Understanding how Medicare (Australia) works – especially when it comes to GP visits, bulk‑billing and out‑of‑pocket or “gap” costs – is more important than ever. With rising healthcare costs and evolving policy incentives for bulk‑billing in 2025‑26, Australians face a changing landscape when they visit a doctor.
This article clarifies what patients should expect when they walk into a GP’s clinic in 2026: how much Medicare will cover, when a “gap fee” may apply, and how bulk‑billing works. It also explores current trends, looks ahead at where things are going and gives clear practical advice so that no one is caught by surprise at the doctor’s office.
What Medicare covers: GP fees, rebates & schedule fees
The “schedule fee” and Medicare benefit
Each medical service listed on the Medicare Benefits Schedule (MBS) has a schedule fee – an amount deemed reasonable for that service. Under Medicare, for a standard GP consultation the schedule fee may be paid in full as the Medicare benefit if the doctor chooses to accept it.
For GPs (non‑specialist, non‑hospital) the Medicare benefit typically covers 100% of the schedule fee when the doctor bulk bills.
What happens if the doctor does not bulk bill
If the doctor or practice does not bulk bill, then:
The patient pays the full fee set by the clinic.
Medicare reimburses the benefit amount.
The difference between what the doctor charges and what Medicare pays is the gap fee or out‑of‑pocket cost.
According to the Australian Institute of Health and Welfare (AIHW), the average out‑of‑pocket cost for a non‑bulk‑billed GP visit in recent data was around $43.
Bulk‑billing: what it means in practice
Bulk‑billing means the doctor bills Medicare directly and the patient pays nothing for that service – the Medicare benefit is accepted by the doctor as full payment.
However:
It is not mandatory. The clinic or GP chooses whether to bulk bill.
Even if one consultation is bulk‑billed, additional services (e.g., tests, procedures) may require payment.
Key takeaway: Always ask ahead: “Do your bulk bill for all patients or am I liable to pay a gap fee?”
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Trends, policy changes & what’s ahead in 2026
Recent bulk‑billing rates and out‑of‑pocket costs
The nationwide GP bulk‑billing rate rose steadily after Medicare’s inception but has declined since the peak in 2020. AIHW data shows a rate of around 78% in the first 10 months of 2024.
In non‑bulk‑billed visits the out‑of‑pocket cost is higher in remote areas ($49) versus major cities ($43) on average.
Government incentives and reforms
As part of the 2025‑26 Federal Budget, the government committed $7.9 billion to expand bulk‑billing and support GP practices.
Important changes include:
From 1 November 2025, bulk‑billing incentives will be extended to all Medicare‑eligible patients, not just children or concession card holders.
Launch of the Bulk Billing Practice Incentive Program, which provides practices an extra 12.5% payment on MBS benefits if they commit to bulk‑bill every patient.
These reforms aim for 9 in 10 GP visits to be bulk‑billed by 2030.
What this means for patients in 2026
In many cases, patients might pay nothing if they attend a practice that bulk bills all patients.
However, not all clinics will offer full bulk‑billing—even with incentives, uptake by practices may vary.
Clinics may increasingly favor shorter consultations or select patients if financially pressured—so checking ahead remains wise.
Understanding gap costs and what you may pay
What determines the fee you pay
If a practitioner does not bulk bill, factors influencing your fee include:
The clinic’s charged fee for consultation (often above the schedule fee).
Whether Medicare pays the full schedule fee (which it does for most GP attendances) or only part.
Whether you receive a Medicare benefit at the time or need to claim it later.
Typical costs and examples
One study found mean out‑of‑pocket costs for non‑bulk‑billed GP visits ranged between $16 and $99, varying by region and socio‑economic area.
According to reports, the average non‑bulk‑billed patient contribution rose to about $49.14 in the recent year.
Tips to minimize gap costs
Ask ahead: At booking, ask what the fee will be and whether the practice accepts your Medicare card for bulk billing.
Check eligibility for concessions: If you have a Health Care or Pensioner concession card, you may access bulk‑billing more easily.
Find a bulk billing clinic: Use tools like the Healthdirect Service Finder to locate clinics that match your preferences and billing model.
Frequently Asked Questions (FAQs)
Q: Is Medicare free for GP visits?
A: Not always. If a GP bulk bills you, the Medicare benefit covers the consultation, and you pay nothing. If not, you may need to pay a gap.
Q: Can anyone access bulk‑billing?
A: In principle yes, if you have a valid Medicare card. However, whether the practice chooses to bulk‑bill you or under what conditions is up to the clinic. From 1 Nov 2025, incentives expand to all Medicare cardholders.
Q: Why are some clinics still charging gap fees?
A: Bulk‑billing rebates may not cover the full operational cost of some clinics—especially smaller, rural or high‑overhead practices. Some doctors may choose to charge above the rebate, resulting in a gap.
Q: Does Medicare cover specialist or hospital costs under bulk‑billing?
A: Bulk‑billing is primarily for out‑of‑hospital services such as GP consults, tests etc. Specialists and private hospital care often involve additional costs beyond the Medicare schedule fee.
Q: What are clinics expected to do under the Bulk Billing Practice Incentive Program?
A: From the reform rollout, clinics that commit to bulk‑bill all non‑referred GP services and advertise this commitment may receive extra incentive payments (12.5% loading) on MBS benefits.
How to prepare for your next GP visit in 2026
Check your Medicare card: Ensure your details are up‑to‑date and the card is valid.
Ask at booking: “Is this appointment bulk‑billed? Will there be any out‑of‑pocket cost?”
Budget for gap: Even if the clinic is bulk‑billing, additional services (pathology, scan, procedure) may be charged separately.
Consider practice location: If living in a remote area, gap costs tend to be higher and bulk‑billing rates may vary.
Keep informed: With recent reforms entering effect, keep an eye on which clinics adopt full bulk‑billing and how your local practice adjusts.
Review your health insurance cover: If you often use specialists or need extra services not covered by Medicare, private insurance or extras may come into play.
Call to Action
Heading to the doctor soon? Before you book, check whether the practice bulk bills you and what, if any, gap you’ll pay. Share this article with friends or family who might not realize that not all GP visits are automatically free under Medicare. Subscribe for updates—health policy and funding are changing in 2026, so staying informed pays off.
Conclusion
In 2026, a visit to the GP under Medicare can mean anything from zero cost (if fully bulk‑billed) to a gap fee depending on the clinic’s billing model. Knowing how Medicare’s schedule fees, rebates and gap fees work empowers patients to make smart decisions and avoid unexpected expenses. With major policy reforms underway, more patients may access bulk‑billed care, but it remains essential to check each appointment ahead of time.
Ultimately, when it comes to GP fees, gap costs and bulk billing under Medicare, the power lies with the patient: be informed, ask the right questions, and plan for your healthcare needs accordingly.
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