What Medicare Actually Covers in 2026 (and Where the Gaps Are)

16 June 20266 min read

Medicare is one of those systems Australians trust without quite understanding. We carry the green card for decades, tap it at reception desks and pharmacy counters, and mostly find out what it does and doesn’t cover at the exact moment it matters: when the receptionist mentions a gap fee, or the chemist rings up a script at ten times the price you expected. The system covers a great deal. But the edges are fuzzy, and the edges are where the surprise bills live.

The good news is that 2026 has brought some genuine improvements, including the cheapest general PBS scripts in more than two decades. The less good news is that the gaps, particularly dental and optical, are as wide as ever. Here is what the card actually buys you this year, what it doesn’t, and the handful of checks that can save a household hundreds of dollars.

The GP visit: why some people pay nothing and you pay $40

Medicare pays a set rebate for a standard GP consultation. What you pay depends entirely on how the practice bills. A bulk-billing clinic accepts the rebate as full payment, so you walk out without opening your wallet. A private-billing clinic charges its own fee, you claim the rebate back, and the difference is your gap. That gap is set by the practice, not by Medicare, which is why two clinics in the same suburb can charge wildly different amounts for the same ten minutes.

Many practices bulk bill children and concession card holders but charge everyone else, and plenty have quietly moved from bulk billing to mixed billing in recent years. None of this is secret; it is just rarely volunteered. Ask how you will be billed when you book, and if the answer stings, the Healthdirect service finder makes it easy to compare clinics near you. Changing your regular GP is a bigger decision than chasing a free appointment, but for routine scripts and referrals, knowing a bulk-billing option exists nearby is useful leverage.

Scripts: the PBS just got noticeably cheaper

When a medicine is listed on the Pharmaceutical Benefits Scheme, the government pays most of the cost and you pay a capped co-payment. From 1 January 2026, that cap dropped to $25 for general patients, down from $31.60 the year before, and the biggest cut to the general co-payment in over twenty years. Concession card holders pay $7.70 a script, a rate that has been frozen since 2024 and is legislated to stay frozen through 2029.

Then there is the PBS Safety Net, which far fewer people use than should. Once your household’s spending on PBS scripts passes $1,748.20 in a calendar year ($277.20 for concession card holders), scripts cost just $7.70 for the rest of the year, and nothing at all for concession holders. The catch is that someone has to be counting. Ask your pharmacist to keep a Safety Net record for your family; they can track the tally and tell you when you qualify. If your household juggles several regular medicines, this one habit can be worth hundreds of dollars in the back half of the year. Current rates are always listed on the PBS website.

The big three gaps: teeth, eyes and everything physio

Now for the part that catches almost every household. For adults, Medicare generally does not cover dental check-ups or treatment, glasses or contact lenses, or routine physiotherapy, podiatry and similar therapies. These are not small omissions; for many families they are the largest health costs of the year, and they sit almost entirely outside the system.

There are two partial exceptions worth knowing. Children aged 0 to 17 in families receiving certain payments, including Family Tax Benefit Part A, may be eligible for the Child Dental Benefits Schedule, which covers up to $1,158 of basic dental work per child over two calendar years. Eligibility is assessed automatically, but plenty of eligible families simply never use it; you can check yours through Services Australia. Public dental services also exist for concession card holders, though waiting lists in most states are measured in months or years, not weeks.

These gaps are the main reason people hold private health extras cover, and extras deserve a cold-eyed annual review. Before renewing, add up what you actually claimed on dental, optical and physio last year and hold it against the premium. If you claimed less than you paid, you are not insuring, you are donating. If you claimed more, keep it and check your limits. It is a ten-minute exercise that regularly changes minds in both directions.

Mental health: more cover than most people realise

If you are struggling, start with your GP. A Mental Health Treatment Plan unlocks Medicare rebates for up to 10 individual psychology sessions each calendar year, plus up to 10 group sessions. The rebate rarely covers the full fee, so ask two questions when booking: what is the gap per session, and does the practitioner bulk bill plan sessions for any patients? Some do, particularly for concession card holders, and your GP often knows who.

Telehealth sessions attract the same rebates, which has quietly transformed access for women in regional areas and for anyone whose week does not accommodate a 3pm appointment across town. If cost is the barrier, Healthdirect’s guide to low-cost mental health services lists the free and subsidised options worth trying first.

Newer treatments: where the out-of-pocket question matters most

The most expensive surprises in Australian healthcare tend to involve newer prescription treatments. There is often a long delay between a medicine being approved by the TGA and it being subsidised on the PBS, and some medicines never make the list at all. In that window, you pay the private price, which can run to hundreds of dollars a month, with none of it counting toward the PBS Safety Net.

Weight loss medication is the clearest current example. It is among the most asked-about prescriptions in the country, and the coverage rules confuse almost everyone, because the answer differs by medicine, by condition and by whether private health is involved. If it is on your radar, this explainer on whether Medicare covers weight loss medication sets out what is subsidised, what private health will and won’t contribute, and what the realistic out-of-pocket costs look like.

The same logic applies to any newer treatment you are offered. Three questions are worth asking the prescriber before you start: Is this PBS-listed for my situation? If not, what will it cost me per month, realistically? And is there a subsidised alternative worth trying first? A doctor worth seeing will not be offended by any of them.

The other Safety Net, quietly working in the background

Separate from the PBS arrangement, there is a Medicare Safety Net for out-of-hospital appointments: GP visits, specialists, scans and tests billed through Medicare. Once your gap costs pass $594.40 in a calendar year, Medicare lifts its rebate to 100 per cent of the schedule fee for the rest of the year. Spend past the extended threshold ($2,699.10 for most families in 2026, or $861.20 for concession card holders and Family Tax Benefit A families) and Medicare starts covering up to 80 per cent of your out-of-pocket costs for the remainder of the year.

Singles are tracked automatically, but here is the detail that costs families money: couples and families must register as a family for their costs to be counted together, even if everyone is on the same Medicare card. Registration takes minutes through your Medicare account on myGov. In a year with a baby, a diagnosis or a parade of specialist appointments, it is the difference between hitting the threshold by May and never hitting it at all.

Five questions worth asking this month

Does your regular clinic bulk bill you, and is there one nearby that would? Are your repeat scripts PBS-listed, and is your pharmacist tracking your Safety Net tally? Is your family registered for the Medicare Safety Net on myGov? Did your extras cover pay for itself last year? And if you are starting any new treatment, do you know what it will cost per month before the first script is filled?

None of it is glamorous. But an hour spent on these questions buys you something the health system rarely hands out on its own: knowing what the next bill will be before it arrives.

Why friendship breakups can hurt more than romantic ones

“A friend is someone who knows all of you and still loves you.” – Elbert Hubbard And that is exactly why it hurts so deeply when a friendship falls apart. Unlike romance, there is often an unspoken belief that friendship will be a constant in an unpredictable world. Friends become our safe place, our chosen family, the people we imagine will be beside us for the long haul. Whether it is a lifelong companion from childhood or a newer connection formed later in life, close friends know our backstory and our vulnerabilities. They see us at our most unfiltered, through life’s highs and lows, and accept us just as we are. That kind of connection feels rare and deeply comforting. Think about the warmth that comes from sharing dreams, secrets and stories over coffee or a glass of wine. Those moments are not just emotionally nourishing, they also trigger powerful chemical reactions in the body. Laughter and connection release dopamine and endorphins, trust encourages oxytocin, and the feeling of being valued strengthens serotonin. Friendship does more than lift our mood, it helps calm our nervous system and brings a sense of ease. When life becomes heavy, friends often show up in meaningful ways. They organise meals, check in without being asked, help with the kids or simply sit beside us when words feel hard to find. Over time, a quiet reliability forms. Because the connection feels so nourishing, we may overlook small frustrations and remind ourselves that no friendship is perfect. We soften, adjust and make space for one another, creating a protective bubble in an otherwise busy world. In neuroscience, this sense of safety is called belonging. Our brains are wired for it. In early human history, belonging to a group meant survival. We shared resources, protected one another and stayed alert to danger together. That wiring still exists today. When we feel we belong, our nervous system settles into a state of safety. So when a friendship breaks down, the grief can feel surprisingly intense. The person we relied on is suddenly absent, and the loss can trigger deep feelings of rejection. It may feel disorienting, like losing a steady anchor we never imagined would disappear. Romantic relationships can be exhilarating, full of excitement and possibility. Yet many of us understand, somewhere deep down, that romance carries risk. Hearts can break and relationships can end, and it is often our friends who help us through those moments. When a trusted friendship ends, it can feel as though a piece of our emotional foundation has shifted. The pain is not only about losing the person, but also about losing the sense of belonging that existed within the friendship. It is not necessarily a failure, but sometimes a reminder that certain relationships are only meant for a season. To help navigate the loss of a friendship, therapist Justine Williams suggests a gentle three-step approach: see, feel and hear. First, see the friendship clearly. Try to view it with perspective, noticing it as it truly was rather than through an idealised lens. Focus your energy on the people who genuinely lift you up and value you. Next, feel your grief rather than pushing it away. Allow sadness to move through you and practise compassion towards yourself. Accept what you cannot control, and if you feel stuck, seeking professional support can help untangle lingering guilt or self-doubt. Finally, hear your inner wisdom. Ask yourself what advice you would offer a child, sibling or close friend in the same situation. Trust that guidance and allow yourself the time and space needed to heal. Friendship breakups can be deeply painful, but they can also invite reflection, growth and a renewed understanding of what connection truly means. About the author Justine Williams Founder of The Feel Good Studio and Hyp Little Fairy Tales® Affectionately known as The Fairy Godmother for her work supporting children, parents and families. A highly regarded Clinical Hypnotherapist, speaker and multi-award-winning author. Website Email

By Justine Williams

Health and Wellness

You are not irreplacable, you are resilient!

You have two kidneys. You only need one. Long before anyone coined a phrase for it, your body quietly modelled the principle we now call resilience at work — packed with spares, one organ at a time, built not to be precious but to last. Evolution looked at the long odds of staying alive and decided that redundancy, a quiet backup sitting ready and unbothered, was the kindest thing it could give you. The Myth of the Irreplaceable Person Your ego disagrees. It has its own theory, and it recites it at 2am: that you’re the one who truly understands the client, the unrepeatable knot of skill the whole thing depends on. It’s a comforting story. The body has spent years gently disagreeing. We’ve always believed this at scale. Every monarchy that claimed divine right discovered, eventually, that divinity has a short attention span. When Steve Jobs died in 2011, the consensus was that Apple had lost the one mind it could never replace; under Tim Cook it went on to become the most valuable company in the world. [SUGGESTED LINK: Tim Cook’s leadership and Apple’s growth post-Jobs] The gap between valuable and irreplaceable is the gap between a fact and a fairy tale. Work culture prefers the fairy tale. It calls you a “key person” and means it as a compliment — when underneath sits a system that falls over the moment one human leaves. Engineering has a blunter name for that. It isn’t talent; it’s a single point of failure. A design flaw. [SUGGESTED LINK: single point of failure in organisational design] What Strong Systems Actually Look Like The body knows better, because it has no ego to defend. Two lungs, two kidneys, two brain hemispheres that cover for each other. A liver that grows back. An immune system that reroutes when a defence is breached. None of this is sentiment. Evolution doesn’t build irreplaceable parts; it builds systems that outlive the failure of any one of them. You are not the jewel in the crown of natural selection. You are a distributed backup system wrapped in skin and anxiety — and that, it turns out, is the good news. Here’s the part we flinch from, so I’ll just say it. Most of what you do — the emails, the meetings, the decisions — someone competent could learn in a few months. Not the intuition, the relationships, the context you carry in your bones. But the function? That’s a transferable skill wearing your name badge. AI didn’t make this true; it only made it loud. The printing press didn’t make the monk less skilled, only less necessary. We spend our lives confusing the two: defending how necessary we are, and missing what we’re for. [SUGGESTED LINK: AI and the future of work] Redundancy as a Design Principle, Not an Insult So before you spiral and refresh your LinkedIn, turn it over. Redundancy was never the insult you took it for. It’s the whole principle of resilience — why planes stay aloft, why your heart keeps beating when one pathway misfires. Strong systems aren’t the ones with an indispensable part; they’re the ones where no part is. When only one person understands the billing system, that isn’t a measure of their importance. It’s a hostage situation. Don’t be the load-bearing wall whose removal brings down the ceiling. Be part of the frame — holding things up precisely because it no longer all rests on you. And here’s the gift hidden in all of it: once you stop defending how hard you are to replace, you start to notice what genuinely can’t be. It was never the spreadsheet or the code. It’s the way you make a colleague feel human again after a brutal quarter; the meaning you pull out of chaos. None of it fits on a CV, because none of it is a component. It’s the connective tissue — not the parts, but what happens between them. What Genuinely Cannot Be Replaced “But doesn’t that mean we’re all worthless?” is the wrong question. It mistakes one axis for another. Any musician in the orchestra can be swapped and the note still sounds — but the ensemble, these people on this particular night, will never happen twice. You’re replaceable as a function and unrepeatable as a presence. You matter not because no one else could do your job, but because you’re the one doing it now, bringing the strange, specific thing only you bring. That’s not nothing. It’s just not what we were taught to call worth. We need this now, in an age of industrial-scale redundancy anxiety. AI writes the emails; an algorithm makes the trades, with no meltdowns and no lunch break. You are more functionally redundant than any generation before you — and the answer isn’t to deny it. It’s to stop hanging your whole identity on the function in the first place. You have two kidneys. You only need one. And you’ve spent your whole life not thinking about the spare — not resenting it, not feeling diminished by it, not lying awake afraid of it. You just lived, while the backup sat there quietly keeping you alive. Maybe it’s time to extend that same grace to the rest of you. The spare was never an accusation that you weren’t enough. It was the most honest kindness your body could manage: a margin, a second chance, the reason the whole fragile system keeps going. You are not irreplaceable. You are something better. You are resilient — and you were built that way on purpose. About the author Andrew Harmer Co-Founder & Software Architect, Get It Media Magazine Operations Software Engineering Andrew is co-founder of Get It Media, where he builds the software behind modern publishing — practical tools for creating, managing and distributing web content. He also writes for Get It Magazine on men's health and lifestyle. Website Email

By Andrew Harmer

Health and Wellness

Simple, realistic ways to reset and feel like yourself again

We have all had those days. A few too many sweet treats, followed by feeling sluggish, bloated or simply not quite like ourselves. While it is easy to fall into guilt afterwards, sugar binges are incredibly common and are often linked to stress, exhaustion or emotions rather than a lack of willpower. The good news is that one indulgent day does not undo your health. With a few simple, practical steps, you can help your body reset and move forward feeling more balanced again. What happens after a sugar binge? When we consume a large amount of sugar, blood glucose levels rise quickly. In response, the body releases insulin to help regulate the surge, which can then lead to a rapid drop in blood sugar levels, often referred to as the “crash”. This is why many people feel tired, irritable, foggy or crave even more sugar shortly afterwards. It can also trigger a cycle of overeating followed by restriction, which tends to make things worse rather than better. Understanding this response is important. Your body is not failing you. It is simply reacting to rapid fluctuations. Why sugar binges happen Sugar binges are rarely just about food. Common triggers can include: Stress or emotional overwhelm Lack of sleep Restrictive dieting or skipping meals Habit, convenience or comfort eating Recognising your own triggers can make it easier to respond differently next time. How to reset without punishing yourself Eat balanced mealsSkipping meals after overeating often backfires. Instead, focus on balanced meals that include protein, fibre and healthy fats, such as eggs, vegetables, whole grains, yoghurt or lean meats. This helps stabilise blood sugar levels and reduce cravings. Hydrate wellWater supports digestion, helps reduce bloating and can improve energy levels. Aim for around two litres a day, particularly if you have been eating heavily or consuming extra salt and sugar. Move your body gentlyYou do not need an intense workout to “make up” for anything. A walk, light stretch or swim can help your body regulate glucose levels and improve how you feel physically and mentally. Prioritise sleepPoor sleep increases hunger hormones and sugar cravings. Giving your body proper rest can help regulate appetite and energy more effectively. Avoid extreme restrictionCutting out all treats or drastically reducing calories often leads to stronger cravings and another binge later on. A balanced, flexible approach is far more sustainable. Choose smarter sweet optionsIf cravings hit, try options that are more balanced, such as fruit with nut butter, Greek yoghurt with berries or a small piece of dark chocolate. Manage stress levelsStress is one of the biggest drivers of sugar cravings. Gentle habits like walking, journaling, deep breathing or yoga can help regulate the nervous system and reduce emotional eating. Let go of the guilt It is normal to feel physically and emotionally off after overeating, but guilt rarely helps recovery. One day does not define your health or your habits. Treat yourself with the same kindness you would offer a friend. Long-term wellbeing is built through consistency, not perfection. Preventing future binges Small habits often make the biggest difference over time: Eat regularly and avoid skipping meals Keep nourishing snacks on hand Be mindful of hidden sugars Identify emotional triggers rather than ignoring them Most importantly, stay curious rather than critical about your habits. Every experience offers insight into what your body may actually need.

Health and Wellness

The women’s health crisis hiding in plain sight

When we think about women’s cancers, breast cancer is often the first that comes to mind. But there is another cancer affecting thousands of Australian women every year, and many people know surprisingly little about it. Blood cancer is now the second most common cancer diagnosed in Australian women, behind only breast cancer, and the leading cancer among girls and women under 30. Yet despite its prevalence, awareness remains relatively low. In 2024, more than 8,300 Australian women were diagnosed with blood cancer. Within the next decade, that number is expected to almost double. Last year alone, more than 2,500 women lost their lives to the disease. Unlike many other cancers, blood cancer cannot be prevented or detected through routine screening. It can affect anyone, at any stage of life. Treatment can be lengthy and intensive, sometimes requiring extended hospital stays or relocation to access specialist care. Chemotherapy and radiotherapy can also affect fertility, adding another layer of emotional complexity for women who may still be planning families. The financial impact can be significant too. Journalist and television presenter Edwina Bartholomew knows that reality firsthand. After being diagnosed with chronic myeloid leukaemia last year, she has spent the past 12 months undergoing treatment while continuing to raise her young family and work. “The day I was diagnosed with blood cancer will stay with me forever,” she says. “When my doctor told me, I had no idea what to expect and what was ahead. But fortunately, my diagnosis of chronic myeloid leukaemia was early, and I have been extremely lucky.” Edwina says advances in medical research have transformed what her diagnosis means for her future. “Thanks to research, I am able to take a tablet that helps me to live a full and healthy life,” she says. “My results are also a testament to the importance of regular health check-ups.” Now serving as a National Ambassador for the Leukaemia Foundation, she hopes speaking openly about her experience will help raise awareness among other women. “I want women in Australia to know that this disease exists and it’s serious,” she says. “But if it touches your life, there is a community here to hold you up.” “You are not alone in this fight and organisations like the Leukaemia Foundation are here to help and support you and your loved ones every step of the way.” One of the challenges facing blood cancer is that symptoms can often be vague or mistaken for other conditions. Persistent fatigue, frequent infections, unexplained bruising, night sweats or ongoing fevers can all be warning signs worth discussing with a healthcare professional. For the Leukaemia Foundation, the message is simple: awareness matters. Blood cancer is already affecting thousands of Australian women, and its impact continues to grow. By understanding the signs, supporting research and ensuring women have access to the care and information they need, more lives can be changed and, ultimately, saved. For more information or support, visit the Leukaemia Foundation.