Medicare and Aged Care: Two Systems, One Goal
Many older Australians assume Medicare automatically covers all their health needs as they age — but this isn't quite the case. Medicare and the aged care system are two distinct programs that often work together, and understanding how they interact can help you or your loved ones plan ahead effectively.
What Medicare Covers for Older Australians
Medicare continues to cover all eligible Australians regardless of age. For older people, this includes:
- GP visits — regular check-ups, medication management, and chronic disease monitoring
- Specialist referrals — cardiologists, geriatricians, and other specialists
- Diagnostic tests — blood tests, imaging, and pathology
- Public hospital care — surgery, emergency treatment, and inpatient services
- Mental health services — subsidised psychology sessions through the Better Access initiative
Health Assessments for Older Australians
Under the Medicare Benefits Schedule, GPs can provide a 75+ Health Assessment — a comprehensive review of an older patient's physical, psychological, and social wellbeing. This is Medicare-funded and helps identify risks early, leading to more coordinated care.
What the Aged Care System Covers (Separate from Medicare)
The aged care system — funded by the Australian Government through the Department of Health and Aged Care — covers:
- Home care packages (help at home with daily tasks)
- Commonwealth Home Support Programme (CHSP) services
- Residential aged care (nursing home placement)
- Short-term restorative care and respite care
Accessing these services typically requires an assessment through the Aged Care Assessment Team (ACAT) or My Aged Care. These services are means-tested and may involve co-contributions depending on your income and assets.
How Medicare and Aged Care Work Together
While Medicare pays for the medical care provided by doctors and specialists, aged care pays for the support services that help people live with dignity. In practice:
- A GP in a residential aged care facility is still billing Medicare for their consultations
- Medications in aged care may be subsidised under the Pharmaceutical Benefits Scheme (PBS), not aged care funding
- Palliative care services can be funded through both Medicare and aged care depending on where care is provided
The NDIS and Older Australians
The National Disability Insurance Scheme (NDIS) is available to Australians under 65 who have a permanent and significant disability. Once a person turns 65, they are generally transitioned to the aged care system rather than entering or staying in the NDIS. However, those already on the NDIS before turning 65 may be able to continue in some circumstances.
Key Tips for Navigating Both Systems
- Register with My Aged Care early — waiting times for home care packages can be lengthy, so it pays to plan ahead.
- Keep your Medicare details current — ensure your GP has your up-to-date Medicare card details for billing.
- Ask about bulk billing — many GPs who visit residential aged care facilities bulk bill, meaning no out-of-pocket costs.
- Use your 75+ health assessment — if you haven't had one recently, ask your GP to arrange it.
Where to Get Help
If you're unsure which system applies to your needs, the following contacts can help:
- My Aged Care: 1800 200 422
- Services Australia (Medicare): 132 011
- Your GP — they can coordinate referrals to both systems
Understanding the boundary between Medicare and aged care isn't always simple, but being informed means you can access everything you're entitled to — and plan ahead for a healthier, more supported future.