Editing Medicare (Australia) (section)

=== Bulk billing and gap payments ===
Service providers can choose how much to charge patients for services, including above or below how much Medicare will pay, with patients responsible for the difference. A 2012 study of the OECD found that Australia was the only country out of the 29 surveyed that gave service providers the right to charge more or less than the rebate amount.<ref>{{cite journal |last1=Paris |first1=Valérie |last2=Devaux |first2=Marion |last3=Wei |first3=Lihan |date=28 April 2010 |title=Health Systems Institutional Characteristics: A Survey of 29 OECD Countries |url=https://www.oecd-ilibrary.org/social-issues-migration-health/health-systems-institutional-characteristics_5kmfxfq9qbnr-en;jsessionid=TSmilSnVSuyMGrrOcmC9_oZU.ip-10-240-5-84 |series=OECD Health Working Papers |language=en |publisher=OECD |doi=10.1787/5kmfxfq9qbnr-en |doi-access=free |website=OECD iLibrary |access-date=8 April 2020 |archive-date=10 July 2024 |archive-url=https://web.archive.org/web/20240710002136/https://www.oecd-ilibrary.org/social-issues-migration-health/health-systems-institutional-characteristics_5kmfxfq9qbnr-en;jsessionid=TSmilSnVSuyMGrrOcmC9_oZU.ip-10-240-5-84 |url-status=live }}</ref>

When a provider chooses to only charge the patient as much as the Medicare rebate for an eligible service, and directly charges Medicare instead of the patient, this is called a "bulk billed" service. As Medicare covers the entire cost of the service, the individual patient does not have to pay anything. Most providers will only bulk bill concessional patients (people with concession cards, or aged 16 years or under), although some will bulk bill all eligible services for all eligible patients. The government pays an additional subsidy, called the ''Bulk Billing Incentive Payment'', to providers when they bulk bill services for concessional patients.<ref>{{Cite web |date=6 February 2024 |title=Increases to Bulk Billing Incentive Payments |url=https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments |url-status=live }}</ref>

If a provider chooses to charge above the Medicare rebate amount (whether that be above the schedule fee, or if Medicare does not pay 100% of the schedule fee), the individual patient is charged a "gap payment". For most services, the patient is responsible for paying the gap.

Many industry and professional groups, such as the [[Australian Medical Association]] (AMA), maintain their own list of recommended fees that their members can use to base their charges off. For example, the AMA's ''List of Medical Services and Fees'' recommends that general practitioners charge $102 for appointments lasting less than 20 minutes. The Medicare schedule fee for the corresponding item code is $41.40, with Medicare paying 100% of the schedule fee for GP services. A doctor that elects to charge the AMA fee will result in the patient being charged the difference of $60.60 as an out-of-pocket cost for the appointment.<ref>{{Cite news |last=Winter |first=Velvet |date=1 November 2023 |title=GP appointment fees are likely to rise from today. Here's what that means for your next visit to the doctor |url=https://www.abc.net.au/news/2023-11-01/why-are-gp-fees-increasing-medicare-bulk-billing-incentives/103038704 |url-status=live |access-date=8 June 2024 |work=[[ABC News (Australia)|ABC News]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.abc.net.au/news/2023-11-01/why-are-gp-fees-increasing-medicare-bulk-billing-incentives/103038704 }}</ref> If a doctor charges less than the AMA recommended fee, the gap payment will decrease, and vice versa.