keep this cover private for the rest of your life.
If you had private hospital insurance before you were 31 years old, you would be eligible for lifetime health insurance. This means that you only pay the base rate on your insurance.
If you first get private hospital insurance after you are 31 years old, you will:
-Pay more 2% for each year over 31 years old when your insurance starts
-Continue to pay this higher rate for at least 10 years.
Example
James and Max are twins at age 41. James has had private hospital insurance since age 29. Max received it for the first time this year. Although he chose the same insurance company and the same level of insurance as James, he paid more for it. This is because James qualifies for a lifetime health insurance discount and Max does not. Max currently pays an additional 2% per year because he waited 10 years after turning 31 to receive private insurance.
Learn more about lifetime health insurance on PrivateHealth.gov.au.
How to get Medicare when you have private health insurance
If you have private health insurance, you can still use Medicare services.
Sometimes you can claim your Medicare benefits and use your private health insurance at the same time. For example, if you go to a public hospital as a private patient, you can ask:
-From us for the expenses we pay
-From your insurance company for some or all of the rest.
This means you will need requests from 2 places for the same bill. You will need to submit a Medicare claim form and a two-way Medicare claim form.
If you submit your form to us, we will transfer your share of your insurance company to them. If you submit your form to your insurance company, they will transfer our portion to us.
Learn more about how to file a complaint with Medicare Two-Way.
You can also use Medicare Two-way to ask for a treatment we don't pay for, like physical therapy, dentistry and optics.
Not all insurance companies offer Medicare Two-way. You will need to check with you. If you do not, you will need to file a complaint with us and with your insurance company.
Two-way Medicare
Making health claims easier, if you have private health insurance.
We pay your Medicare benefits using Electronic Funds Transfer (EFT). To pay you, we need your current bank details. We cannot pay you by check or cash.
We will keep your Medicare benefits if we do not have your bank details. We will write to you within 2 days of evaluating your request. We will tell you how to give us your bank details so we can pay you.
Remember that we only send you one letter. We will not write to you every time we hold your Medicare benefits.
How to give us your bank details
If we do not have your bank account details, you need to provide us. We need your BSB, account number and account name.
Follow the steps below to provide us with your bank details.
Online
Add your bank account details using:
-Your Medicare account online through myGov
-The Express Plus Medicare mobile app.
To add your bank details with your online Medicare account, follow these steps.
-Sign in to your Medicare account online through myGov.
-Choose Continue with online account.
-Select Bank details.
-Enter your bank details, then select Submit.
You can read our guide to help you add your bank details with your Medicare online account through myGov.
To add your bank details by application, follow these steps.
-Open the application and enter your 4-digit PIN.
-Select My Profile, on the main screen.
-Select Finance.
-Select Bank details, enter your bank details, then select Next.
If you are an app user for the first time, log in with your username and password
your myGov. This includes 2 letters and 6 numbers and can be found in your myGov account in Account Settings.
Complete a form
You can print and complete a bank account details form. Mail the form to the address on the form or bring it to a service center.
Visit or call us
Visit your nearest service center or call the general Medicare request line.
How to check if we have your bank details
You can check your bank account details with:
-A Medicare account online through myGov
-Express Plus Mobile Medicare app.
In your online account, select Bank details on the main page to view your details.
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