What Does Medicare Not Cover in Australia in 2026?

The health costs Medicare does not pay in Australia in 2026: dental, optical, ambulance, private hospital fees and the gap.

Published: 10 July 2026 Reading time 12 min

Medicare does not cover dental care, optical care or ambulance transport, and it does not pay private hospital fees. Those four items are the ones that most often arrive as a full bill in your first months as a permanent resident — usually at the moment you least expect it, such as the first dental check-up or an emergency trip to hospital. This article follows the Department of Home Affairs "Health and Wellbeing" page for people settling in Australia, alongside the other government pages listed at the end. It is general information for planning purposes, not advice tailored to your own circumstances; where the amounts involved are significant, confirm the details on the official pages or with a qualified professional.

What does Medicare cover, before we get to the gaps?

Medicare is a federal government service that pays toward health care and medicine. It delivers free care as a public patient in a public hospital, helps with the cost of care outside hospital (such as seeing a GP or a specialist), and works alongside the Pharmaceutical Benefits Scheme (PBS), under which the government subsidises the cost of most medicine.

The mechanism matters as much as the list. In most cases you pay for the medical care first and then receive a refund for some of the payment after you submit a claim through Medicare. So "covered" does not mean "free at the counter" — it means part of the cost comes back to you afterwards.

Enrolment is what unlocks any of this. Migrants, refugees and humanitarian entrants generally have immediate access to health care under Medicare depending on their visa, while other temporary migrants may have to hold private health insurance.

Why do you still get a bill for a visit Medicare covers?

Because doctors set their own fee and Medicare returns most, not all, of it. GPs and specialists charge a fee for their service, and the government returns most of that fee once you claim. The remaining difference is the out-of-pocket cost you carry.

Bulk billing is the exception. Some GPs bulk bill, which means they do not charge you a fee at all; Medicare pays them a fixed fee per service directly. Whether a practice bulk bills can change, so the practical step is to ask whether they bulk bill at the time you book or attend the appointment.

Specialists add one more condition: you must be referred to a specialist by your GP instead of just ringing to book an appointment yourself.

What does Medicare not cover at all?

Three categories are named outright on the official settling-in page, and none of them are small.

Dental care. Dental care in Australia can be very expensive and is not covered by Medicare. Health insurance extras packages often include dental cover to offset check-ups and major work.
Optical care. Optical care is not covered by Medicare. Private health insurance commonly includes most optical care as part of an extras package.
Ambulance transport. You must pay a fee when you are transported to a hospital in an ambulance. Most private health insurance schemes include ambulance cover, or the cover can be purchased separately at a much lower price.

For genuine emergencies, call 000 — triple zero is the national emergency number for ambulance, police and fire services. Calling it does not make the transport itself free; the ambulance fee is a separate charge from any hospital care that follows.

Does Medicare pay anything if you choose a private hospital?

Yes, but only part of it. Private hospitals exist to offer a choice of doctor and control over timing, and patients pay for that care: you pay the doctor's fees and the fees for your stay. Medicare will cover some of the doctor's fee but does not cover the hospital fees, and private hospital care can be very expensive depending on the length of stay and the services provided.

Public hospitals work on a different basis. They are open to people referred by a doctor, people with a grievous injury, or people brought in by ambulance, and the hospital chooses the doctor who treats you. Waiting times follow clinical urgency rather than arrival order, and outpatient services can involve a long wait when a case is not an emergency.

Which medicines are subsidised, and which do you buy outright?

Prescription medicines are where the PBS does the work: the government subsidises the cost of most medicine under the scheme, which is administered by Services Australia. Your doctor prescribes the medication and a chemist dispenses it, and chemists are found in most shopping centres.

Medicines that do not require a prescription — paracetamol or antacids, for example — are bought at supermarkets and are outside the PBS arrangement entirely. Labels and instructions on any medicine are worth reading carefully; pharmacists and the Medicines Line service can answer questions about medicines.

What other care runs on a different funding model?

Some services you may use are not Medicare items but are funded separately, which is worth knowing before you assume a bill is coming.

Community health centres are funded by local government, with services such as vaccination, health checks for babies and children, health education and counselling, and most women's health programs. Free-of-charge vaccination programs are available for children and older people under the National Immunisation Program. Support for permanent and significant disability comes through the National Disability Insurance Scheme, which is not means-tested but requires you to meet age and location requirements, and aged care is paid for on an ability-to-pay basis with government help.

Complementary therapies such as acupuncture, aromatherapy and naturopathy are accepted by health regulators and are more readily available in metropolitan areas.

How does private health insurance change the picture?

Private health insurance is the main tool for the gaps above, and it can be bought by citizens and non-citizens. Funds may cover your treatment as a private patient in a private or public hospital, and some policies include services Medicare does not cover — dental care, most optical care and ambulance transport.

Cover and cost vary widely between funds, so comparison is the point rather than a formality; the government's privatehealth.gov.au site sets out how funds and the private system work and links to most Australian health providers. Two tax-side details also matter: the Australian Taxation Office provides rebates for private health insurance depending on your income level, and there is a Medicare Levy Surcharge if you do not hold the insurance and are aged 31 or older.

How do you enrol, and what should you check at the first appointment?

To enrol, visit a Medicare Service Centre seven to 10 days after you arrive in Australia and bring your passport or travel documents. Medicare Service Centres sit inside Services Australia service centres, which also house Centrelink and My Aged Care.

Two questions are worth asking at your first contact with a practice: does this doctor bulk bill, and will I be sent to a specialist with a referral if one is needed. Both determine whether the visit costs you nothing at the time or leaves you claiming part of the fee back later.

Frequently Asked Questions

Does Medicare pay anything toward dental treatment? No. Dental care is not covered by Medicare, and dental work in Australia can be expensive. Dental cover is normally obtained through an extras package on a private health insurance policy, which typically contributes to both check-ups and major work.

Is an ambulance free if it takes me to a public hospital? No. You must pay a fee when you are transported to a hospital in an ambulance, regardless of the hospital you are taken to. Ambulance cover is included in most private health insurance schemes or can be bought separately at a much lower price.

Are eye tests and glasses covered? Optical care is not covered by Medicare. Most optical care is one of the services that private health insurance extras packages include, so glasses, contact lenses and eye tests usually come out of your own pocket or an extras policy.

What does Medicare pay if I go to a private hospital? Medicare covers some of the doctor's fee but not the hospital fees, so you pay for the doctor and for your stay. Private health insurance can often cover much of the cost of private hospital care, which is why the choice of hospital has a direct bearing on your bill.

Do I have to pay first and claim later? In most cases, yes: you pay for the medical care and then receive a refund for some of the payment after submitting a Medicare claim. Bulk billing removes that step, because the doctor bills Medicare directly and charges you nothing.

Do I need private health insurance as a new permanent resident? It is not a condition of Medicare enrolment, but it is the usual way to cover dental, optical and ambulance costs. A Medicare Levy Surcharge applies to people aged 31 or older who do not hold private hospital cover, and the ATO provides income-dependent rebates for those who do.