Medicare feels like it should cover everything. For a lot of healthcare, it does. But plenty of Australians only find out where the gaps sit when a bill lands in their inbox after a specialist visit or a hospital stay, and the amount doesn’t match what they expected. Understanding where those gaps actually are, and how to plan for them, makes a real difference before that bill ever arrives.
Medicare Covers a Lot, But Not Everything
Medicare is genuinely substantial. It covers public hospital treatment at no cost, contributes to GP and specialist visits, and subsidises a wide range of prescription medicines through the Pharmaceutical Benefits Scheme. For a large share of everyday healthcare, most or all of the cost is taken care of.
That said, Medicare was never designed to cover every health-related expense a person might face. There are entire categories of care it generally doesn’t cover at all, and there’s a separate, less obvious situation where Medicare covers part of a cost but leaves the rest to the patient. Both matter, and they work differently.
What Doesn't Medicare Cover?
Some services sit mostly or entirely outside Medicare, generally speaking. Individual circumstances can affect exact coverage, so it’s worth checking your own situation rather than assuming.
Healthcare cost or service | Medicare position | What the patient may need to consider |
Most dental services | Generally not covered | Extras cover through private insurance may help |
Glasses and contact lenses | Generally not covered | Medically necessary eye tests to diagnose conditions can still attract a Medicare benefit |
Ambulance services | Not covered by Medicare; arrangements vary by state and territory | Some states offer broader cover for residents; others don’t |
Physiotherapy and allied health (outside hospital) | Generally not covered | Often included under extras cover |
Hearing aids and devices | Generally not covered | Worth checking eligibility for other support schemes |
Elective cosmetic surgery | Not covered unless medically necessary | Clinical necessity is assessed case by case |
Overseas medical treatment | Not covered, except where a reciprocal agreement applies | Travel insurance is a separate consideration |
Medical costs for private hospital treatment | Partially covered | Medicare generally covers 75% of the MBS schedule fee for associated medical services; private health insurance may cover some remaining costs depending on your policy |
Sometimes Medicare Covers Part of the Cost
This is where things get genuinely confusing for a lot of people, and it’s worth slowing down on.
Medicare doesn’t pay a provider’s actual invoice. It pays a benefit based on the Medicare Benefits Schedule, or MBS, which sets a scheduled fee for a given service. For an outpatient specialist visit, Medicare generally covers 85% of that MBS fee, not 85% of whatever the specialist actually charges. If the provider’s fee is higher than the schedule fee, which happens often, the difference becomes a gap payment.
Bulk billing avoids this entirely. When a provider bulk bills, they accept the Medicare benefit as full payment, so there’s nothing left for the patient to pay. When a provider doesn’t bulk bill, the patient generally pays upfront and either claims the Medicare benefit back or has it processed automatically, and whatever’s left over is the out-of-pocket cost.
It’s a subtle but important distinction. “Medicare covers 85%” sounds reassuring, but it only tells you 85% of one specific number, the schedule fee, not 85% of the bill you’re actually holding.
Medicare Safety Net and Informed Financial Consent
Two things are worth knowing about when you’re trying to manage out-of-pocket medical costs: the Medicare Safety Nets and informed financial consent.
The government confirms that Medicare Safety Nets apply to eligible out-of-hospital MBS services and increase Medicare benefits after the relevant thresholds are reached
The Medicare Safety Net. Once your out-of-pocket costs for out-of-hospital MBS services reach a set threshold within a calendar year, Medicare increases the rebate you receive for the rest of that year. For 2026, the Original Medicare Safety Net threshold is $594.40. There’s also a related mechanism called the Greatest Permissible Gap, currently set at $104.50 from 1 November 2025, which caps the gap for certain specialist services where it applies. Neither of these makes future healthcare free. They reduce what you pay once you’ve already crossed a certain point of out-of-pocket spending in a year.
Informed Financial Consent. This is the government’s term for something genuinely practical: Before treatment, you can ask for an estimate of what you’ll be expected to pay. Ask what the provider will charge, what Medicare is expected to contribute, what your insurer may cover, and what you’ll need to pay yourself
What Out-of-Pocket Medical Costs Can Look Like
Some of the more common situations where out-of-pocket costs can arise include: A specialist who doesn’t bulk bill and charges above the schedule fee. A private hospital admission where the 75% Medicare contribution still leaves a meaningful balance, especially if your insurance doesn’t cover the rest. A dental issue that needs attention now rather than waiting for an extras policy’s annual limit to reset. An ambulance callout in a state where cover isn’t automatic.
None of these are unusual. They’re just the specific spots where the system’s design leaves a genuine gap, and where planning ahead actually helps.
How to Plan for Medical Costs Before You Get the Bill
A few questions, asked before treatment rather than after the invoice arrives, tend to change the outcome.
Is this service listed on the MBS, and will you get a Medicare rebate at all? Will the provider bulk bill, or will there be a gap? What does the provider actually charge, separate from what Medicare contributes? Does your private health insurance apply here, and if so, does it come with a waiting period, an annual limit, or an exclusion that might catch you out?
For some specialist and hospital services, the Australian Government’s Medical Costs Finder can also help you understand typical fees and potential out-of-pocket costs. It isn’t a substitute for a quote from your provider, but it can give you another reference point when you’re planning for treatment.
It’s also entirely reasonable to ask for a written quote before agreeing to a procedure, and to ask whether the provider offers a payment arrangement if the cost is significant. None of this is unusual to ask for. Providers deal with these questions regularly.
What Private Health Insurance May Cover
Private health insurance can help with some of what Medicare doesn’t, depending on your policy. Broadly, cover splits into hospital cover, which relates to treatment in hospital, extras or general treatment cover, which can include things like dental, optical and physio, and ambulance cover, which varies by insurer and state.
What’s actually included depends entirely on your specific policy. Waiting periods, annual limits, and exclusions all affect what you’re covered for and when. It’s worth checking your level of cover directly with your insurer before assuming a service is included, rather than assuming based on having a policy at all.
What If You Still Have a Medical Bill to Pay?
If a gap remains after checking Medicare and insurance, there are usually a few paths worth considering before anything else. Using available savings, if that’s realistic without creating a different kind of financial pressure. Asking the provider directly whether a payment plan is available, which is more common than people expect. Checking whether you’ve crossed a Medicare Safety Net threshold that might reduce future costs this year. And, where appropriate, speaking with a financial counsellor if the situation feels genuinely difficult to manage.
None of these will suit every situation. The point isn’t that one option is automatically right. It’s that borrowing is one possible option among several, not the default answer the moment a bill arrives.
Could a Medical Expense Loan Be an Option?
For some people, once other options have been checked and a gap genuinely remains, a medical expense loan is one way to spread a healthcare-related cost over time rather than paying it in full upfront. It’s a form of borrowing, specifically for costs that aren’t fully covered by Medicare, insurance, or savings, and like any loan, it comes with a repayment obligation that needs to fit your actual budget.
It isn’t a way to get treatment sooner than you otherwise would, and it isn’t something to take on lightly. It’s simply one tool, relevant in some circumstances and not others.
What to Consider Before Borrowing for Medical Expenses
A few practical questions are worth working through properly before deciding. What will you repay altogether, once fees and interest are included, not just the amount you’d receive upfront? Can you comfortably manage the repayments alongside everything else in your budget? Have you actually checked the other options first, including whether insurance contributes anything here? And, if the loan is secured against an asset, what does that mean for you specifically if your circumstances change?
How Quickzy Approaches Medical Expense Borrowing
Quickzy Finance offers a secured personal loan that some people use for medical-related costs, among other purposes.Quickzy currently offers a secured personal loan of $2,417 to $5,000, inclusive of fees, which some customers may use for medical-related expenses, with a $400 establishment fee and $16 in other fees, at an interest rate of 47% per annum.
The loan is secured against a vehicle the applicant owns.The vehicle must be owned and registered in the applicant’s name to be used as security. That’s worth being clear about upfront because the loan is secured, the vehicle used as security may be at risk if the borrower does not meet the loan obligations. Every application is assessed individually, based on the applicant’s actual financial circumstances and ability to repay, in line with responsible lending and suitability requirements, rather than approved automatically because a bill happens to be for something medical. You can read more about how that assessment works in Quickzy’s responsible lending policy.
The Bottom Line
Medicare covers a lot, but understanding where the gaps sit, and asking the right questions before treatment rather than after the bill arrives, puts you in a much stronger position. Checking your Medicare rebate, your insurance, and whether a payment arrangement is available should generally come before considering a loan. If a medical expense loan does turn out to be the right fit for your situation, it’s worth understanding the full cost and the security involved before applying.
Worried About Unexpected Medical Bills?
Find out what options may be available if healthcare costs are becoming difficult to manage.
This article is general in nature and does not take your personal financial situation, objectives or needs into account. Consider getting independent financial advice before making any borrowing decision. Fees, criteria, and terms and conditions apply. All loans are subject to assessment under our Australian Credit Licence (ACL 544927). Borrow responsibly, only what you need and can afford to repay.
Frequently Asked Questions
What does Medicare not cover in Australia?
Medicare generally doesn’t cover most dental services, glasses and contact lenses, ambulance services (arrangements vary by state), most out-of-hospital allied health, hearing aids, elective cosmetic surgery, and overseas treatment outside reciprocal agreements.
What is a Medicare gap payment?
It’s the difference between the Medicare benefit paid toward a service and what the provider actually charges. It happens when a provider charges above the MBS scheduled fee and doesn’t bulk bill.
What is the Medicare Safety Net?
A mechanism that increases your Medicare rebate for the rest of the calendar year once your out-of-pocket costs for out-of-hospital services reach a set threshold, currently $594.40 for 2026.
Can I get a loan for medical expenses in Australia?
Medical expense loans are available in Australia, although eligibility and suitability depend on the lender and the applicant’s circumstances. Quickzy’s application process includes an assessment of the applicant’s financial situation and ability to repay
Is a medical expense loan secured or unsecured?
It depends on the lender. Quickzy’s product is secured against a vehicle the applicant owns.
What should I consider before borrowing for medical expenses?
The total amount repayable, whether the repayments genuinely fit your budget, whether you’ve checked other options like insurance or a payment plan, and what’s at risk if the loan is secured.
