Medicare in Australia doesn't cover many common services like most dental care, ambulance transport (except in some states/for some people), glasses, hearing aids, and cosmetic surgery; it also doesn't cover costs as a private hospital patient (accommodation, theatre fees) or most alternative therapies, though it covers doctor visits, tests, and public hospital treatment. Many excluded services can be covered by private health insurance, notes.
Medicare does not cover private patient hospital costs, ambulance services, and other out of hospital services such as dental, physiotherapy, glasses and contact lenses, hearings aids. Many of these items can be covered on private health insurance.
does not cover:
There are certain services that Medicare does not cover. These include vision, dental, and hearing care. A person may be able to get coverage for some of the noncovered services through Medicare Advantage, Medicaid, and PACE plans.
There are some things Original Medicare won't cover. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams.
Most people don't pay a Part A premium because they paid Medicare taxes while working. If you don't get premium-free Part A, you pay up to $565 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty.
No, Medicare in the United States generally does not cover routine dental care (exams, cleanings, fillings, dentures, etc.) for adults, but it does cover certain dental services if they are part of a medically necessary hospital procedure, like jaw reconstruction, or for children under specific state programs like the Child Dental Benefits Schedule (CDBS) in Australia (which isn't US Medicare). For most adults, dental coverage in the U.S. comes from private insurance, dental-specific plans, or state programs for low-income individuals, while Medicare primarily handles medical care, not dental.
2 ways to find out if Medicare covers what you need:
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
You can use your Medicare card to access medical services, hospital services for public patients, surgical services, prescription medicines, eye tests, pathology tests, imaging and scans.
Medicare does not cover:
To avoid the Medicare Levy Surcharge (MLS) in Australia, the primary method for high-income earners is to take out an appropriate private hospital insurance policy that covers you for the entire financial year (July 1 to June 30). This policy must have a low excess (under $750 for singles, $1500 for couples/families), not just 'extras' cover, and be in place before the financial year starts to avoid liability for any gaps, say Nanak Accountants and Qantas Insurance. Alternatively, you might be exempt if your income is below the threshold or you qualify for other specific Medicare levy exemptions, according to the ATO.
Only specific MRI services listed on the MBS are eligible for a Medicare rebate, and therefore bulk billing. Even if your scan is performed on a fully licensed MRI machine, Medicare rebates only apply when specific MBS criteria are met.
Medicare does not generally cover routine foot care (RFC) services unless the enrollee has systemic medical conditions that increase the risk of infection or injury if the services are not performed by a medical nonprofessional (e.g., a podiatrist).
Medicare will cover the treatment of corns, calluses, and toenails once every 61 days in persons having certain systemic conditions. Examples of such conditions include: Diabetes with peripheral arterial disease, peripheral arterial disease, peripheral neuropathy, and chronic phlebitis.
Medicare parts A and B will cover the cost of ankle replacement surgery, but it's important for your doctor to indicate that the surgery is medically necessary.
Where the reduction of a fracture is carried out by hospital staff in the out-patient or emergency department of a public hospital, and the patient is then referred to a private practitioner for aftercare, Medicare benefits are payable for the aftercare on an attendance basis.
Per Medicare.gov, Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.
Some of the items and services Medicare doesn't cover include:
Yes, Medicare generally covers most common blood tests and pathology services when ordered by a doctor, often at no cost if the provider "bulk bills" (meaning they accept the Medicare payment as full payment). While many tests are fully covered, some may incur out-of-pocket costs, and certain specific tests might not be covered at all, so it's always best to ask your doctor or the lab about potential costs upfront.
Medicare (US) doesn't cover glasses, but Medicare (Australia) covers eye tests (often bulk-billed), though not the glasses themselves, but various state schemes (like QLD's Spectacle Supply Scheme, NSW Spectacles Program, VIC's VES) offer help for eligible residents, especially pensioners or low-income earners, sometimes providing free basic spectacles, while private health insurance 'extras' can also provide rebates.
If you need dental work but have no money, look for public dental clinics, apply for government assistance programs, explore options to access your superannuation (retirement funds), or find dentists offering interest-free payment plans, especially for emergencies, as ignoring severe issues like infections can worsen the problem. Check your state/territory health department and local community health centers for available low-cost or free services, keeping in mind that waiting lists for non-urgent care can be long.
No, Original Medicare (Parts A & B) generally does not cover root canals or most routine dental care for adults in the U.S., but Medicare in Australia has specific exceptions like the Child Dental Benefits Schedule (CDBS) for kids, while private insurance or specific programs handle most adult dental needs. For U.S. beneficiaries, a root canal might only be covered under Part A if it requires an inpatient hospital stay for emergency care, but typically, you'll need dental insurance (often through private plans or Medicare Advantage) or pay out-of-pocket.