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Bulk Billing In Australia: What Is It And Who Can Qualify

    Smiling african american female doctor talking to teen patient making notes in clipboard listening to black kid school teenage girl tell complaints fill form at medical clinic checkup appointment.

    When you receive healthcare services in Australia, you can either be bulk billed or given a patient account. When you’re bulk billed, it means you don’t need to pay for the services received out of pocket. Instead of paying a fee, your healthcare provider will accept as full payment the rates provided in Medicare Benefits Schedule (MBS). They’ll then bill the government directly through Medicare. It’s called bulk billing because your healthcare provider will bill Medicare with a bulk bill at a given time for services offered to various patients. Check out this medical billing outsourcing services.

    You can also be bulk billed when you receive online healthcare services. All you need to do is download the Doctor AI App and get a free online doctor in Australia. The online doctor will issue an e-prescription, medical certificate, or referral after consultation. The same will be sent to your email immediately after the consultation.

    What Is Gap Payment?

    When you aren’t bulk billed, you’ll be incurred fees through a patient account. It’s when the provider charges you and you make a partial claim through Medicare. A portion you can’t claim is called gap payment or out of pocket.

    How Is Bulk Billing Determined?

    The Australian government sets what it deems a fair fee for each medical service, and the rebate you receive is determined by the Medical Schedule Fee:

    • 100% – consultation with a GP
    • 85% – all out-of-hospital services given by a medical practitioner
    • 75% – in-hospital services received as a private patient 

    You should note that fees charged by healthcare providers aren’t set by the Medical Schedule Fee and they’re at liberty to set their own fees for services provided. In such an instance, you can claim a partial rebate from Medicare or pay a gap payment for services received.

    What Does Bulk Billing Cover?

    Bulk billing covers a number of health services as listed in the MBS. The healthcare provider, however, has the discretion to choose the services that’ll be bulk billed and will receive a standard proportion of the scheduled fee. This method is convenient for healthcare providers because they receive their fees without the risks and costs of collecting a debt.

    You may need to check with your healthcare provider if you’re eligible for bulk billing for the services sought before accessing services. The MBS covers a variety of medical services, consultations, and procedures inclusive of:

    • Surgical and therapeutic procedures done by doctors
    • Doctors’ and specialists’ consultation fees
    • Eye tests by optometrists
    • Tests and examinations that require diagnosis such as X-rays, ultrasounds, and pathology tests
    • Specific dental covered by cleft lip and palate scheme
    • Surgical dental procedures are done by approved dentists
    • Psychologist consultations
    • Specific health services to help manage chronic diseases and services for patients with terminal illnesses

    Medicare, however, doesn’t cover ambulance services, examination for life insurance, dental examinations and treatment, or glasses and contact lenses, to name a few.

    Who Qualifies For Bulk Billing?

    Healthcare providers offer different packages of bulk-billed treatment and services. Some bulk bill all patients without considering their ages, income, or situations while others only bulk bill on certain days or after business hours. Some even bulk bill on services offered at home.

    All patients who’ve enrolled with Medicare under the bulk billing program or are under 16 years are eligible for bulk billing. However, Medicare, with the intention of increasing bulk billing rates in Australia, provides additional payment to healthcare providers if they bulk bill people who hold:

    • Pensioner Concession Card
    • Foster Care Card
    • Ex-Carer Allowance Health Care Card
    • Pensioner Card
    • Health Care Card
    • Commonwealth Seniors Health Card
    • Low Income Health Care Card

    Is Every Visit Bulk Billed?

    As long as the services you seek fall under the services that are bulk billed in the facility you attend, you’ll be bulk billed. For services that aren’t bulk billed, you may have to pay out of pocket using the patient account and claim through the Medicare rebate program.


    When seeking healthcare services, it’d be imperative to enquire with your healthcare provider if your appointment will be bulk billed before receiving healthcare services. Doing so will enable you to make informed decisions. Let your health care provider also know beforehand if you hold any of the cards that qualify you for bulk billing under Medicare. As a rule of thumb, always make an informed decision about the program.

    For treatments and services that don’t fall under Medicare bulk billing, you may want to try getting private health insurance that suits you and your loved ones. Consider the ideas mentioned here as you plan and prepare.