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Medicare

Medicare is run by the Australian Government and is funded by Australian tax payers. Medicare provides Australians with access to free or low-cost public healthcare and the ability to claim some medical expenses.

Medicare Benefit Schedule changes

There have been some recent changes to the Medicare Benefits Schedule (MBS). These changes do not affect your nib policy.

Read our FAQs for more information. 

So why get private health insurance?

Private health insurance aims to fill the gaps in Medicare and for many, it’s about minimising the time you may have to sit on a public hospital waiting list. As a public patient you will have limited choice in the doctor that treats you or the hospital you are treated at. Unless your condition is considered life threatening, you might have to wait in the queue to be treated which could leave you waiting months for treatment.

Median day wait^
Tonsil removal122
Hip replacement119
Coronary bypass surgery17
Knee replacement198

^Source: Australian Institute of Health and Welfare, Elective surgery waiting times 2017 - 2018: Australian hospital statistics. Waiting times at the 50th percentile. Report dated December 2018.

As a public patient, if you choose to go to a private hospital without the right level of private health insurance, it could cost you thousands and, in some cases, you may need to pay upfront.

Extras cover also helps cover the cost for services that generally aren’t covered by Medicare such as a visit to the dentist, a new pair of glasses or rehab with a physio.

nib helps you afford the private hospital treatment you want

Private health insurance helps you avoid public hospital waiting lists, pays benefits toward the cost of private treatment and also allows you to (subject to availability):

Frequently Asked Questions

Q: Who is covered by Medicare?

A: Medicare covers people residing in Australia who are Australian citizens, New Zealand citizens or holders of permanent visas. Some visitors and temporary residents, from countries with which Australia has made reciprocal healthcare agreements, are eligible for Medicare with some restrictions - visit Medicare Australia for more information.

Q: Do I need private health insurance if I have Medicare?

A: Private health insurance aims to fill in the gaps in Medicare, covering the costs of services not covered, and minimising the time you have to sit on a public hospital waiting list. Head to What’s the difference between private health insurance and Medicare to find out more.

Q:What funds do I contribute to Medicare?

A: Australian taxpayers contribute a Medicare Levy of 1.5% of their taxable income. The Medicare Levy Surcharge is an additional 1% in tax that you may have to pay if your annual taxable income is above the Medicare Levy Surcharge thresholds and you do not have an appropriate level of private hospital cover.

Q:What is covered by Medicare?

A: Benefits covered by Medicare include:

  • A stay in a public hospital as a public patient.

  • Part of the cost of pharmaceutical prescriptions, through the Pharmaceutical Benefits Scheme.

  • Part of the cost of GP and specialist consultants through the Medicare Benefits Schedule.

  • Part or whole consultation fees for doctors, including specialists.

  • Part or the whole cost of tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests.

  • Part or the whole cost of eye tests - undertaken by optometrists.

  • Part or the whole cost of psychology services - you must be referred by your GP, psychiatrist or paediatrician to receive the benefits.

Q: What is not usually covered by Medicare?

A: Items not usually covered by Medicare include:

  • Private patient hospital costs (for example, theatre fees or accommodation)

  • Dental examinations and treatment

  • Ambulance services

  • Glasses and contact lenses

  • Home nursing

  • Physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry

  • Psychology services (unless as part of an agreed procedure referred by your GP, psychiatrist or paediatrician)

  • Acupuncture (unless part of a doctor's consultation)

Q: What is the Medicare Benefits Schedule?

A: The Medicare Benefits Schedule (MBS) is a list of medical procedures, consultations and tests that are recognised by Medicare for a benefit. Each item on the MBS has its own Schedule Fee and is set by the Commonwealth Government. If a treatment isn’t listed on the MBS, there’s a good chance we won’t be able to help you cover the cost of it.

Q: What are the changes to the Medicare Benefits Schedule?  

A: The Australian Government has announced changes to more than 900 items on the Medicare Benefits Schedule (MBS) following an extensive review by the MBS Review taskforce. These changes are effective 1 July 2021, and  are designed to support Australians in continuing to receive high quality care in line with current best medical practice.  

 These changes will provide greater consistency across procedures for both members and providers, helping members to avoid unnecessary treatment and reduce any unexpected out of pocket costs. 

Learn more about why the Australian Government is making changes to the MBS on their website

Q: What does that mean for me? 

A: There won’t be any impact to your nib policy as a result of these changes. However, we will be updating our systems and MediGap Schedule to reflect these changes.  

If you have a surgery or treatment scheduled after 1 July 2021, we encourage you to ask your specialist or medical provider for a written breakdown of expected costs or identify any out of pocket expenses. This is known as informed financial consent.   

If you make a claim for a treatment included in your cover and the item number is invalid, contact your provider and ask for a new item number which is included in the new MBS changes. 

For more information about the MBS changes or help with your cover, please contact us.  

More information

For more information about Australia’s healthcare system, visit the Department of Health and Ageing and Medicare Australia website.

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