When a GP bulk bills, Medicare pays the doctor directly and you pay nothing for the visit. When a GP privately bills, you pay the clinic’s fee, then Medicare pays part of it back to you. The difference between the fee and the Medicare rebate is your out-of-pocket cost, often called the gap.
Knowing which one applies before you book saves surprises at the front desk. If you are new to our clinic, read about new patient appointments in Gympie for what to bring and how your first visit works. This guide explains what bulk billing is, how private billing and the Medicare rebate work, and what Medicare does not cover.
What is bulk billing?
Bulk billing means your GP accepts the Medicare benefit as full payment for the consultation. The clinic claims the money from Medicare, and you do not pay anything on the day.
To be bulk billed you need:
- a valid Medicare card (or a Medicare number from the Express Plus Medicare app or myGov)
- a service that Medicare covers, such as a standard GP consultation
- a clinic that agrees to bulk bill you for that service
Bulk billing is a choice each clinic makes. Two clinics in the same town can have different billing policies, and one clinic may bulk bill some patients or services and charge for others.
What is private billing?
With private billing, the clinic sets its own fee for the consultation. You pay that fee, and Medicare gives you a rebate for the part it covers.
Most clinics can process your Medicare claim at the counter, so the rebate goes into your bank account within a day or two. For this to work, your bank details need to be registered with Medicare.
How the Medicare rebate and the gap fee work
Every Medicare service has a set amount listed in the Medicare Benefits Schedule (MBS). For GP visits outside hospital, Medicare pays 100% of that schedule fee as your rebate.
If the clinic’s fee is higher than the schedule fee, you pay the difference. A simple way to think about it:
Clinic fee − Medicare rebate = your gap (out-of-pocket cost)
The rebate depends on the type and length of the appointment. A longer consultation has a higher schedule fee than a short one, so both the fee and the rebate are higher. You can look up current schedule fees on MBS Online, the Australian Government’s Medicare Benefits Schedule website.
Bulk billing vs private billing at a glance
| Bulk billing | Private billing | |
|---|---|---|
| Who pays the GP | Medicare, directly | You pay the clinic |
| Cost to you on the day | Nothing | The full fee, then the rebate comes back |
| Medicare rebate | Goes straight to the clinic | Paid into your bank account |
| Out-of-pocket cost | None | The gap between the fee and the rebate |
| Who decides | The clinic | The clinic |
Does Medicare help if I have a lot of GP costs?
Yes. The Medicare Safety Net gives you a higher rebate once your out-of-pocket costs for out-of-hospital services, such as GP visits and tests, pass a set amount in a calendar year. Families and couples can register together so their costs count towards one total. Register through myGov or Services Australia.
What Medicare does not cover
Some GP services are not covered by Medicare at all, so you pay the full fee whether or not the clinic usually bulk bills. These include:
- medicals for a job, such as pre-employment medicals
- some licence medicals, for example a driver’s licence medical for a commercial licence
- reports and forms for insurance or legal purposes
- cosmetic treatments
- some vaccines that are not on the National Immunisation Program, such as most travel vaccines
Work injuries are different again. If you have an accepted WorkCover claim, the insurer usually pays for treatment instead of Medicare.
What about DVA, telehealth and visitors?
DVA card holders. If you have a Veteran Card, your GP can bill the Department of Veterans’ Affairs directly for covered services, so you do not pay.
Telehealth. Medicare covers many phone and video GP appointments. In most cases you need to have seen the same GP or clinic in person in the last 12 months, or be registered with the practice through MyMedicare. Read more about our telehealth appointments.
Visitors and people without Medicare. If you do not have a Medicare card, you pay the full fee. Visitors from some countries, including the United Kingdom, Ireland and New Zealand, can get Medicare-covered care for medically necessary treatment under a reciprocal health care agreement.
Questions to ask before your appointment
Billing policies change, so it is worth asking when you book:
- Will this appointment be bulk billed for me?
- If not, what is the fee, and what will the gap be after the Medicare rebate?
- Is a longer appointment charged differently?
- Will any procedure, dressing or test have an extra cost?
At Gympie Day and Evening Clinic, reception can answer these before you come in. Call (07) 2140 4888 or book online. We are open 7 days, with appointments until 9pm on weeknights.
Frequently asked questions
For you, a bulk billed visit has no cost on the day. The visit is still paid for, by Medicare, which is funded through taxes and the Medicare levy.
Yes. Each clinic sets its own policy. Some bulk bill everyone with a Medicare card, others bulk bill only children, concession card holders or certain services.
If the clinic claims your rebate at the counter and your bank details are registered with Medicare, it usually reaches your account within one or two business days.
No. You can still see a GP, but without a valid Medicare card you pay the full fee and cannot claim a rebate.
A gap fee is the difference between what the clinic charges and what Medicare pays back to you. It is your out-of-pocket cost for the visit.
Sources: Services Australia, Department of Health, Disability and Ageing, MBS Online, Healthdirect, Department of Veterans’ Affairs
This article is general information about Medicare and GP billing in Australia. Fees and eligibility can change. Check with the clinic and Services Australia for your own situation.