How to Submit a Medicare Claim & Get Reimbursed

If you’ve paid for a medical service upfront instead of being bulk billed, you can usually claim back the Medicare rebate, the portion Medicare covers, directly into your bank account. This guide walks you through the different ways to submit a Medicare claim and get reimbursed.

What Is a Medicare Claim?

A Medicare claim is a request to be reimbursed for the Medicare-eligible portion of a medical service you’ve already paid for. This differs from bulk billing, where the provider claims directly from Medicare and you pay nothing upfront. With a claim, you pay the full fee at the time of your appointment, then claim back the Medicare rebate afterwards.

When Can You Claim Medicare?

You can generally submit a Medicare claim when:

• You’ve paid out of pocket for a Medicare-eligible service, such as a GP or specialist visit
• Your provider doesn’t offer bulk billing, or you chose to pay upfront
• You’ve received a receipt showing the item numbers and amount charged

Most claims need to be submitted within two years of the date of service, so it’s best not to leave it too long.

What You’ll Need Before You Claim

• Your Medicare card number
• Your receipt from the provider, showing the item numbers, date of service, and amount paid
• Your bank account details, for the rebate to be paid into
• A linked myGov account, if claiming online

How to Submit a Medicare Claim Online

1. Sign in to my.gov.au and select Medicare.
2. Go to Claims, then select Make a claim.
3. Enter the details from your receipt, including the provider, service date, and item numbers.
4. Confirm your bank account details for the rebate payment.
5. Submit your claim.

Most online claims are processed within a few business days, with the rebate paid directly into your nominated bank account.

How to Submit a Medicare Claim Through the Express Plus Medicare App

1. Open the Express Plus Medicare app and sign in with your myGov details.
2. Select Claims, then Make a claim.
3. Take a photo of your receipt, or enter the details manually.
4. Confirm your bank details and submit.

The app is a convenient option if you want to claim shortly after your appointment, right from your phone.

How to Submit a Medicare Claim In Person or by Mail

If you’d rather not claim online, you can also:

• Visit a Services Australia service centre with your original receipt and Medicare card
• Mail your claim, along with your original receipt, to the address listed on the Medicare claim form, available on the Services Australia website

In-person claims at a service centre are often processed on the spot, with the rebate paid directly to your linked bank account.

How Long Does a Medicare Claim Take?

Online and app-based claims are typically processed within a few business days. In-person claims at a service centre are often instant. Mailed claims generally take longer, since processing only begins once your claim is received and reviewed.

What Is the Medicare Rebate?

The Medicare rebate is the amount Medicare pays back for an eligible service, based on the Medicare Benefits Schedule (MBS) fee for that particular item number. If your provider charges more than the scheduled fee, known as the gap, you’re only reimbursed the Medicare rebate amount, not the full fee you paid. Some providers also offer gap cover through arrangements with private health insurers, which can reduce your out-of-pocket cost further.

Common Issues When Submitting a Medicare Claim

• Claim rejected due to missing item numbers – Make sure your receipt clearly lists the Medicare item numbers for each service.
• Incorrect bank details – Double-check your linked bank account is current before submitting, to avoid payment delays.
• Claim submitted too late – Remember most claims need to be lodged within two years of the service date.
• Provider not eligible for Medicare – Confirm the service you received is actually Medicare-eligible before submitting a claim.

FAQs About Medicare Claims

Q: How long do I have to submit a Medicare claim?

Generally up to two years from the date of service, though it’s best to claim as soon as possible.

Q: How much will I get back from a Medicare claim?

You’ll receive the Medicare rebate amount for that service, based on the Medicare Benefits Schedule fee, which may be less than the full amount you paid if your provider charges above the scheduled fee.

Q: Can I submit a Medicare claim without a myGov account?

Yes, you can claim in person at a Services Australia service centre, or by mailing your original receipt with a completed claim form.

Q: How quickly will I be reimbursed?

Online and app claims are typically processed within a few business days, while in-person claims at a service centre are often instant.

Q: What happens if I lose my receipt?

You may need to request a duplicate receipt or itemised statement from your healthcare provider, since Medicare generally requires proof of the service and amount paid.

Conclusion

Submitting a Medicare claim is straightforward once you have your receipt and bank details ready, whether you do it online, through the app, in person, or by mail. Claiming promptly and keeping your receipts organised makes it easy to get your Medicare rebate back without unnecessary delays.