Medicare — Universal Healthcare in Western Australia
Reviewed by the Commoner Law Editorial Team. Sourced from Commonwealth Acts of Parliament, federal regulations, and official government guidance. State-level information reflects each state's own Acts and court decisions. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards
What is this right?
Medicare is Australia's universal public health insurance system. It is established under the Health Insurance Act 1973 and funded through general taxation plus a Medicare levy of 2% of taxable income.
Medicare covers:
- Free treatment as a public patient in a public hospital
- 75% of the Medicare Benefits Schedule (MBS) fee for out-of-hospital services like GP visits and specialist consultations
- 85% of the MBS fee for in-hospital services provided by your doctor
- 100% of the MBS fee when a doctor bulk bills — meaning you pay nothing
If your out-of-pocket costs for out-of-hospital Medicare services exceed the Medicare Safety Net threshold in a calendar year, Medicare pays a higher percentage of future costs for the rest of that year. There are two thresholds: the original threshold (around $560.40) and the extended threshold (around $2,544.30).
To enrol, you need to be an Australian citizen, permanent resident, or hold an eligible visa. New Zealand citizens living in Australia are also eligible.
When does it apply?
- You are an Australian citizen or permanent resident.
- You hold a visa that provides Medicare eligibility (including certain temporary visas under reciprocal healthcare agreements).
- You are a New Zealand citizen living in Australia.
- Citizens of countries with Reciprocal Health Care Agreements (including the UK, Ireland, New Zealand, Sweden, the Netherlands, and others) may access limited Medicare services.
What to Do If You Have a Problem with Your Medicare Claim in Australia
- Enrol in Medicare at a Services Australia centre or online through myGov as soon as you are eligible.
- Carry your Medicare card to every medical appointment. You can also use the digital card in the Medicare app.
- Ask your doctor if they bulk bill — this means Medicare covers the full cost and you pay nothing.
- Check MBS item numbers on your receipt to make sure the correct service was claimed.
- Lodge claims promptly — you have 2 years from the date of service to claim a Medicare rebate.
- Track your safety net balance through myGov to see if you have reached the threshold for higher rebates.
What should you NOT do?
- Don't assume all services are covered — dental, most optical, cosmetic surgery, and ambulance services are generally not included.
- Don't ignore gap fees — if your doctor charges above the MBS fee, you pay the difference (the "gap").
- Don't delay enrolment — you may miss out on rebates for services you have already received.
- Don't forget to update your address with Services Australia when you move, or you may miss important correspondence.
How Western Australia differs from federal law
Medicare is a federal program. WA delivers public hospital services through the WA Department of Health and WA Health Service Providers (HSPs), established under the Health Services Act 2016 (WA).
- WA's health system is organised into Health Service Providers including the metropolitan HSPs (North, South, East, Child and Adolescent) and the WA Country Health Service (WACHS), which covers the vast regional and remote areas of the state.
- WACHS is one of the largest country health services in the world by geographic coverage, serving communities spread across 2.5 million square kilometres. It operates hospitals, health centres, and nursing posts across regional WA.
- WA operates the Patient Assisted Travel Scheme (PATS), which provides financial assistance for patients who need to travel more than 100 km one way (or 70 km for certain specialities) to access specialist medical services not available locally.
- The Royal Flying Doctor Service (RFDS) provides critical aeromedical services across remote WA, including emergency evacuations and primary healthcare clinics.
Additional Steps in Western Australia
Enrol in Medicare through Services Australia. For public hospital services, contact your nearest Health Service Provider. Apply for PATS through your referring doctor or WACHS. Call healthdirect (1800 022 222) for health advice 24/7. Contact WACHS (wacountry.health.wa.gov.au) for regional health services.
Relevant Law: Health Insurance Act 1973 (Cth); Health Services Act 2016 (WA); National Health Reform Agreement
Common Questions
When does medicare — universal healthcare apply?
You are an Australian citizen or permanent resident.You hold a visa that provides Medicare eligibility (including certain temporary visas under reciprocal healthcare agreements).You are a New Zealand citizen living in Australia.Citizens of countries with Reciprocal Health Care Agreements (including the UK, Ireland, New Zealand, Sweden, the Netherlands, and others) may access limited Medicare services.
What should I do if my Medicare claim is rejected or I am charged more than expected in Australia?
Enrol in Medicare at a Services Australia centre or online through myGov as soon as you are eligible.Carry your Medicare card to every medical appointment. You can also use the digital card in the Medicare app.Ask your doctor if they bulk bill — this means Medicare covers the full cost and you pay nothing.Check MBS item numbers on your receipt to make sure the correct service was claimed.Lodge claims promptly — you have 2 years from the date of service to claim a Medicare rebate.Track your safety net balance through myGov to see if you have reached the threshold for higher rebates.
What mistakes should I avoid with medicare — universal healthcare?
Don't assume all services are covered — dental, most optical, cosmetic surgery, and ambulance services are generally not included.Don't ignore gap fees — if your doctor charges above the MBS fee, you pay the difference (the "gap").Don't delay enrolment — you may miss out on rebates for services you have already received.Don't forget to update your address with Services Australia when you move, or you may miss important correspondence.
Medicare — Universal Healthcare in other states
Same topic, different jurisdiction. Pick the one that applies to you.