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With bulk billing rates climbing to 81.4% of all GP consultations and the government pledging $7.9 billion to strengthen Medicare, plenty of Australians are asking a very reasonable question: do I actually need private health insurance anymore?
What Bulk Billing Actually Covers in 2026
Bulk billing means your GP charges Medicare directly — and you pay nothing out of pocket. No gap fee, no invoice, no surprise bill on the way out.
Since 1 November 2025, the government expanded bulk billing incentives to cover every Australian with a Medicare card, not just concession card holders and children under 16. GPs now receive an extra $20.65 per consultation when they bulk bill any Medicare patient — a significant financial nudge that’s already reshaping how clinics operate.
Worth noting: The decision to bulk bill still rests with the clinic, not the government. Before you book, ring ahead and confirm.
Under Medicare, bulk billing typically covers:
- Standard GP consultations (short and long)
- Chronic disease management reviews
- Mental health care plans
- Pathology and some diagnostic imaging
- Specialist referrals (though specialists may charge separately)
What Private Health Insurance Actually Covers
Private health insurance works differently. Hospital cover gets you a private room, your choice of specialist, and shorter wait times for elective procedures. Extras cover handles things like dental, optical, physio, and chiro — none of which Medicare touches.
Here’s the honest comparison most insurers won’t put in their brochures:
| Service | Medicare/Bulk Billing | Private Health Insurance |
|---|---|---|
| GP visits | ✅ Covered (if bulk billed) | ❌ Not typically covered |
| Public hospital admission | ✅ Fully covered | ✅ With private room option |
| Specialist consultations | ⚠️ Partial (85% of MBS fee) | ✅ With gap insurance |
| Dental | ❌ Not covered | ✅ (extras cover) |
| Optical | ❌ Not covered | ✅ (extras cover) |
| Physiotherapy | ❌ Not covered | ✅ (extras cover) |
| Mental health (GP plan) | ✅ Up to 20 sessions/year | ⚠️ Varies by policy |
| Elective surgery wait times | ⚠️ Public waitlist | ✅ Significantly shorter |
The Real Cost Difference in 2026
Private health insurance premiums rose again in April 2026. The average Australian couple now pays around $4,200–$6,500 per year for hospital and extras cover combined.
If your GP bulk bills and you’re reasonably healthy, you might pay nothing for primary care all year. That’s a meaningful contrast to a $350+ monthly insurance premium.
In practice: A single 28-year-old with no chronic conditions, whose GP bulk bills, might find that Medicare covers everything they need — and private insurance mainly covers dental and optical. Worth doing the maths on your actual usage.
Five scenarios where private health insurance still makes sense:
- You need elective surgery and can’t wait on a public waitlist
- You want choice of specialist or obstetrician
- You use dental, optical, or allied health services regularly
- You want to avoid the Medicare Levy Surcharge (if income exceeds $93,000)
- You want the Lifetime Health Cover loading locked in at a younger age
MyMedicare and BBPIP: The New Equation
The Bulk Billing Practice Incentive Payment (BBPIP) is a newer program that pays clinics an extra 12.5% on all Medicare payments when they bulk bill 100% of their patients. Clinics register through MyMedicare, and payments started flowing in Q1 2026.
The result? The number of fully bulk-billing clinics nearly doubled in late 2025. That means more choice for patients — and more reason to question whether private insurance is covering anything you’d actually use.
Here’s the thing: BBPIP changed the incentive structure for clinics. It’s now financially smarter for many practices to bulk bill everyone rather than selectively charge gap fees. That’s genuinely good news for Medicare patients.
To check if your GP participates in BBPIP, register on myGov and link to MyMedicare — then search for your clinic. You can also simply ring ahead and ask.
Who Should Still Consider Private Cover
This isn’t a one-size answer. Private health insurance still delivers real value for specific groups — particularly those who:
- Are planning a family and want choice of obstetrician
- Have known conditions requiring regular specialist care
- Earn above the Medicare Levy Surcharge threshold
- Live in areas where bulk billing availability is limited
- Want the psychological reassurance of faster elective access
For everyone else — especially those on concession cards, JobSeeker, or lower incomes — a fully bulk-billing GP combined with Medicare often covers the essentials without the monthly premium.
Frequently Asked Questions
Does private health insurance cover GP visits?
Generally no. GP consultations are considered “out of hospital” services and aren’t covered by private hospital insurance. Your extras policy may offer some GP rebates, but this is uncommon and limited.
Can I use both Medicare and private health insurance?
Yes. Medicare covers the basic public health costs; private insurance covers the gap or additional services. They’re designed to work together, not replace each other.
What’s the Medicare Levy Surcharge?
If you earn more than $93,000 (singles) or $186,000 (couples) and don’t hold adequate private hospital cover, you pay an extra 1–1.5% tax. For many higher earners, private insurance is actually cheaper than the surcharge.
Is bulk billing guaranteed under the 2025 changes?
No. The government expanded incentives, but bulk billing remains the clinic’s decision. Always confirm before your appointment.
What if my GP charges a gap fee?
You pay the gap — the difference between what Medicare reimburses and what the GP charges. Medicare typically covers 85% of the MBS schedule fee for out-of-hospital services.
Will private insurance premiums keep rising?
They’ve risen every year in recent memory. The government caps the annual increase, but it’s consistently above inflation. Factor that into any long-term value calculation.
