Medicare information for health professionals

Important information for accessing Medicare as a health professional.

National health care

The national health care funding system gives eligible Australian residents access to health care at an affordable cost or no cost.

The health care system includes a mixture of public and private sector health services.

The Australian Government's health funding is made up of 3 major national subsidy schemes:

  • Medicare, Australia's key health care program
  • the Pharmaceutical Benefits Scheme (PBS)
  • the Australian Government rebate on private health insurance.

Medicare and the PBS cover eligible Australian residents and subsidise their payments for private medical services and most prescription medicine.

The Australian Government rebate on private health insurance helps people to choose and keep private health insurance.

Medicare

Medicare provides access to free or subsidised treatment by health professionals such as:

  • doctors
  • specialists
  • optometrists
  • dentists
  • other allied health professionals.

Medicare also provides access to 75% of the Medicare Schedule fee for services and procedures if you’re a private patient in a public or private hospital. This doesn’t include hospital accommodation and items such as theatre fees and medicines.

Federal, state or territory and local government responsibilities

The Australian Government has the primary role of developing national policies, regulations and administer funding.

The Australian Government and state and territory governments mutually fund Australia’s public hospital system.

State, territory, and local governments are responsible for delivering and managing public health services and for maintaining direct relationships with most health care providers. This includes regulating health professionals and private hospitals.

How we work with the Department of Health

We work in partnership with the Department of Health (Health) to achieve the Australian Government's health policy objectives.

We make payments for services provided by eligible health professionals under Medicare, the PBS and other programs, such as the Australian Immunisation Register.

Health is responsible for the policy development of the Medicare program and the Medicare Benefits Schedule (MBS).

We are responsible for administering the Medicare program on behalf of Health. This includes registering details for health professionals eligible to have Medicare benefits paid for their services.

Working as a health professional in Australia

To work as a health professional in Australia, you must meet eligibility requirements for your health profession.

You also need to have a Medicare provider number for every practice location.

A Medicare provider number lets you:

  • refer patients to specialists
  • imaging or pathology services
  • claim or bill Medicare services.

A Medicare provider number doesn’t automatically let you get Medicare benefits for your services.

If you meet legislative requirements, you can use a provider number to access Medicare benefits for the services you provide to eligible private patients.

Eligibility to access Medicare benefits is determined by the Health Insurance Act 1973 (the Act) and related regulations. You can read the Act on the Federal Register of Legislation website.

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Page last updated: 16 June 2021