Medicare is supposed to make seeing a doctor affordable. But between rebates, gap fees, bulk billing, and out-of-pocket costs, it can be confusing to know what you're actually paying — and why. Here's the plain-English version.
How Medicare works for GP visits
When you visit a GP, the consultation is listed on the Medicare Benefits Schedule (MBS) with a specific "schedule fee." Medicare pays a rebate equal to 100% of the schedule fee for GP consultations (unlike specialists, where Medicare covers 85%). The GP can then choose to either accept the Medicare rebate as full payment (this is bulk billing — you pay nothing) or charge their own fee, which can be higher than the schedule fee (you pay the difference — the "gap").
What's a gap fee?
The gap is the difference between what the GP charges and what Medicare rebates. For example, if the schedule fee for a standard consultation is $41.40 and Medicare rebates that amount, but the GP charges $80, you pay a $38.60 gap. The GP sets their own fees — there's no cap on what they can charge. National average out-of-pocket costs for a non-bulk-billed GP visit were around $43 in 2024, but this varies enormously by location and practice.
What you need
To claim Medicare benefits, you need a Medicare card. Australian citizens, permanent residents, and some visa holders are eligible. If you're on a temporary visa, check whether your country has a Reciprocal Health Care Agreement with Australia — citizens of the UK, Ireland, New Zealand, and several other countries can access Medicare during their stay.
Keep your Medicare details up to date. If you've moved, changed banks, or had a baby, update your details through myGov or by calling Medicare on 132 011.
How claiming works
If your GP bulk bills, you don't need to do anything — the practice claims directly from Medicare. If you pay a gap, you can claim your rebate through the Medicare app or myGov (usually processed within a day), at a Medicare service centre, or through your private health insurer if you have extras cover that includes GP gaps (rare, but some policies offer it). Many practices now offer "easyclaim" at the front desk — you swipe your Medicare card and the rebate is processed immediately.
Private health insurance and GP visits
Private health insurance generally does not cover GP visits. Medicare is the system that subsidises GP care. Private health insurance covers hospital treatment (as an alternative to the public system) and "extras" like dental, optical, and physio. A small number of extras policies include a limited benefit for GP gap fees, but this is uncommon. Don't assume your private health insurance covers the GP — it almost certainly doesn't.
The Medicare Safety Net
If your out-of-pocket costs for Medicare services add up over a calendar year, the Medicare Safety Net kicks in and increases your rebate for the rest of the year. There are two thresholds: the Original Medicare Safety Net (lower, covers everyone) and the Extended Medicare Safety Net (higher, with greater rebates). Commonwealth concession card holders and families receiving Family Tax Benefit Part A have a lower threshold. Once you hit the threshold, Medicare covers a higher percentage of the schedule fee for all out-of-hospital services for the rest of the year.
Bottom line
If your GP bulk bills, you pay nothing. If they don't, you pay the gap between their fee and the Medicare rebate. The gap varies by practice — it could be $20 or $80. Always ask about fees when you book. And if you're looking for a GP near you, search GPScout by suburb or postcode to see what's available in your area.