Medicare Explained for Australians Over 60: What You Need to Know

Most Australians have used Medicare their whole adult lives, but as you move into your 60s and beyond, the way you interact with the system tends to change. You see GPs more often, you start dealing with specialists, you might need surgery, and the costs of medications begin to add up. Suddenly, things you barely thought about — bulk billing, the Medicare Safety Net, the PBS — become very relevant.

This guide is a calm, plain-English overview of how Medicare works for older Australians in 2026, what it covers, what it doesn't, and the small things that can save you a surprising amount of money.

What Medicare Actually Is

Medicare is Australia's universal public health system. Through Medicare, the federal government pays for or contributes towards a wide range of medical services — visits to GPs and specialists, blood tests, scans, surgery in public hospitals, and many other health services.

It is funded primarily through general taxation and a Medicare Levy of 2% on most taxpayers' incomes. By the time you reach pension age, you have already paid into Medicare for most of your working life. Now is the time it is meant to repay that investment.

You access Medicare with your Medicare card. Anyone enrolled is entitled to use the system, and the card itself is free.

The Three Things Medicare Covers Best

It helps to break Medicare down into three big categories:

1. GP and specialist visits. Medicare pays a set rebate for each consultation. If your GP "bulk bills," they accept the Medicare rebate as full payment, and you pay nothing. If they don't bulk bill, you pay the full fee and Medicare reimburses you the rebate amount, leaving a "gap" for you to cover.

2. Tests and scans. Pathology (blood tests, urine tests) and diagnostic imaging (X-rays, ultrasounds, CT scans, MRIs) are usually partially or fully covered. Many pathology providers bulk bill seniors, but radiology often involves a gap fee, particularly for newer types of imaging.

3. Public hospital treatment. As a public patient in a public hospital, your treatment is fully covered by Medicare. You don't choose your doctor, but the standard of care is generally excellent. You can also choose to be treated as a private patient in a public hospital using your private health insurance, which gives you more choice of doctor.

What Medicare Doesn't Cover

This is where many older Australians get caught out. Medicare doesn't cover everything you might think it does. The main gaps include:

• Most dental care (except for some children and limited public dental schemes)
• Optical care — eye tests are generally covered, but glasses and contact lenses are not
• Most physiotherapy, podiatry, dietitian, and other allied health visits, except under specific care plans
• Hearing aids (though there is a separate government program for eligible people — see below)
• Cosmetic surgery and most elective non-clinical procedures
• Ambulance services in most states (a major surprise to many)

This is why many older Australians take out private health insurance, particularly extras cover for things like dental and optical, and hospital cover for choice of doctor and shorter wait times.

The Medicare Safety Net

This is one of the most important — and most underused — features of Medicare for older Australians. Once your out-of-pocket costs for Medicare-covered services in a calendar year reach a certain threshold, Medicare starts paying a higher rebate, meaning your out-of-pocket costs go down for the rest of the year.

There are two thresholds:

• The Original Medicare Safety Net lowers the gap once your out-of-pocket costs reach a fairly modest threshold.
• The Extended Medicare Safety Net (EMSN) kicks in at a higher threshold and provides much more substantial relief, particularly for people seeing specialists frequently.

If you are a concession card holder (Pensioner Concession Card, Commonwealth Seniors Health Card, Health Care Card), the threshold is lower than for the general public.

The Safety Net is calculated automatically. You don't need to apply, but you do need to be registered as a family if you want costs combined with a partner's. It is well worth checking your registration if you and your partner share medical expenses.

The Pharmaceutical Benefits Scheme (PBS)

Alongside Medicare sits the PBS — the Pharmaceutical Benefits Scheme. The PBS is what makes thousands of prescription medications affordable in Australia.

When you fill a PBS prescription at your pharmacy, you pay a heavily subsidised price (the "co-payment"), and the government pays the rest. As of 2026, the standard co-payment is around $31.60 per script, and the concessional co-payment for pension and concession card holders is just $7.70.

If you take regular medications, this difference matters enormously. Many older Australians are on three, four, or five regular scripts a month. The concession rate can save you well over $1,000 a year compared to standard rates.

There is also a PBS Safety Net. Once your spending on PBS medications passes a yearly threshold, the price drops further — concession card holders get their medications free for the rest of the calendar year, and general patients pay the concession rate.

What Changes at 65 and 70

Medicare itself doesn't suddenly change at 65 or 70, but the way you use it tends to shift. A few things worth knowing:

• Annual health assessments are available through your GP and are funded by Medicare for people aged 75 and over. This is a longer, more thorough check-up than a regular GP visit.
• Care plans for chronic conditions can give you Medicare-funded access to allied health services (physio, podiatry, dietetics) — limited in number per year, but valuable.
• Mental health care plans are also Medicare-funded and worth knowing about. Mental health is just as important in retirement as in any other life stage.
• Telehealth consultations — phone or video calls with your GP — have become a permanent part of Medicare and are particularly useful if mobility is an issue.

Concession Cards and Medicare

If you are over 60, your access to discounted Medicare and PBS services is closely linked to which concession card you hold:

• Pensioner Concession Card (PCC) — issued automatically if you receive the Age Pension or certain other Centrelink payments.
• Commonwealth Seniors Health Card (CSHC) — for self-funded retirees over Age Pension age who don't qualify for the Age Pension but meet a (relatively generous) income test.
• Health Care Card — for people on lower-paid Centrelink payments.

All three give you cheaper PBS medications. The first two also give you the lower Safety Net thresholds and access to additional state-based concessions.

If you don't have any of these cards, check your eligibility — particularly for the Commonwealth Seniors Health Card, which many self-funded retirees are eligible for but never apply for.

Hearing, Glasses, and Dental

These are the three areas where Medicare leaves the biggest gaps for older Australians.

Hearing. The Australian Government Hearing Services Program provides subsidised hearing services and devices to eligible older Australians, particularly Pensioner Concession Card holders. This is run separately from Medicare but is a significant entitlement.

Glasses and eye care. Medicare covers a comprehensive eye exam, usually free, with an optometrist who bulk bills. Glasses and contact lenses are not covered, but private extras cover and some state pensioner schemes can help.

Dental. This is the biggest gap. There is no general adult Medicare dental coverage. Public dental services exist in every state for concession card holders, but waiting lists can be long. Private health extras cover, dental savings plans, and bulk-billing dental schools (for non-urgent work) are the main alternatives.

A Few Practical Tips

A few things that experienced patients learn over time:

• Ask if your GP bulk bills. Many GPs bulk bill pensioners and Commonwealth Seniors Health Card holders even if they don't bulk bill the general public.
• Ask about the gap fee before a specialist appointment. The difference between specialists for the same procedure can be hundreds of dollars.
• Use the Medicare app. It shows your claims history, lets you track Safety Net progress, and updates your details easily.
• Register for a My Health Record if you haven't already. It gives every doctor you see access to your medical history, allergies, and medications.

The Bottom Line

Medicare is one of Australia's great public institutions, and as an older Australian you are now well-placed to make the most of it. The key things to know are: bulk billing matters, the Safety Net thresholds are lower for concession card holders, the PBS dramatically reduces medication costs, and the gaps in dental, hearing, and optical are real and need separate planning.

If you have not reviewed your healthcare arrangements recently — your concession card, your private health cover, your regular GP, your specialists — your 60s is a good decade to do so. A small amount of planning here can make a real difference to your health, your stress levels, and your bank balance.

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This article provides general information and is not medical or financial advice. For your personal situation, speak to your GP, a registered specialist, or a qualified financial adviser. For Medicare and PBS specifics, see Services Australia.