What is Medicare and how does it work?
Once you leave the ADF, Medicare supports access to public hospital care and subsidised medical services.
Every health service that Medicare funds is itemised in the Medicare Benefits Schedule (MBS). This enormous list defines the fee that Medicare sets for a service. Medicare will then contribute a percentage of the relevant fee for itemised medical treatment.
When you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for service provided by a specialist. You will have to pay the gap between the Medicare rebate and the doctor’s charge, which is often higher than the MBS fee.
Registering for Medicare early and finding a local GP are important first steps after transition.
Medicare helps cover
Medicare helps pay for:
- Public hospital treatment as a public patient
- GP consultations
- Specialist services (with a referral)
- Diagnostic tests such as blood tests and x-rays (Up to 85% of the MBS fee)
- Subsidised prescription medicines through the Pharmaceutical Benefits Scheme (PBS)
What Medicare doesn't usually cover
Medicare does not usually cover:
- Dental care
- other allied health services such as physiotherapy
- Glasses and contact lenses
- Ambulance services
This means many people have out-of-pocket costs for everyday health care.
Pharmacy medication
You need a prescription from your doctor to purchase prescription medicine.
With a Medicare card, many prescription medicines are subsidised through the Pharmaceutical Benefits Scheme (PBS). If you’re eligible for the Repatriation Pharmaceutical Benefits Scheme, you may have access to a wider range of subsidised medicines.
PBS medicines usually involve a co-payment. You pay part of the cost and the government subsidises the rest. Co-payment amounts are set by the government and are reviewed each year.
If you or your family have high prescription medicine costs, the PBS safety net(s) may reduce what you pay once you reach a set threshold. Your pharmacist can help you keep track of your prescriptions.
If a medicine is not listed on the PBS, you’ll usually need to pay the full cost. In some cases, extras cover may help with the cost of non-PBS medicines.
Your pharmacist may also offer a generic brand of your medicine. Generic medicines contain the same active ingredients and work the same way as brand-name medicines, but often cost less.
Registering for Medicare
If you don’t already have a Medicare card, register as early as possible through Services Australia.
Next steps
- Register for Medicare
- Learn how DVA support fits
- Understand your private health insurance requirements and options
Transition Newsletter
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