Your GP charges you $85. Medicare gives you back $41.40. You're down $43.60. That's the gap, and most Australians have no idea how it's calculated until they see the bill.
Here's how the Medicare Benefits Schedule (MBS) works, what common procedures actually cost, and when the Safety Net kicks in to reduce your out-of-pocket expenses.
How the MBS fee system works
Every medical service covered by Medicare has an item number and a schedule fee. The schedule fee is the amount the government says that service is worth. Medicare pays you back a percentage of that fee as a rebate.
For GP (out-of-hospital) services, Medicare pays 100% of the schedule fee. For specialists and in-hospital services, Medicare pays 85% of the schedule fee.
The catch: your doctor can charge whatever they want. If they charge exactly the MBS fee, you pay nothing. That's bulk billing. If they charge more, the difference is your gap.
Common GP visits and what they cost
Standard GP consultation (Item 23)
MBS schedule fee: $41.40. This covers a Level B consultation, which is the standard 10 to 20 minute GP visit. If your GP bulk bills, you pay $0. If they charge privately, typical fees range from $70 to $95, leaving you with a gap of $28.60 to $53.60.
Long GP consultation (Item 36)
MBS schedule fee: $80.10. A Level C consultation runs 20 to 40 minutes and covers more complex issues. Private fees for long consults typically run $120 to $160, meaning a gap of $39.90 to $79.90. Your GP can tell you more about whether your visit qualifies for this item.
Skin check
A full-body skin check is usually billed under Item 23 ($41.40) or Item 36 ($80.10) depending on duration. Some dermatology clinics charge $150 to $250 for a skin check, with a gap of $108.60 to $208.60. Many GPs include a skin check as part of a standard bulk-billed consult if you ask during your appointment.
Mental health treatment plan (Item 2715)
MBS schedule fee: $96.65. This covers the initial mental health care plan, which gives you access to up to 10 Medicare-subsidised psychology sessions per calendar year. Many GPs bulk bill this item because it takes about 30 to 40 minutes. If charged privately, expect fees of $120 to $180, with a gap of $23.35 to $83.35.
Blood test (pathology)
Most routine blood tests (full blood count, liver function, cholesterol, glucose) are bulk billed by pathology labs. You'll pay $0 at places like Dorevitch, Melbourne Pathology, Laverty, or QML. The MBS fees for common pathology items range from $11.45 to $27.00 per test. Some specialised tests (hormone panels, allergy testing) may attract a small gap of $5 to $30.
Pap smear / cervical screening
The cervical screening test itself (Item 73925) has an MBS fee of $38.75. The GP consultation to perform it is usually billed under Item 23 ($41.40). Most GPs bulk bill both items. If you're charged privately, the total gap is usually $20 to $50 on top of the two rebates.
The gap: why doctors charge more
MBS fees haven't kept pace with the cost of running a medical practice. The schedule fee for a standard GP visit was $37.05 back in 2018. It's $41.40 now. That's an 11.7% increase over eight years, while rent, staff wages, and insurance have risen 25% to 40% in the same period.
GPs who bulk bill effectively earn less per consultation than they did a decade ago in real terms. That's why many have switched to mixed billing or full private billing to stay financially viable.
You'll pay about $0 to $5 gap at clinics that charge close to the schedule fee. You'll pay about $30 to $60 at typical privately-billing urban practices. And you'll pay $70 or more at premium clinics in affluent suburbs or specialist practices.
The Extended Medicare Safety Net
If your out-of-pocket medical costs add up over a calendar year, the Extended Medicare Safety Net (EMSN) starts covering a bigger share. Here's how it works.
Concessional threshold: $772.90 per year. This applies if you hold a Commonwealth concession card or receive Family Tax Benefit Part A. Once your family's gap payments hit $772.90 in a calendar year, Medicare pays 80% of any further gap amounts for out-of-hospital services.
General threshold: $2,544.30 per year. For everyone else. Same deal: once you hit $2,544.30 in gap payments, Medicare covers 80% of further gaps.
Here's what that looks like in practice. Say you're on the general threshold and you've spent $2,544.30 in gaps by September. For the rest of the year, if your GP charges $85 for a visit (gap of $43.60), Medicare pays 80% of that $43.60 gap ($34.88 extra), so your actual gap drops to $8.72.
The Safety Net resets on 1 January each year. Medicare tracks your out-of-pocket costs automatically through claims lodged electronically. You don't need to apply. Once you hit the threshold, the higher rebates kick in for the rest of the calendar year.
How to keep your out-of-pocket costs down
- Ask about bulk billing before you book. Many clinics bulk bill concession card holders and children under 16, even if they privately bill others.
- Use the bulkbill.ai checker to see bulk billing availability in your suburb before you start calling around.
- Choose pathology labs that bulk bill. Almost all major pathology chains bulk bill routine blood work. Ask your GP to refer you to one.
- Track your gap spending. Log into myGov and check your Medicare claims history. If you're approaching the Safety Net threshold, it might be worth scheduling remaining appointments before 31 December rather than waiting until the new year.
- Ask about telehealth. Phone consults have lower MBS fees but are more commonly bulk billed. A $0 phone consult beats a $45 gap for an in-person visit when you just need a script renewed.
- Get a mental health care plan. The plan itself is often bulk billed, and it entitles you to 10 Medicare-rebated psychology sessions per year at $93.35 per session rebate (Item 80010).
For a state-by-state look at where bulk billing is most common, read Where to Find Free GP Visits in Australia (2026 Bulk Billing Rates by State).
If you're a student, pensioner, or visa holder, check Bulk Billing for Students, Pensioners, and Visa Holders: Your Options for specific eligibility details.
More questions? Our FAQ page covers the basics of how bulk billing works.