Medicare Australia
Medicare Australia began as the Health Insurance Commission in 1974. It is a government agency within the Department of Human Services portfolio.Medicare Australia administers Medicare and a range of other government programs and services such as the Pharmaceutical Benefits Scheme (PBS), Australian Childhood Immunisation Register and Practice Incentives Program.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital; and
- free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only).
- ensuring Medicare benefits are paid to eligible health care consumers for services provided by eligible medical practitioners, and
- assessing and paying Medicare benefits for a range of medical services, whether provided in or out of hospital, based on a schedule of fees determined by the Australian Government Department of Health and Ageing (AGDHA) in consultation with professional bodies.
Medicare Benefits Schedule (MBS)
The Medicare Benefits Schedule (MBS) allocates each service an item number and provides item descriptors, fees (Medicare benefit) and explanatory notes to assist health professionals in delivering the service and to appropriately claim the Medicare benefit.All MBS item numbers and fees are uniform across Australia.
All Medicare benefits are based on the standard MBS fee for that service and not the fee determined by the individual health professional. All fees set above the MBS fee are at the patient expense, which is called ‘the gap’ or ‘co-payment’.
Reference: medicareaustralia.gov.au