Seeing a doctor in Australia: fees, referrals and Medicare (2026)
Plan your first appointment by checking three things: whether you can claim Medicare, what the clinic charges for your appointment, and what follow-up you need. A Medicare card does not mean every visit is free.
In this guide
Book the right appointment
Use Healthdirect’s service finder to locate a GP. Ask whether the clinic accepts new patients, whether your concern needs a longer appointment, and how to arrange an interpreter or accessible consultation. Walk-in availability varies; call first when practical.
Booking script: “I am a new patient with [Medicare/OSHC/OVHC/no cover]. What is the full fee for this appointment, is it bulk billed for me, and what rebate or insurer benefit can I claim? Are tests, procedures or forms charged separately?”
Understand the fee before the visit
Bulk billing means the provider accepts the Medicare benefit as full payment for that eligible service. Mixed billing means some appointments or patients are bulk billed and others pay fees. A private-billed visit may require the full amount upfront before a Medicare claim is processed.
Illustrative budget, not an MBS rate: if a clinic quotes $100 and confirms your benefit is $45, the gap is $55. Budget for $100 at the appointment unless the clinic confirms a different payment arrangement. Without Medicare, ask the insurer about the benefit for the actual service; domestic extras generally does not cover Medicare outpatient GP gaps.
Check what Medicare covers
Medicare helps with eligible medical services and public-patient treatment in public hospitals. Providers can charge above the benefit. Routine dental, glasses and ambulance are generally outside Medicare; separate programs or insurance may help. Routine eye tests are generally covered once every three years below age 65 and annually from age 65, with other item rules for clinical needs. Check Medicare coverage and exceptions.
Referrals and follow-up
A valid referral is generally needed for a Medicare rebate for specialist care. GP referrals usually last 12 months from the first specialist attendance, but different periods and exceptions apply. A specialist-to-specialist referral is usually three months. Ask the receiving practice to confirm the referral, appointment fee and expected benefit. A referral does not make a visit free. Services Australia’s referral rules.
Before leaving, ask who will contact you about test results, when to seek review, and who to call if symptoms change. If you change practices, arrange transfer of relevant records and a follow-up plan.
Urgent help and after-hours care
Call 000 for a life-threatening emergency. For health advice when you are unsure where to go, call Healthdirect 1800 022 222. Emergency departments prioritise clinical urgency. Do not delay emergency care to check a Medicare card or insurance; charges and eligibility can be sorted separately. For less urgent care, ask about your GP’s after-hours service or a nearby urgent care clinic. Healthdirect.
Prescriptions and PBS costs
Ask the prescriber or pharmacist whether your medicine and circumstances meet PBS requirements. In 2026 eligible general patients pay up to $25 for most PBS medicines and concession patients up to $7.70, before applicable premiums or other permitted charges. A private prescription or medicine outside PBS criteria can cost more. PBS co-payments and Safety Net.
Keep a medicine list with active ingredients, dose and allergies. For medicine brought from overseas, check TGA traveller rules before travelling; quantity, documentation and controlled-medicine rules matter.
Mental health care plans and costs
A GP can assess your needs and, where clinically appropriate for a diagnosed mental disorder, prepare a mental health treatment plan and referral. Eligible Better Access care can include up to 10 individual and 10 group services per calendar year, with review and referral requirements. The plan and therapy visits are not automatically free; ask each provider for its fee and benefit. Mental health care and Medicare.
Illustrative therapy budget: a $220 appointment less a confirmed $100 benefit leaves a $120 gap. These invented inputs show the calculation only, not a standard fee or current Medicare rebate. Support is also available through our mental health services guide.
Confirm telehealth eligibility
A Medicare card alone does not guarantee a rebate for a remote appointment. GP telehealth generally requires a qualifying face-to-face service with the practitioner or practice within the previous 12 months. From 1 November 2025, registration with the practice through MyMedicare provides an alternative pathway. Limited exemptions and item-specific conditions apply. Ask the practice to check eligibility, clinical suitability, phone/video rules and fees before booking. Current AskMBS telehealth guidance.
Bring a short appointment checklist
- Medicare details if enrolled, or your insurer and policy information
- A medicine and allergy list, relevant reports and vaccination history
- A clear description of symptoms, when they started, and your top questions
- Referral if the receiving provider needs one; payment method and interpreter arrangements
Write down the care plan, follow-up date and result-notification arrangements. Ask for an explanation if a cost or clinical instruction is unclear.
Frequently asked questions
Is a Medicare GP visit always free?
No. It is free for the eligible service if the provider bulk bills you. Otherwise ask for the full fee, Medicare benefit and gap.
Do I need a referral for a specialist?
Generally a valid referral is needed for a Medicare specialist rebate. Referral duration and exceptions depend on the circumstances; confirm with the receiving practice.
Does a mental health treatment plan give free therapy?
It can support Medicare benefits for eligible treatment, but clinicians set fees and a gap may remain. Ask the provider before booking.
Can I use Medicare for any online GP?
No. GP telehealth eligibility includes practitioner or practice relationship requirements, a MyMedicare pathway and limited exemptions. Check eligibility for the actual service.
What is the PBS medicine cap in 2026?
For eligible patients, most PBS medicines cost up to $25 for general patients or $7.70 for concession patients. Premiums and other permitted charges can be additional.
Source review: 1 October 2026. This is general navigation and decision support, not a diagnosis, an eligibility decision or a personalised insurance recommendation. Confirm your circumstances with the service or insurer before relying on cover.