Medicare for Seniors: What's Covered and How to Save on Health Costs

Medicare is one of the most valuable supports for older Australians. But many seniors miss out on benefits simply because they don't know what's covered. This guide explains the basics and shows you how to keep your health costs as low as possible.

What does Medicare cover?

Medicare covers most of the cost for:

• Visits to the doctor (GP)
• Tests and scans your doctor orders
• Most surgery and procedures in public hospitals
• Eye tests by an optometrist
• Some mental health services
• Many prescription medicines (through PBS)

Medicare does NOT cover most dental work, glasses, hearing aids, physiotherapy, or ambulance services in most states.

What is bulk billing?

Bulk billing means the doctor charges Medicare directly. You pay nothing. Many GP clinics bulk bill seniors automatically, especially if you have a Pensioner Concession Card or Commonwealth Seniors Health Card.

Tip: Always ask before booking: "Do you bulk bill pensioners?" If they say no, try another clinic nearby.

The Medicare Safety Net

If you spend a lot on medical care in one year, Medicare pays back more once you reach a yearly limit. This is called the Safety Net.

In 2026, the thresholds are:

• Concession card holders: $834.50 in out-of-pocket costs
• Other singles and families: $2,615.50

Once you reach the limit, Medicare covers up to 80% of further out-of-pocket costs for the rest of the calendar year.

PBS: Cheaper prescriptions

The Pharmaceutical Benefits Scheme (PBS) makes most prescription medicines cheaper. If you have a concession card:

• Each prescription costs only $7.70 (instead of $31.60)
• After spending $277.20 in a year, prescriptions become free for the rest of the year (PBS Safety Net)

Should I get private health insurance?

Private health insurance can help cover things Medicare doesn't, like dental, glasses, and faster access to surgery. But for many seniors on a tight budget, the public Medicare system is enough.

Consider private health if:

• You want to avoid long waits for elective surgery
• You need regular dental, glasses, or hearing aids
• You can comfortably afford the monthly premium

Tips to save on health costs

• Always show your concession card at the doctor and pharmacy.
• Keep all your receipts so Medicare can track your Safety Net total.
• Ask for the generic version of your medicine. It works the same and costs less.
• Use My Health Record to keep all your medical information in one safe place.
• Get free annual health checks from your GP if you're 75 or older.

Need help?

Call Medicare on 132 011 for general questions. For PBS questions, call 1800 020 613. Both lines are free from any phone.

Knowing how Medicare works can save you hundreds of dollars a year. Take a few minutes to check your card, your bulk billing options, and your Safety Net progress. It really adds up.