How Medicare Fits Into the Broader Care System
For older Australians and people with disability, Medicare is one piece of a larger puzzle. The Australian health and care system includes Medicare for medical services, the aged care system for residential and home-based support, and the National Disability Insurance Scheme (NDIS) for people with permanent and significant disability. Understanding how these systems interact helps you get the most from your entitlements.
Medicare and Aged Care
Medicare continues to cover eligible medical services for older Australians, regardless of whether they live independently, receive home care support, or reside in an aged care facility. Key Medicare benefits relevant to older Australians include:
- 75+ Health Assessments: GPs can conduct a comprehensive health assessment for patients aged 75 and over. This helps identify health risks and plan appropriate care. Medicare covers this assessment.
- Chronic Disease Management Plans: Older Australians with ongoing conditions like diabetes, heart disease, or arthritis can access Medicare-subsidised allied health services (up to 5 sessions per year) through a CDM plan from their GP.
- GP Management Plans: For people with complex, ongoing health needs, GPs can develop a management plan that coordinates care across multiple providers — all subsidised by Medicare.
- Telehealth: Medicare-funded telehealth services can be particularly valuable for older Australians with limited mobility or those in regional areas.
Residential Aged Care and Medicare
Residents of aged care facilities retain their Medicare entitlements. They can still see GPs, access specialists, have pathology tests, and claim Medicare rebates. However, nursing and personal care provided within the facility is funded through the aged care system — not Medicare.
It's also worth noting that Medicare does not cover:
- Accommodation fees in residential aged care
- Personal care assistance (bathing, dressing, etc.)
- Meals and domestic services provided by the facility
These costs are covered through the aged care system, which has its own fee and subsidy structure administered by the Australian Government's Aged Care Quality and Safety Commission.
Medicare and the NDIS
The National Disability Insurance Scheme (NDIS) provides funding for supports and services that help people with permanent and significant disability live more independently. The NDIS and Medicare serve different purposes and generally cover different things — but they work alongside each other.
What the NDIS Covers (That Medicare Does Not)
- Personal care and daily living support
- Assistive technology (wheelchairs, communication devices, etc.)
- Home modifications
- Specialist disability accommodation
- Support coordination and capacity building
- Some therapy supports (e.g., speech therapy, occupational therapy beyond Medicare limits)
What Medicare Covers for NDIS Participants
NDIS participants retain full access to Medicare. Medical consultations, specialist appointments, pathology, and other MBS-listed services are still funded through Medicare — not the NDIS. The general rule is:
- Medicare covers clinical and medical services (GP visits, hospital care, diagnostics).
- NDIS covers disability-related supports that help with everyday functioning and participation.
Where a support could be considered both medical and disability-related, Services Australia and the NDIA (National Disability Insurance Agency) have guidelines to determine which scheme should fund it, avoiding duplication.
Disability-Specific Medicare Services
Medicare also has specific supports for people with disability, including:
- Disability Care Plans: GPs can create care plans for people with an intellectual disability, providing access to Medicare-funded health check items.
- Annual Health Assessments for People with Intellectual Disability: A specific MBS item allows GPs to conduct annual health assessments for patients with intellectual disability, helping identify often-overlooked health issues.
Key Contacts and Resources
| Service | Contact / Access Point |
|---|---|
| Medicare general enquiries | Services Australia — 132 011 |
| NDIS enquiries | NDIA — 1800 800 110 or ndis.gov.au |
| Aged care information | My Aged Care — 1800 200 422 or myagedcare.gov.au |
| Online Medicare services | myGov — my.gov.au |
Navigating Medicare alongside aged care or the NDIS can feel complex, but understanding how each system contributes to your care makes it easier to access the full range of support available to you.